Annals of Nuclear Medicine

, Volume 24, Issue 5, pp 395–401

Ability of 18F-FDG PET/CT to diagnose recurrent colorectal cancer in patients with elevated CEA concentrations

  • Yukishige Kyoto
  • Mitsuru Momose
  • Chisato Kondo
  • Michio Itabashi
  • Shingo Kameoka
  • Kiyoko Kusakabe
Original Article

Abstract

Objective

Elevated levels of serum carcinoembryonic antigen (CEA) in patients with colorectal cancer (CRC) during follow-up suggest recurrence, which can be visualized by 18F-FDG PET/CT. Since the magnitude of CEA elevation reflects cancer volume, the ability of PET/CT to detect recurrence in patients with only mildly elevated CEA might be limited. However, the accuracy of PET/CT in detecting recurrence associated with elevated CEA has not been fully assessed. We retrospectively evaluated the diagnostic performance of 18F-FDG PET/CT postoperatively relative to CEA levels among patients with CRC.

Methods

We visually assessed 75 PET/CT evaluations of 57 postoperative patients with CEA >5.0 ng/ml. Tumor volumes were also determined using image analysis software. The final diagnosis was confirmed based on histopathological findings, or at least on 6 months of clinical follow-up.

Results

Two lung cancers were excluded and we finally analyzed data from 73 of the 75 PET/CT evaluations. Recurrences were diagnosed in 54 (prevalence 74%). The sensitivity and specificity of PET/CT to detect recurrence was 50/54 (93%) and 14/19 (74%), respectively. The positive and negative predictive values were 91 and 78%, respectively, and the positive and negative likelihood ratios were 3.52 and 0.10, respectively. Values for the sensitivity of PET/CT were 88 and 95%, and those for specificity were 78 and 70%, at serum CEA concentrations of 5–10 and >10 ng/ml, respectively. Serum CEA (r = 0.500, p < 0.001) significantly correlated with cancer volumes.

Conclusions

The present findings showed that 18F-FDG PET/CT could accurately detect recurrent CRC irrespective of the elevated CEA concentration.

Keywords

Positron emission tomography (PET) Recurrent colorectal cancer Carcinoembryonic antigen (CEA) Tumor volume 

References

  1. 1.
    Martin EJ, Cooperman M, Carey L, Minton J. Sixty-second-look procedures indicated primarily by rise in serial carcinoembryonic antigen. J Surg Res. 1980;28:389–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Hine K, Dykes P. Serum CEA testing in the post-operative surveillance of colorectal carcinoma. Br J Cancer. 1984;49:689–93.PubMedGoogle Scholar
  3. 3.
    Minton J, Hoehn J, Gerber D, Horsley J, Connolly D, Salwan F, et al. Results of a 400-patient carcinoembryonic antigen second-look colorectal cancer study. Cancer. 1985;55:1284–90.CrossRefPubMedGoogle Scholar
  4. 4.
    McCall J, Black R, Rich C, Harvey J, Baker R, Watts J, et al. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum. 1994;37:875–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Moertel C, Fleming T, Macdonald J, Haller D, Laurie J, Tangen C. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA. 1993;270:943–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Flanagan F, Dehdashti F, Ogunbiyi O, Kodner I, Siegel B. Utility of FDG-PET for investigating unexplained plasma CEA elevation in patients with colorectal cancer. Ann Surg. 1998;227:319–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Flamen P, Hoekstra O, Homans F, Van Cutsem E, Maes A, Stroobants S, et al. Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET). Eur J Cancer. 2001;37:862–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Huebner R, Park K, Shepherd J, Schwimmer J, Czernin J, Phelps M, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med. 2000;41:1177–89.PubMedGoogle Scholar
  9. 9.
    Arnaud J, Koehl C, Adloff M. Carcinoembryonic antigen (CEA) in diagnosis and prognosis of colorectal carcinoma. Dis Colon Rectum. 1980;23:141–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17, 1996 by the American Society of Clinical Oncology. J Clin Oncol. 1996;14:2843–77.Google Scholar
  11. 11.
    Choi M, Lee K, Chung J, Lee D, Jeong J, Park J, et al. Correlation between serum CEA level and metabolic volume as determined by FDG PET in postoperative patients with recurrent colorectal cancer. Ann Nucl Med. 2005;19:123–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Okubo M, Nishimura Y, Nakamatsu K, Okumura M, Shibata T, Kanamori S, et al. Static and moving phantom studies for radiation treatment planning in a positron emission tomography and computed tomography (PET/CT) system. Ann Nucl Med. 2008;22:579–86. doi:10.1007/s12149-008-0166-8.CrossRefPubMedGoogle Scholar
  13. 13.
    Dupont W, Plummer WJ. Power and sample size calculations. A review and computer program. Control Clin Trials. 1990;11:116–28.CrossRefPubMedGoogle Scholar
  14. 14.
    Findlay M, Young H, Cunningham D, Iveson A, Cronin B, Hickish T, et al. Noninvasive monitoring of tumor metabolism using fluorodeoxyglucose and positron emission tomography in colorectal cancer liver metastases: correlation with tumor response to fluorouracil. J Clin Oncol. 1996;14:700–8.PubMedGoogle Scholar
  15. 15.
    Gutman F, Alberini J, Wartski M, Vilain D, Le Stanc E, Sarandi F, et al. Incidental colonic focal lesions detected by FDG PET/CT. AJR Am J Roentgenol. 2005;185:495–500.CrossRefPubMedGoogle Scholar
  16. 16.
    Konishi J, Yamazaki K, Tsukamoto E, Tamaki N, Onodera Y, Otake T, et al. Mediastinal lymph node staging by FDG-PET in patients with non-small cell lung cancer: analysis of false-positive FDG-PET findings. Respiration. 2003;70:500–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Delbeke D, Martin W, Sandler M, Chapman W, Wright JJ, Pinson C. Evaluation of benign vs malignant hepatic lesions with positron emission tomography. Arch Surg. 1998;133:510–5 (discussion 5–6).Google Scholar
  18. 18.
    Hany T, Steinert H, Goerres G, Buck A, von Schulthess G. PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology. 2002;225:575–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Locker G, Hamilton S, Harris J, Jessup J, Kemeny N, Macdonald J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313–27.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2010

Authors and Affiliations

  • Yukishige Kyoto
    • 1
    • 2
  • Mitsuru Momose
    • 2
  • Chisato Kondo
    • 2
  • Michio Itabashi
    • 3
  • Shingo Kameoka
    • 3
  • Kiyoko Kusakabe
    • 2
  1. 1.Department of RadiologyJapan Self-Defense Forces Central HospitalTokyoJapan
  2. 2.Department of Diagnostic Imaging and Nuclear MedicineTokyo Women’s Medical UniversityTokyoJapan
  3. 3.Department of SurgeryTokyo Women’s Medical UniversityTokyoJapan

Personalised recommendations