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We read with interest the report by Rubio et al¹ on "Carcinoid Tumor Metastatic to the Breast" in the October 1998 ARCHIVES. We agree that the presentation is consistent with carcinoid tumor metastatic to the breast; however, consideration should be given to the addition of serum chromogranin A, the somatostatin receptor for scintigraphy, and endoscopic ultrasonography to elucidate the occult primary carcinoid tumor. Chromogranin A is a valuable serum marker for neuroendocrine tumors, with the highest values found in patients with metastatic carcinoids of unknown primary sites. A correlation has been demonstrated between serum chromogranin A levels and somatostatin receptor positivity for midgut carcinoids.² Evaluation for occult foregut carcinoid tumor should include endoscopic ultrasonography, which has a sensitivity of approximately 90% for tumors smaller than 2 cm.³ Scintigraphy combines the advantage of whole-body imaging with sensitivity of 75% to 100% and specificity of 90% to 100% to detect the unknown . . . [Full Text of this Article]

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