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HelpTest ID: NSE Neuron-Specific Enolase, Serum
Reporting Name
Neuron Specific Enolase, SUseful 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
Specimen Type
SerumSpecimen 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.
Clinical Reference
1. Burghuber OC, Worofka B, Schernthaner G, et al. Serum neuron-specific enolase is a useful tumor marker for small cell lung cancer. Cancer. 1990;65(6):1386-1390
2. Lamberts SW, Hofland LJ, Nobels FR. Neuroendocrine tumor markers. Front Neuroendocrinol. 2001;22(4):309-339
3. Aksamit AJ Jr, Preissner CM, Homburger HA. Quantitation of 14-3-3 and neuron-specific enolase proteins in CSF in Creutzfeldt-Jacob disease. Neurology. 2001;57(4):728-730
4. Riley RD, Heney D, Jones DR, et al. A systematic review of molecular and biological tumor markers in neuroblastoma. Clin Cancer Res. 2004;10(1 Pt 1);4-12
5. Portela-Gomes GM, Hacker GW, Weitgasser R. Neuroendocrine cell markers for pancreatic islets and tumors. Appl Immunohistochem Mol Morphol. 2004;12(3):183-192
6. Wijdicks EFM, Hijdra A, Young GB, Bassetti CL, Wiebe S. Quality Standards Subcommittee of the American Academy of Neurology: Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). Neurology. 2006;67(2):203-210
7. Huang L, Zhou JG, Yao WX, et al. Systematic review and meta-analysis of the efficacy of serum neuron-specific enolase for early small cell lung cancer screening. Oncotarget. 2017;8(38):64358–64372
8. Cheng F, Yuan Q, Yang J, Wang W, Liu H. The prognostic value of serum neuron-specific enolase in traumatic brain injury: systematic review and meta-analysis. PLoS One. 2014;9(9):e106680
Report Available
1 to 3 daysDay(s) Performed
Monday through Saturday
Method Name
Homogeneous Time-Resolved Fluorescence
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
mml-endocrine-cancer, mml-endocrine-cancer, mml-gastrointestinal-cancer, mml-pulmonary-cancer