A prospective study of 2-[18F] fluoro-2-deoxy-D-glucose/positron emission tomography scan, 99mTc-labeled arcitumomab (CEA-scan), and blind second-look laparotomy for detecting colon cancer recurrence in patients with increasing carcinoembryonic antigen levels.
BACKGROUND
An increasing carcinoembryonic antigen (CEA) level in the absence of disease on imaging studies can present a diagnostic challenge. We evaluated 2-[18F] fluoro-2-deoxy-D-glucose and positron emission tomography (FDG-PET) scan and CEA scan before second-look laparotomy as a means of localizing recurrent colorectal cancer.


METHODS
Patients underwent computed tomography scan, bone scan, colonoscopy, and magnetic resonance imaging, and those without evidence of disease or resectable disease in the abdomen had FDG-PET and CEA scans. At second-look laparotomy, a surgeon blinded to the results of the FDG-PET and CEA scans performed an exploration and mapped findings. A second surgeon, with knowledge of the FDG-PET and CEA scans, then explored the patient; all lesions were biopsied or resected for pathology.


RESULTS
In 28 patients explored, disease was found at operation in 26 (94%). Ten had unresectable disease. FDG-PET scans predicted unresectable disease in 90% of patients. CEA scans failed to predict unresectable disease in any patient. In 16 patients found to have resectable disease or disease that could be treated with regional therapy, FDG-PET scan predicted this in 81% and CEA scan in 13%.


CONCLUSIONS
FDG-PET scan can predict those patients who would likely benefit from a laparotomy. If the FDG-PET scan indicates resectable disease, laparotomy can be considered. However, if the findings predict unresectable disease or the absence of disease, the patient should pursue systemic therapy or continued observation.
Libutti
S K
SK
Surgery Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland 20892-1502, USA. slibutti@nih.gov
Alexander
H R
HR
Choyke
P
P
Bartlett
D L
DL
Bacharach
S L
SL
Whatley
M
M
Jousse
F
F
Eckelman
W C
WC
Kranda
K
K
Neumann
R D
RD
Carrasquillo
J A
JA
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012008:Recurrence; D024162:Second-Look Surgery; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods
D000911:Antibodies, Monoclonal; D003287:Contrast Media; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C114976:technetium Tc-99m arcitumomab; D019788:Fluorodeoxyglucose F18