Thompson, M and Parameswaran, V and Burgess, J, Clinical utility of chromogranin A for surveillance of succinate dehydrogenase B- and D-related paraganglioma, Annals of clinical biochemistry ISSN 0004-5632 (2018) [Refereed Article]
Background: Patients with mutations of succinate dehydrogenase B (SDHB) and D (SDHD) are at high risk of paraganglioma (PGL) necessitating surveillance. Chromogranin A (CgA) has been proposed as a biochemical marker of PGL. We sought to determine the diagnostic utility of CgA in a population based SDHx sample.
Methods: Tasmania is an island state with one tertiary referral centre for endocrine neoplasia. We performed cross sectional analysis of all adult SDHB (n=52) and SDHD (n=10) patients undergoing PGL surveillance between 2011 and 2017. CgA was referenced against the outcome of PGL surveillance with a minimum of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and plasma metanephrines (metanephrine and normetanephrine).
Results: CgA correctly predicted the result of PGL surveillance more often in patients with SDHB compared to those with SDHD (77% vs 22%, p=0.003). In the SDHB group, CgA demonstrated a sensitivity of 67% and specificity of 79% compared to 22% and 0% in the SDHD group. CgA identified one of three PET/CT-visualised SDHB-related PGLs with normal plasma metanephrines at the expense of nine false positive results. A normal CgA demonstrated a negative predictive value of 92% for SDHB-related PGL. In patients with SDHB, plasma normetanephrine and metanephrine offered superior specificity (100%, p=0.01 and 100%, p<0.01, respectively) with comparable sensitivity (67%, p=1.0 and 11%, p=0.06, respectively) to CgA.
Conclusion: CgA does not provide additive benefit to standard surveillance for predicting the presence of SDHB- or SDHD-related PGL, but has a useful negative predictive value when normal in patients with SDHB mutation.
|Item Type:||Refereed Article|
|Keywords:||Chromogranin A, paraganglioma, SDHx|
|Research Division:||Medical and Health Sciences|
|Research Group:||Oncology and Carcinogenesis|
|Research Field:||Oncology and Carcinogenesis not elsewhere classified|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Endocrine Organs and Diseases (excl. Diabetes)|
|Author:||Burgess, J (Professor John Burgess)|
|Deposited By:||Medicine (Discipline)|
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