Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET).
The aim of the study was to evaluate the use of positron emission tomography with [18F]-fluorodeoxyglucose (FDG-PET) in patients with unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer. 50 consecutive patients with elevated CEA levels and a completely normal (n=31) or equivocal (n=19) conventional diagnostic work-up (CDW) were retrospectively selected. All PET images were reviewed with full knowledge of the CDW. The gold standard consisted of histology, or clinical follow-up of more than 1 year. Recurrent disease was established in 56 lesions in 43 patients. On a patient-based analysis, the sensitivity of FDG-PET was 34/43 (79%), and the positive predictive value 34/38 (89%). In 14/50 patients (28%), the FDG-PET findings led to a surgical resection with curative intent. On a lesion-based analysis, FDG-PET detected 42/56 lesions (sensitivity: 75%), the positive predictive value was 79% (42/53). These results demonstrate that FDG-PET can have a clear impact on patient management in patients with an unexplained elevation in CEA levels.
Flamen
P
P
Departments of Nuclear Medicine, Internal Medicine, and Abdominal Surgery, University Hospital Gasthuisberg, Katholieke Universiteit Leuven (KUL), Herestraat 49, 3000, Leuven, Belgium. patrick.flamen@uz.kuleuven.ac.be
Hoekstra
O S
OS
Homans
F
F
Van Cutsem
E
E
Maes
A
A
Stroobants
S
S
Peeters
M
M
Penninckx
F
F
Filez
L
L
Bleichrodt
R P
RP
Mortelmans
L
L
D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015179:Colorectal Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging; D011182:Postoperative Care / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods*
D002272:Carcinoembryonic Antigen; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18