Neuroblastoma Screening (PDQ®): Screening - Health Professional Information [NCI] - Significance
There are no standard cut-off levels between positive and negative VMA and HVA tests. One recommendation is to use a VMA cut-off level of 25 μg/mg creatinine and an HVA cut-off level of 32 μg/mg creatinine. Alternatively, individual laboratories use a level of two standard deviations above that laboratory's age-specific mean to identify specimens for reanalysis. On reanalysis, a level of three standard deviations above the mean is used to determine the need for diagnostic evaluation.
The sensitivity of the screening procedure used in different studies ranges from 40% to 80%.[10,11,12,13] False-positives can be caused by dietary agents such as bananas and vanilla  but are rare with quantitative assays such as gas chromatography (specificity approximates 99.9%).[12,15] Because of the low prevalence of the disease, even in the Quebec Neuroblastoma Screening Project in which the specificity of the test was extremely high, the positive-predictive value was only 52%, i.e., for every two children identified by screening as being likely to have neuroblastoma, only one was actually affected. In the German Neuroblastoma Screening Project, the positive-predictive value has been reported as only 8.4%. False-positive cases are generally followed for prolonged periods with serial noninvasive testing before a definitive diagnosis excluding cancer can be offered to the parents.
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