title: An update on the clinical diagnostic value of β-hCG and αFP for intracranial germ cell tumors.
abstract: BACKGROUND
  Pathological examination combined with tumor markers has become a standard for the diagnosis of intracranial germ cell tumors (ICGCTs), but the current concept of 'secreting germ cell tumors' and three empirically highly specific diagnostic criteria (β-hCG ≥ 50 IU/L or αFP ≥ 10 ng/mL; β-hCG ≥ 100 IU/L or αFP ≥ 50 ng/mL; β-hCG > 50 IU/L or αFP > 25 ng/mL) are not based upon pathology examination or CSF cytology. Further investigation is needed to re-evaluate their value.
  
  
  METHODS
  A multidisciplinary diagnostic team was created. Valid β-hCG/αFP data were collected from cases of ICGCTs confirmed by pathology and CSF cytology (n = 58) between 1991 and 2012, and from suspected ICGCTs cases (n = 17) between 2011 and 2012 as controls [Langerhans cell histiocytosis (LCH), n = 12; and other intracranial tumor (ICT), n = 5]. The cut-off points for β-hCG and αFP were calculated using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  This study clarifies the relative rationality of one criteria (β-hCG > 50 IU/L and αFP > 25 ng/mL); confirms new β-hCG diagnostic cut-off points: CSF β-hCG ≥ 8.2 IU/L and serum β-hCG ≥ 2.5 IU/L (sensitivity of 47 and 34%, respectively, specificity of 100%, both; P < 0.05); and empirically adjusts the criteria for αFP to ≥ 3.8 ng/mL in CSF and to ≥ 25 ng/mL in serum. The total diagnostic sensitivity for ICGCTs finally increased from 34.6 to 65.4% (P < 0.05, diagnostic value of CSF β-hCG exceeds 90%). Subtype diagnosis improved with αFP in 16.7% of non-geminomatous germ cell tumor cases.
  
  
  CONCLUSIONS
  New evidence-based criteria of β-hCG and αFP can help improving early and formal diagnosis of ICGCTs, and is of great clinical significance.
authors.affiliation: Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Key Lab of Ministry of Health, Beijing, 100730, China.
authors.forename: Mingming
authors.initials: M
authors.lastname: Hu
authors.affiliation: Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Guan
authors.affiliation: Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX, 77030, USA.
authors.forename: Ching C
authors.initials: CC
authors.lastname: Lau
authors.affiliation: Children's Cancer Center, National Center for Child Health and Development, Tokyo, 157-8535, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Terashima
authors.affiliation: Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Key Lab of Ministry of Health, Beijing, 100730, China.
authors.forename: Zimeng
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China. pumchcuily@sina.com.
authors.forename: Liying
authors.initials: L
authors.lastname: Cui
authors.affiliation: Department of Oncology, Peking Union Medical College Hospital,Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Yuzhou
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Beijing Xuanwu Hospital, Beijing, 100053, China.
authors.forename: Guilin
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Neurosurgery and Oncology, University of Rochester, Rochester, NY, 14642, USA.
authors.forename: Yan Michael
authors.initials: YM
authors.lastname: Li
authors.affiliation: Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Dingrong
authors.initials: D
authors.lastname: Zhong
authors.affiliation: Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Xirun
authors.initials: X
authors.lastname: Wan
authors.affiliation: Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lian
authors.affiliation: Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Feng
authors.affiliation: Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Yanhuan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
authors.forename: Xinqi
authors.initials: X
authors.lastname: Cheng
authors.affiliation: Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Key Lab of Ministry of Health, Beijing, 100730, China. cuiliyingsci@126.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Gu
mesh_terms: D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000097:blood / Q000134:cerebrospinal fluid; D001932:Brain Neoplasms / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis* / Q000097:blood / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D012372:ROC Curve; D012016:Reference Values; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis* / Q000134:cerebrospinal fluid
chemical_list: D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins
keywords: Alpha-fetoproteins; Beta subunit; Chorionic gonadotropin; Human; Intracranial germ cell tumors; Tumor markers