title: Chromogranin A: is it a useful marker of neuroendocrine tumors?
abstract: OBJECTIVE
  We evaluated the pattern of chromogranin A (CgA) plasma levels in a large number of patients with neuroendocrine tumors (NETs), in a series of patients with chronic atrophic gastritis (CAG) with and without enterochromaffin-like (ECL) cell hyperplasia, and in healthy participants (HPs).
  
  
  METHODS
  Two hundred thirty-eight patients with NETs, 42 patients with CAG with or without ECL cell hyperplasia, and 48 HPs were studied. All patients underwent a baseline visit, biochemical routine check-up, imaging techniques, endoscopy, and histologic determination.
  
  
  RESULTS
  CgA plasma levels were higher in patients with NETs compared with CAG patients or HPs (P < .001). In the NET group, we observed higher CgA levels in patients with diffuse disease compared with patients with local or hepatic disease (P < .001). CgA plasma levels were significantly higher in patients with Zollinger-Ellison syndrome compared with other types of endocrine tumors (P < .001). We found the best cutoff range between HPs and NET patients to be 18 to 19 U/L (sensitivity, 85.3%; specificity, 95.8%). Comparing all participants without neoplasia (HPs, CAG patients, and disease-free patients) and patients with endocrine tumors, the best cutoff range was 31 to 32 U/L (sensitivity, 75.3%; specificity, 84.2%). Setting the specificity at 95%, the cutoff range was 84 to 87 U/L (sensitivity, 55%).
  
  
  CONCLUSIONS
  Our study confirms the high specificity and sensitivity of CgA in diagnosing an endocrine tumor. It is necessary to use a cutoff range of 84 to 87 U/L to obtain a high specificity in diagnosing NETs, with the aim of excluding patients in whom the CgA was elevated as a result of other non-neoplastic diseases.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Campana
authors.forename: Francesca
authors.initials: F
authors.lastname: Nori
authors.forename: Lidya
authors.initials: L
authors.lastname: Piscitelli
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Morselli-Labate
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Roberto
authors.initials: R
authors.lastname: Corinaldesi
authors.forename: Paola
authors.initials: P
authors.lastname: Tomassetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D016022:Case-Control Studies; D053379:Chromogranin A / Q000097:blood*; D003937:Diagnosis, Differential; D019861:Enterochromaffin-like Cells / Q000473:pathology*; D005260:Female; D005757:Gastritis, Atrophic / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000097:blood / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D015043:Zollinger-Ellison Syndrome / Q000097:blood / Q000175:diagnosis*
chemical_list: D014408:Biomarkers, Tumor; C506150:CHGA protein, human; D053379:Chromogranin A