title: Discriminating capacity of indole markers in the diagnosis of carcinoid tumors.
abstract: BACKGROUND
  We evaluated the discriminating capacity of the indole markers urinary 5-hydroxyindoleacetic acid (5-HIAA), urinary serotonin, and platelet serotonin in the diagnosis of carcinoid tumors.
  
  
  METHODS
  Indole markers were measured in 688 patients with suspected carcinoid disease. The initial values of indole markers from patients in whom a carcinoid tumor was confirmed during follow-up (n = 98) were used for ROC analysis. Two groups served as reference populations. The first consisted of 45 healthy individuals ("healthy controls"). The second was a random sample of 40 patients, drawn from the 590 (688 minus 98) patients with carcinoid-like symptoms but without a carcinoid tumor ("clinically suspected patients").
  
  
  RESULTS
  ROC curve analysis showed platelet serotonin to have the highest discriminating capacity, especially in foregut carcinoids. Cutoff values for platelet serotonin obtained from ROC analysis with healthy controls as reference group (5.4 nmol/10(9) platelets) gave a sensitivity of 74%, specificity of 91%, positive predictive value of 63%, and negative predictive value of 95% when applied to the initial 688 patients. Using the cutoff value with the clinically suspected patients as the reference group (9.3 nmol/10(9) platelets) gave a sensitivity of 63%, specificity of 99%, positive predictive value of 89%, and negative predictive value of 93%. Indole markers were increased in 169 (25%) of 688 patients. In 76 (45%) of these 169 patients, a carcinoid tumor was present. Slight increases of markers were associated with non-carcinoid neuroendocrine tumors, non-neuroendocrine tumors, and disturbed bowel motility.
  
  
  CONCLUSIONS
  ROC curve analysis shows that platelet serotonin is the most discriminating indole marker for the diagnosis of carcinoid tumors. Platelet serotonin especially improves the diagnosis of carcinoids producing small amounts of serotonin.
authors.affiliation: Departments of Medical Oncology and Pathology and Laboratory Medicine, University Hospital Groningen, 9700 RB Groningen, The Netherlands.
authors.forename: W G
authors.initials: WG
authors.lastname: Meijer
authors.forename: I P
authors.initials: IP
authors.lastname: Kema
authors.forename: M
authors.initials: M
authors.lastname: Volmer
authors.forename: P H
authors.initials: PH
authors.lastname: Willemse
authors.forename: E G
authors.initials: EG
authors.lastname: de Vries
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D001792:Blood Platelets / Q000378:metabolism; D002276:Carcinoid Tumor / Q000175:diagnosis*; D002851:Chromatography, High Pressure Liquid; D005260:Female; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000032:analysis* / Q000652:urine; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012701:Serotonin / Q000032:analysis* / Q000097:blood / Q000652:urine
chemical_list: D014408:Biomarkers, Tumor; D012701:Serotonin; D006897:Hydroxyindoleacetic Acid