Do Neuron-Specific Enolase Levels Discriminate between Small-Cell Lung Cancer and Mediastinal Tumors?

Abstract

The capacity of pretherapeutically assessed neuron-specific enolase (NSE) to differentiate between small cell lung cancer (SCLC) and mediastinal tumors was investigated retrospectively in a series of 320 patients. NSE was found to be increased in 95/130 (73.1%) patients with SCLC, in 4/62 (6.5%) patients with Hodgkin’s disease, in 10/58 (17.2%) patients with non-Hodgkin’s lymphoma, in 5/16 (31.3%) patients with teratoma, and in 6/54 (11.1 %) patients with thymoma. The cut-off value, defined as the 95% percentile of a reference population suffering from benign pulmonary disorders (n = 192), was set at 13.8 ng/ml. When this discrimination level was increased to 26.4 ng/ml, which corresponds to a 95% specificity versus the total group with mediastinal tumors, SCLC was recognized with a detection rate of only 49.2%. In conclusion, increased NSE concentrations in a patient with a hilar mass and/or mediastinal widening on X-ray are not always diagnostic of SCLC due to the high rate of elevated NSE values associated with mediastinal tumors. However, in a patient who presents with a hilar mass and a high NSE level, bronchoscopy is always indicated to obtain adequate specimens for histology in order to plan an appropriate therapeutic regimen.

Technical Performance and Diagnostic Utility of the New Elecsys® Neuron-Specific Enolase Enzyme Immunoassay

“…Of the 50 lung cancer patients with NSE levels above 100 ng/ml, 44 suffered from SCLC (23.4% of all SCLC patients) and six from NSCLC (1.6% of all NSCLC patients). These figures are in good agreement with the EGTM recommendations (40). However, these findings also show that the definite diagnosis in an individual patient cannot be made on the basis of NSE level.…”

“…Also, NSE is not able to differentiate unequivocally between SCLC and mediastinal tumors such as thymoma, teratoma and Hodgkin's and non-Hodgkin's lymphomas. Elevated NSE was also reported in 13.2% of the latter tumors (40). This is of particular importance because both malignancies express similar roentgenographic features, presenting with a hilar mass and mediastinal widening.…”

Enhanced Expression of Neuron‐specific Enolase (NSE) in Pyothorax‐associated Lymphoma (PAL)

“…6) As for malignant lymphomas, elevation of serum NSE levels was reported in 17 to 21% of NHL and 6.5 to 23% of Hodgkin's disease. 5,6) Values of NSE in the serum were reported to be 3.1±0.9 ng/ml in healthy individuals 13) and to range from 5 to 22 (median 10) ng/ml in NHL. 6) Whether serum NSE levels correlated with stage or histology of NHL was not mentioned in the previous reports.…”

“…Though the serum concentration of NSE is seldom assayed in patients with malignant lymphoma, there are reports of the elevation of serum concentration of NSE in 17 to 21% of cases with non-Hodgkin's lymphoma (NHL). 5,6) Pyothorax-associated lymphoma (PAL) is a B-cell lymphoma developing in the pleural cavity of patients with over 20 years' history of chronic pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. 7,8) PAL is one of the Epstein-Barr virus (EBV)-associated lymphomas, and expresses latent genes of EBV including latent membrane proteins and EB nuclear antigens.…”

Neuron-Specific Enolase: Reference Values in Cord Blood

“…However, not every case of foetal neuroblastoma shows increased NSE levels (12). Von Schweinitz et al (13) reported slightly increased NSE values in 3 of 7 cases of hepatoblastoma and Ebert et al (14) in 5 of 16 patients with teratoma. On the other hand haemolysis in blood samples leads to higher NSE values and should be excluded by inspection of serum after centrifugation.…”