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Tests for monitoring disease progression

Various imaging techniques and biochemical tests are available for characterizing, localizing, and monitoring changes in primary NETs and their metastases.

Changes in symptom severity or the appearance of new symptoms may be indicators of progressive disease.10

Imaging studies

Computed tomography (CT)

Widely available, CT may be ordered for surgical candidates as part of preoperative planning, and may help identify the spread of disease.20,21 Triple-phase CT, in particular, offers good resolution for intrahepatic and extrahepatic metastases, and may help identify bone metastases.22,23

Noncontrast, arterial phase, and venous phase CT images of liver metastases

Magnetic resonance imaging (MRI)

MRI has been shown to be effective in the detection of hepatic and bone metastases.20,24-26

Octreoscan™ (somatostatin receptor scintigraphy)

Octreoscan is a whole-body imaging technique that may be particularly helpful in identifying previously unsuspected extrahepatic and lymph node metastases.24,26,27 The technique is also useful for identifying patients who may be candidates for peptide receptor radionuclide therapy (PRRT).13

Octreoscan is a trademark of Covidien AG or one of its affiliates.

Positron emission tomography (PET)

PET can be used with chemical tracers to detect metastases, and with [11C]-labeled and [18F]-labeled amine precursors, such as serotonin and levodopa. PET with [68Ga]-labeled somatostatin analog (SSA) may identify metastatic NETs; however, [68Ga] generators are not widely available.10

Biochemical tests

Chromogranin A (CgA)

CgA levels are typically highest in metastatic disease, particularly in patients with multiple liver metastases.28,29 Serum CgA levels may also be associated with tumor burden and may be correlated with survival.30,31 Importantly, CgA levels may start to increase before changes in tumor size can be seen on CT or MRI.32

Serum CgA as an indicator of tumor presence

5-Hydroxyindoleacetic acid (5-HIAA)

In patients with serotonin-producing NETs who exhibit symptoms of carcinoid syndrome, elevated levels of 5-HIAA are associated with increased tumor mass and poor outcomes.27,33,34 Very high elevations have been linked to carcinoid heart disease.34,35

Additionally, specific biochemical tests can be used to monitor symptoms, response to treatment, and extent of disease.14

Certain medications, such as antacids and proton pump inhibitors, can alter tumor biomarker levels.11

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