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Test Code LAB12560 Neuron-Specific Enolase, Serum

Reporting Name

Neuron Specific Enolase, S
Covenant HealthCare Laboratory Test Directory Note:

Neuron-Specific Enolase (NSE) Serum

Useful For

A follow-up marker in patients with neuron-specific enolase-secreting tumors of any type

 

An auxiliary test in the diagnosis of small cell lung carcinoma

 

An auxiliary test in the diagnosis of carcinoids, islet cell tumors, and neuroblastomas

 

An auxiliary tool in the assessment of comatose patients

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum


Specimen Required


Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions:

1. Specimens should not be transported by tube system prior to centrifugation.

2. Centrifuge and aliquot serum into a plastic vial.


Specimen Minimum Volume

0.3 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days
  Ambient  5 days

Reference Values

≤15 ng/mL

Serum markers are not specific for malignancy, and values may vary by method.

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83520

LOINC Code Information

Test ID Test Order Name Order LOINC Value
NSE Neuron Specific Enolase, S 15060-7

 

Result ID Test Result Name Result LOINC Value
NSE Neuron Specific Enolase, S 15060-7

Clinical Information

Enolase is a glycolytic enzyme that catalyzes the conversion of 2-phosphoglycerate to phosphoenolpyruvate. Enolase exists in the form of several tissue-specific isoenzymes, consisting of homo or heterodimers of 3 different monomer-isoforms (alpha, beta, and gamma). Neuron-specific enolase (NSE) is a 78 kDa gamma-homodimer and represents the dominant enolase-isoenzyme found in neuronal and neuroendocrine tissues. Its levels in other tissues, except erythrocytes, are negligible. The biological half-life of NSE in body fluids is approximately 24 hours.

 

Due to this organ-specificity, concentrations of NSE in serum or, more commonly, cerebrospinal fluid (CSF) are often elevated in diseases that result in relative rapid (hours/days to weeks rather than months to years) neuronal destruction. Measurement of NSE in serum or CSF can therefore assist in the differential diagnosis of a variety of neuron-destructive and neurodegenerative disorders. The most common application is in the differential diagnosis of dementias, where elevated CSF concentrations support the diagnosis of rapidly progressive dementias, such as Creutzfeldt-Jacob Disease. NSE may also have utility as a prognostic marker in neuronal injury. For example, there is increasing evidence that elevated serum NSE levels correlate with a poor outcome in coma, particularly when caused by hypoxic insult.

 

NSE is frequently overexpressed by neural crest-derived tumors. Up to 70% of patients with small cell lung carcinoma (SCLC) have elevated serum NSE concentrations at diagnosis. Approximately 90% of patients with advanced SCLC will have serum levels above the healthy reference range. Other neuroendocrine tumors with frequent expression of NSE include carcinoids (up to 66% of cases), islet cell tumors (typically <40% of cases), and neuroblastoma (exact frequency of NSE expression unknown). NSE levels in NSE-secreting neoplasms correlate with tumor mass and tumor metabolic activity. High levels have, therefore, some negative prognostic value. Falling or rising levels are often correlated with tumor shrinkage or recurrence, respectively.

Interpretation

Serum neuron-specific enolase (NSE) measurement has its greatest utility in the follow-up of patients with tumors of any type that have been shown to secrete NSE. With successful treatment, serum concentrations should fall with a half-life of approximately 24 hours. Persistent NSE elevations in the absence of other possible causes (see Cautions) suggest persistent tumor. Rising levels indicate tumor spread or recurrence in patients who had previously become NSE negative.

 

In the context of a patient with a lung mass, disseminated malignancy of unknown origin, or symptoms suggestive of paraneoplastic disease without identifiable tumor, elevated NSE levels suggest an underlying small cell lung carcinoma (SCLC).

 

In patients with suspected carcinoid, islet cell tumor, or neuroblastoma, who have no clear elevations in the primary tumor markers used to diagnose these conditions, an elevated serum NSE level supports the clinical suspicion.

-Carcinoid: chromogranin A, urinary 5-hydroxyindoleacetic acid, serum/blood 5-hydroxytryptamine (serotonin)

-Islet cell tumors: variety of peptide and amine-derived hormones, chromogranin A

-Neuroblastoma: vanillylmandelic acid and homovanillic acid

 

When considered alongside established outcome predictors of coma, such as Glasgow coma scale and other clinical predictors (papillary light responses, corneal reflexes, motor responses to pain, myoclonus, status epilepticus), electroencephalogram, sensory evoked potentials, measurement of serum NSE concentrations provides additional information. Elevated levels are indicative of a poor outcome. Currently, no established algorithms exist to combine serum NSE concentrations and the various other predictors into a composite score that gives clear predictive outcome information. The NSE measurement, therefore, needs to be considered in a qualitative or semi-quantitative fashion and carefully weighed against other predictors by a physician experienced in examining and managing coma patients.

Report Available

1 to 3 days

Reject Due To

Gross hemolysis Reject
Gross lipemia OK
Gross icterus Reject
Hemolysis at any level Reject

Day(s) Performed

Monday through Saturday

Method Description

Neuron-specific enolase is measured in this homogeneous automated immunofluorescent assay on the BRAHMS Kryptor. The Kryptor uses TRACE (time resolved amplified cryptate emission) technology based on a nonradioactive transfer of energy. This transfer occurs between 2 fluorescent tracers: the donor (europium cryptate) and the acceptor (XL665). In the NSE assay, 2 monoclonal antibodies are labeled, 1 with europium cryptate and 1 with XL665. NSE is sandwiched between the 2 antibodies, bringing them into close proximity. When the antigen-antibody complex is excited with a nitrogen laser at 337 nm, some fluorescent energy is emitted at 620 nm, and the rest is transferred to XL665. This energy is then emitted as fluorescence at 665 nm. A ratio of the energy emitted at 665 nm to that emitted at 620 nm (internal reference) is calculated for each sample. Signal intensity is proportional to the number of antigen-antibody complexes formed and, therefore, to antigen concentration.(Unpublished Mayo method)

Method Name

Homogeneous Time-Resolved Fluorescence

Forms

If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.

Secondary ID

80913