Abstract

Purpose: Algorithms for the detection of a malignancy in patients with unclear neurologic symptoms of suspicious paraneoplastic origins are not universally applied. Frequently, circulating tumor markers (TMs) are considered a valuable tool for cancer diagnosis in patients with paraneoplastic neurologic syndromes (PNS). Our aim was to extract the recommendations on the use of TMs and onconeural antibodies (Abs) for the diagnosis of malignancies in PNS from clinical practice guidelines and put them forward as evidence in a common framework to facilitate diffusion, dissemination, and implementation.Methods: Systematic literature searches were performed for guidelines on both oncology and PNS published since 2007. Guidelines containing information and recommendations for clinical practice pertaining to the screening and diagnosis of PNS were selected. Information on circulating TMs and onconeural Abs was extracted and synthesized in consecutive steps of increasing simplification.Results: We retrieved 799 eligible guidelines on oncology for the potential presence of information on PNS but only six covered treated diagnosis or the screening of cancer in PNS, which were then selected. Seventy-nine potentially relevant guidelines on PNS were identified as eligible and 15 were selected. Synoptic tables were prepared showing that classical TMs are not recommended for the screening or the diagnosis of a malignancy in patients with a suspected PNS. Neither should onconeural Abs be considered to screen for the presence of a malignancy, although they could be helpful to define the probability of the paraneoplastic origin of a neurologic disorder.Conclusion: The present work of synthesis may be a useful tool in the diffusion, dissemination, and implementation of guideline recommendations, potentially facilitating the decrease of the inappropriate use of circulating biomarkers for cancer screening in the presence of PNS.

Highlights

  • Paraneoplastic neurologic syndromes (PNS) are neurologic immune-mediated disorders occurring as a remote effect of a tumor, frequently associated with antibodies [1, 2]

  • In a survey performed in three general hospitals in Italy as part of an internal quality assurance program, tumor markers (TMs) requests were registered in recovery charts of 10.4–21.9% of consecutive patients admitted in neurological wards

  • A consistent agreement was found among recommendations on the use of circulating biomarkers in PNS management across multiple guidelines from various societies, reflecting the strength of the evidence

Read more

Summary

Introduction

Paraneoplastic neurologic syndromes (PNS) are neurologic immune-mediated disorders occurring as a remote effect of a tumor, frequently associated with antibodies [1, 2]. Antibodies (Abs) associated with PNS can recognize intracellular antigens (onconeural Abs) or bind to cell surface antigens on neuronal cells [3]. While neuronal surface Abs often occur in the absence of tumors in non-paraneoplastic autoimmune diseases such as autoimmune encephalitis, onconeural Abs are closely related to the presence of a malignancy [4]. Neurologic symptoms suggestive of a PNS necessitate the proper diagnosis of PNS and the identification of a malignancy. Evidence shows that PNS may occur in most cases before the clinical appearance of the malignancy, increasing the need for tools for early cancer detection in these patients [5, 6].

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call