Can PET/CT detect recurrence in post-operative colorectal carcinoma patients with elevated CEA level?

Ragheb, Samar Ramzy; Sharara, Sherine Mohamed

doi:10.1186/s43055-020-00170-w

Cited by 3 publications

(7 citation statements)

References 18 publications

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“…However, several authors reported FDG PET/CT as highy sensitive in the detection of liver metastases in patients with CRC [71,72]. If compared to CECT, FDG PET/CT is superior, in particular for the detection of occult metastases [40,42]. Results obtained in a study of Cinar et al are in line with previous reports.…”

Section: Discussionsupporting

confidence: 75%

“…Ragheb et al performed FDG PET/CT on 45 CRC patients with elevated CEA levels during the postoperative surveillance. Compared to previous authors, they obtained similar sensitivity, specificity, PPV, and NPV of 96.9%, 83.3%, 94.2%, and 90%, respectively [40]. In addition, Gade et al reported a high diagnostic performance of FDG PET/CT in recurrent CRC obtained on 73 patients with rising CEA levels.…”

Section: Discussionmentioning

confidence: 70%

“…According to the guidelines, further use of FDG PET/CT in the detection of CRC recurrence in patients with elevated CEA levels is controversial [38]. However, several authors advocate the high efficacy of FDG PET/CT in detecting tumor recurrence if CEA levels are elevated [21,[39][40][41]. Uzun et al retrospectively studied 75 patients with CRC during the follow-up suspicious of having recurrence because of elevated CEA levels and/or equivocal/positive findings at conventional imaging modality.…”

Section: Discussionmentioning

confidence: 99%

“…However, several authors show that increased CEA levels are not necessary for an FDG PET/CT to detect recurrent CRC [40,[44][45][46][47]. In a recent study done by Miloradovic et al, FDG PET/CT imaging was performed on 50 CRC patients with normal or elevated CEA levels, previously treated by initial surgery.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

Mihailovic,

Roganovic,

Starcevic

et al. 2024

Preprint

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Background/Objectives: Although the role of F-18 FDG PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, we retrospectively studied 134 CRC patients referred for FDG PET/CT imaging on the suspicion of recurrence based on elevated CEA and/or CA 19-9, and/or equivocal radiological findings. According to the Institutional Tumor Board CRC protocol, after initial treatment which was dependent on TNM stage (neoadjuvant therapy, primary resection or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy every 6 months. The statistics including univariate and multivariable analyses were conducted using the IBM SPSS 20.0 statistical software. P-values <0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. FDG PET/CT shows high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA shows a high sensitivity of 98.1%, but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy, for CA 19-9 and CIM for the correct diagnosis in CRC patients were: 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for FDG PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824-0.946; p<0.001), 0.844 (95% CI: 0.772-0.916; p<0.001), 0.753 (95% CI: 0.612-0.844; p<0.001); and 0.547 (95% CI: 0.442-0.652; p=0.358). Univariate analysis shows that both FDG PET/CT- and CIM-positive results were highly associated with CRC recurrence (p<0.001 and p<0.001, respectively), while gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) have no significance (p=0.211, p=0.158, p=0.583, and p=0.201, respectively). Our multivariate analysis shows that independent predictors for CRC recurrence are: positive FDG PET/CT scans (p<0.001), positive CIM results (p=0.001) and elevated CA19-9 levels (p=0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p=0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting CRC recurrence (p=0.023). Conclusions: FDG PET/CT shows a high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the postoperative follow-op in patients with elevated tumor markers.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

Mihailovic,

Roganovic,

Starcevic

et al. 2024

Preprint

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“…In addition, PET/CT is also reported as a highly sensitive method in diagnostics of liver metastatic disease [ 73 , 74 ]. In comparison to CT, PET/CT is a superior diagnostic method, particularly in detecting occult metastases [ 38 , 48 ]. Results obtained in a study by Cinar et al align with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

Mihailović,

Roganović,

Starčević

et al. 2024

JCM

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Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution’s Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824–0.946; p < 0.001), 0.844 (95% CI: 0.772–0.916; p < 0.001), 0.753 (95% CI: 0.612–0.844; p < 0.001), and 0.547 (95% CI: 0.442–0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers.

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The diagnostic performance of 2-[18F]FDG PET/CT for the recurrent colorectal cancer in patients with elevated CEA versus normal CEA: a systematic review and meta-analysis

Yao

Zhang

Liang

et al. 2022

Clin Transl Imaging

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Can PET/CT detect recurrence in post-operative colorectal carcinoma patients with elevated CEA level?

Cited by 3 publications

References 18 publications

Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

The diagnostic performance of 2-[18F]FDG PET/CT for the recurrent colorectal cancer in patients with elevated CEA versus normal CEA: a systematic review and meta-analysis

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