Clinical Usefulness of Plasma Chromogranin A in Pancreatic Neuroendocrine Neoplasm

Paik, Woo Hyun; Ryu, Ji Kon; Song, Byeong Jun; Kim, Jaihwan; Park, Joo Kyung; Kim, Yong‐Tae; Yoon, Yong Bum

doi:10.3346/jkms.2013.28.5.750

Cited by 36 publications

(28 citation statements)

References 27 publications

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“…This is a challenging clinical issue as, despite the high specificity demonstrated by CT and MRI (Ichikawa et al 2000, Sundin et al 2009), the radiological phenotype of pancreatic NENs is variable, thus hampering instrumental diagnosis (Singhi et al 2012). The retrospective analysis by Paik et al (2013) reported only 56% specificity of the marker in differentiating pancreatic NENs from other pancreatic masses, whereas the prospective study by Jun et al (2017), who specifically focused on patients suspected for a pancreatic NEN, showed a higher value, namely 77.8%, which even rose to 100% when selecting lesions larger than 4 cm. However, these data are not conclusive and the role of circulating CgA for the pre-surgical diagnosis of pancreatic NENs needs to be addressed in other clinical series.…”

Section: Oncological Causes Of Cga Elevationmentioning

confidence: 99%

Chromogranin A as circulating marker for diagnosis and management of neuroendocrine neoplasms: more flaws than fame

Marotta

Zatelli

Sciammarella³

et al. 2018

Endocrine-Related Cancer

128

104

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Owing to the heterogeneity of neuroendocrine neoplasms (NENs), the availability of reliable circulating markers is critical for improving diagnostics, prognostic stratification, follow-up and definition of treatment strategy. This review is focused on chromogranin A (CgA), a hydrophilic glycoprotein present in large dense core vesicles of neuroendocrine cells. Despite being long identified as the most useful NEN-related circulating marker, clinical application of CgA is controversial. CgA assays still lack standardization, thus hampering not only clinical management but also the comparison between different analyses. In the diagnostic setting, clinical utility of CgA is limited as hampered by (a) the variety of oncological and non-oncological conditions affecting marker levels, which impairs specificity; (b) the fact that 30-50% of NENs show normal CgA, which impairs sensitivity. Regarding the prognostic phase, there is prospective evidence which demonstrates that advanced NENs secreting CgA have poorer outcome, as compared with those showing non-elevated marker levels. Although the identification of cut-offs allowing a proper risk stratification of CgA-secreting patients has not been performed, this represents the most important clinical application of the marker. By contrast, based on prospective studies, the trend of elevated circulating CgA does not represent a valid indicator of morphological evolution and has therefore no utility for the follow-up phase. Ultimately, current knowledge about the role of the marker for the definition of treatment strategy is poor and is limited by the small number of available studies, their prevalent retrospective nature and the absence of control groups of untreated subjects.

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Section: Oncological Causes Of Cga Elevationmentioning

confidence: 99%

Chromogranin A as circulating marker for diagnosis and management of neuroendocrine neoplasms: more flaws than fame

Marotta

Zatelli

Sciammarella³

et al. 2018

Endocrine-Related Cancer

128

104

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“…Five of the 8 included studies deal with a mixed cohort of patients with both metastatic and non-metastatic pNET [30,31,33,35,36]. Eriksson et al included only 5 patients in whom tumor stage was not defined [37].…”

Section: Resultsmentioning

confidence: 99%

Standard Pre- and Postoperative Determination of Chromogranin A in Resectable Non-Functioning Pancreatic Neuroendocrine Tumors - Diagnostic Accuracy: NF-pNET and Low Tumor Burden

et al. 2014

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Background: Chromogranin A (CgA) is often used in metastatic patients with nonfunctioning pancreatic neuroendocrine tumors (NF-pNET). The aim of this study is to assess the diagnostic accuracy of CgA in patients with low tumor burden. Methods: Resectable patients with NF-pNET without metastases at time of diagnosis were included between 2002 and 2013 in the Academic Medical Center of Amsterdam. CgA was determined at time of diagnosis and during follow-up according to a standardized method. The upper reference range was 94 µg/l. Results: Overall, 47 patients were included in this study. CgA was elevated preoperatively in only 10 patients (27%). In the detection of metastases during follow-up, the positive predictive value for CgA was 50% and negative predictive value was 81%. In 50% of the patients with an elevated CgA during follow-up, this test result was false-positive. Conclusions: The diagnostic accuracy of CgA was low preoperatively in patients with resectable NF-pNET and low tumor burden. In the detection of recurrent disease after curative resection of NF-pNET, the diagnostic accuracy of CgA was moderate (50%). We conclude that the routine measurement of CgA at time of diagnosis or during follow-up after curative resection had limited value in patients with resectable NF-pNET.

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“…It is worth noting that CgA is hindered by a moderate specificity (sensitivity: 72-100 %; specificity: 50-80 %), and NSE has been reported to have a poor sensitivity (sensitivity: 30-40 %; specificity: ∼100 %) limiting their utility as reliable diagnostic tools. Nevertheless, characteristic of serum CgA levels is their direct correlation with tumor burden and metastatic disease; therefore, CgA levels are often used to evaluate progression or response to therapy [21,22,24].…”

Section: Diagnosismentioning

confidence: 99%

Pancreatic Neuroendocrine Tumors: an Update

2015

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Pancreatic neuroendocrine tumors (pNETs) are rare and comprise only 1-2 % of all pancreatic neoplastic disease. Although the majority of these tumors are sporadic (90 %), pNETs can arise in the setting of several different hereditary genetic syndromes, most commonly multiple endocrine neoplasia type 1 (MEN1). The presentation of pNETs varies widely, with over 60 % having malignant distant disease at the time of initial diagnosis involving the liver or other distant sites. Functioning pNETs represent approximately 10 % of all pNETs, secrete a variety of peptide hormones, and are responsible for several clinical syndromes caused by profound hormonal derangement. Surgery remains the cornerstone of therapy and the only curative approach. It should be pursued for localized disease and for metastatic lesions amenable to resection. Multimodality therapies, including liver-directed therapies and medical therapy, are gaining increasing favor in the treatment of advanced pNETs. Their utility is multifold and spans from ameliorating symptoms of hormonal excess (functional pNETs) to controlling the local and systemic disease burden (non-functional pNETs). The recent introduction of target molecular therapy has promising results especially for the treatment of progressive well-differentiated G1/G2 tumor. In this review, we summarize the current knowledge and give an update on recent advancements made in the therapeutic strategies for pNETs.

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Clinical Usefulness of Plasma Chromogranin A in Pancreatic Neuroendocrine Neoplasm

Cited by 36 publications

References 27 publications

Chromogranin A as circulating marker for diagnosis and management of neuroendocrine neoplasms: more flaws than fame

Chromogranin A as circulating marker for diagnosis and management of neuroendocrine neoplasms: more flaws than fame

Standard Pre- and Postoperative Determination of Chromogranin A in Resectable Non-Functioning Pancreatic Neuroendocrine Tumors - Diagnostic Accuracy: NF-pNET and Low Tumor Burden

Pancreatic Neuroendocrine Tumors: an Update

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