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Case Reports
. 2014 Aug 5:14:564.
doi: 10.1186/1471-2407-14-564.

Blood transcript analysis and metastatic recurrent small bowel carcinoid management

Irvin M Modlin  1 , Ignat Drozdov, Lisa Bodei, Mark Kidd
Affiliations
Case Reports

Blood transcript analysis and metastatic recurrent small bowel carcinoid management

Irvin M Modlin et al. BMC Cancer. .

Abstract

Background: Detection of neuroendocrine tumor (NET) disease progression is a key issue in determining management. Currently, assessment is by imaging (MRI/CT and Octreoscan®) and plasma Chromogranin A (CgA) measurement.

Case presentation: We report use of a NET-specific multigene PCR-derived blood transcript signature (NET Index) to assess disease and correlated CgA and gene transcripts with MRI, CT, Octreoscan®, 11C-5HTP-PET/CT and (68)Ga-DOTA-PET/CT in a patient with NET.

Conclusions: Our results identify limitations in evaluating disease status by CgA and identify that a PCR-based test is more sensitive. Alteration in NET blood gene transcript levels prior to image-based tumor confirmation suggests this parameter may also have utility as an index of therapeutic efficacy.

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Figures

Figure 1
Figure 1
Distinctive appearance at 11 C-HTP and 68 Ga-SST PET/CT of the liver (A and D) and bone metastases (B and E); no other lesions were detected at control PET scan performed with 68 Ga-SST (C).
Figure 2
Figure 2
Time line correlating plasma CgA measurements (DAKO ELISA, U/L) and the NET Index (%) (both y-axis) with the imaging and interventions (x-axis).
See this image and copyright information in PMC

References

    1. Modlin IM, Oberg K, Chung DC, Jensen RT, de Herder WW, Thakker RV, Caplin M, Delle Fave G, Kaltsas GA, Krenning EP, Moss SF, Nilsson O, Rindi G, Salazar R, Ruszniewski P, Sundin A. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol. 2008;9:61–72. doi: 10.1016/S1470-2045(07)70410-2. - DOI - PubMed
    1. Giandomenico V, Modlin IM, Pontén F, Nilsson M, Landegren U, Bergqvist J, Khan MS, Millar RP, Långström B, Borlak J, Eriksson B, Nielsen B, Baltzer L, Waterton JC, Ahlström H, Öberg K. Improving the diagnosis and management of neuroendocrine tumors: utilizing new advances in biomarker and molecular imaging science. Neuroendocrinology. 2013;28:28. - PubMed
    1. Lawrence B, Gustafsson BI, Kidd M, Pavel M, Svejda B, Modlin IM. The clinical relevance of chromogranin A as a biomarker for gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011;40:111–134. doi: 10.1016/j.ecl.2010.12.001. - DOI - PubMed
    1. Modlin I, Drozdov I, Kidd M. The Identification of gut neuroendocrine tumor disease by multiple synchronous transcript analysis in blood. PLoS One. 2013;8:e63364. doi: 10.1371/journal.pone.0063364. - DOI - PMC - PubMed
    1. Modlin IM, Gustafsson BI, Drozdov I, Nadler B, Pfragner R, Kidd M. Principal component analysis, hierarchical clustering, and decision tree assessment of plasma mRNA and hormone levels as an early detection strategy for small intestinal neuroendocrine (carcinoid) tumors. Ann Surg Oncol. 2009;16:487–498. doi: 10.1245/s10434-008-0251-1. - DOI - PubMed
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/14/564/prepub

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