The question is not a simple one as neuroblastoma covers a span
of related but different tumours with different biochemical profiles.
Problems arise with extra-abdominal tumours as well as highly
differentiated ones. There is also the problem of the type of
collection random or timed (24 hour). I always think that the
difficulties of collecting the latter are grossly exaggerated and I
believe that small neuroblastomas are more likely to be missed
with random urines.
Our experience of several hundred cases is that a combination of
dopamine and HVA with laboratory based age related reference
ranges gives 98% sensitivity. The specificity depends on patients
selected for test but there is no doubt the more analytes you
measure the more false positives you get. There is a danger when
using tests aimed more at phaeos of missing cases. The problem
of non-secretors described in many series does not appear to be
so great using the dopamine/HVA combination.
My advice is where you do very few cases per year to send the
samples to a paediatric laboratory.
Mike Addison
Dr G.Michael Addison
Royal Manchester Children's Hospital
Pendlebury
Manchester M27 4HA
United Kingdom
Tel 0161-727-2250(AM)or 0161-220-5342(PM)
FAX 0161-727-2249
Email [log in to unmask]
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