Diagnosis and Follow Up Tests

Laboratory Tests

Chromogranin A (CgA) - At A Glance
Why test? Read more . . .

Elevated Plasma Chromogranin A Is the First Indication of Recurrence in Radically Operated Midgut Carcinoid Tumors (Full Text)
Published online: January 29, 2009

Staffan Welin, Mats Stridsberg, Janet Cunningham, Dan Granberg,
Britt Skogseid, Kjell Öberg, Barbro Eriksson, Eva T. Janson
Department of Medical Sciences, Unit of Endocrine Oncology, Clinical   Chemistry, University Hospital, Uppsala, Sweden

Conclusion: P-CgA was the first marker to indicate tumor recurrence in the majorityof radically operated midgut carcinoid patients. To avoid unnecessaryand costly examinations in asymptomatic patients,we suggest that follow-up should comprise measurementsof P-CgA twice a year and annual ultrasonographyuntil P-CgA is elevated or clinical symptoms occur, at which time all efforts should be made to identify recurrent tumorlesions in order to give the patient the best possible treatment which, if possible, should be surgical removal of the recurrence.

NOTE: The importance of Chromogranin A as a neuroendicrine marker has been known and documented in the medical literature for over 20 years.

CgA Medical References
(Share these references with your doctor)

From the Medical Director of the Carcinoid Cancer Foundation
LETTER OF MEDICAL NEED AND EXPLANATION FOR UNUSUAL BLOOD TESTS BEING USED ROUTINELY

Note: The test for Octreotide (Sandostatin) blood levels is still considered experimental by most insurance companies and these companies may therefore NOT pay for this test. For more information regarding this test contact InterScience Institute.

How to Diagnose and Monitor Carcinoid (neuroendocrine tumors): Which Tests and How Often?

Compiled by Susan L. Anderson – September 9, 2002, Updated September 2007

Susan (a carcinoid patient) has compiled a summary of "Which tests and how often" from information provided by Drs. Anthony, Warner and Woltering. After her summary there is additional information from each of these doctors based on their own experience and additional information for the physician. Susan has provided information and support to the carcinoid community since early 1997.

Testing preparation

Preparing for the 24-hour Urine 5HIAA Test

How and Why the 5HIAA Test Is Performed, Normal Range (from Medline Plus, a service of the U.S. National Library of Medicine, National Institutes of Health)

Imaging

(4/28/10) Functional Imaging of NeuroendocrineTumors: A Head-to-Head Comparison of Somatostatin Receptor Scintigraphy, 123I-MIBG Scintigraphy, and 18F-FDG PET

Tina Binderup, Ulrich Knigge, Annika Loft, Jann Mortensen, Andreas Pfeifer, Birgitte Federspiel, Carsten Palnaes Hansen, Liselotte Højgaard, and Andreas Kjaer

Authors’ Affiliations: Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark; Cluster for Molecular Imaging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

J Nucl Med 2010; 51:704–712

Abstract: Functional techniques are playing a pivotal role in the imaging of cancer today. Our aim was to compare, on a head-to-head basis, 3 functional imaging techniques in patients with histologically verified neuroendocrine tumors: somatostatin receptor scintigraphy (SRS) with 111-Indiethylenetriaminepentaacetic acidoctreotide, scintigraphy with 123I-metaiodobenzylguanidine (MIBG), and 18F-FDG PET. Methods: Ninety-six prospectively enrolled patients with neuroendocrine tumors underwent SRS, 123I-MIBG scintigraphy, and 18F-FDG PET on average within 40 d. The functional images were fused with low-dose CT scans for anatomic localization, and the imaging results were compared with the proliferation index as determined by Ki67. Results: The overall sensitivity of SRS, 123I-MIBG scintigraphy, and 18F-FDG PET was 89%, 52%, and 58%, respectively. Of the 11 SRS-negative patients, 7 were 18F-FDG PET-positive, of which 3 were also 123I-MIBG scintigraphy–positive, giving a combined overall sensitivity of 96%. SRS also exceeded 123I-MIBG scintigraphy and 18F-FDG PET based on the number of lesions detected (393, 185, and 225, respectively) and tumor subtypes. 123I-MIBG scintigraphy was superior to 18F-FDG PET for ileal neuroendocrine tumors, and 18F-FDG PET was superior to 123I-MIBG scintigraphy for pancreaticoduodenal neuroendocrine tumors. The sensitivity of 18F-FDG PET (92%) exceeded that of both SRS (69%) and 123I-MIBG scintigraphy (46%) for tumors with a proliferation index above 15%. Conclusion:The overall sensitivity of 123I-MIBG scintigraphy and 18F-FDG PET was low compared with SRS. However, for tumors with a high proliferation rate, 18F-FDG PET had the highest sensitivity. The results indicate that, although SRS should still be the routine method, 18F-FDG PET provides complementary diagnostic information and is of value for neuroendocrine tumor patients with negative SRS findings or a high proliferation index.

PMID: 20395333 [PubMed - as supplied by publisher]


What is an OctreoScan®?

From the Ohio State University Medical Center website.

Scintigraphic Evaluation of Neuroendocrine Tumors (MIBG, Octreoscan)
from Applied Radiology

Michael W. Hanson, MD
Division of Cardiology at Duke University Medical Center, Durham, NC.
Appl Radiol 30(6):11-17, 2001. © 2001 Anderson Publishing, Ltd


Whole-body 11C-5-hydroxytryptophan positron emission tomography as a universal imaging technique for neuroendocrine tumors - comparison with somatostatin receptor scintigraphy and computed tomography

(Full text)
Orlefors H, Sundin A, Garske U, Juhlin C, Oberg K, Langstrom B, Bergstrom M, Eriksson B.
J Clin Endocrinol Metab. 2005 Mar 8
Conclusion: This study indicates that WB-(11)C-HTP-PET can be used as a universal imaging method for detection of NET's. This study also shows that WB-(11)C-HTP-PET is sensitive in imaging small NET-lesions, such as primary tumors, and can in a majority of cases image significantly more tumor lesions than SRS and CT. Presently only available at Uppsala Medical Center, Sweden.


Gallium-68 PET: a new frontier in receptor cancer imaging.

The recent introduction of PET imaging with gallium-68 has major bearings in current and future clinical practice. Its labelling with DOTA compounds has cleared the way for somatostatin receptor imaging with a viable PET agent, with all its inherent imaging advantages compared to single photon imaging. The pre-clinical and clinical applications of this technique has been successful in a variety of tumours, particularly Neuroendocrine Tumors (NETs) and its labelling with other ligands and molecules will improve the management of other tumours and the assessment of infection.