How Useful Are Tumor Markers in Detecting Metastases with FDG-PET/CT during Breast Cancer Surveillance?

Abstract

Background: To assess the clinical usefulness of serum tumor markers for early detection of distant breast cancer recurrence using FDG-PET/CT. Methods: We retrospectively analyzed 561 consecutive patients who underwent surgery for invasive primary breast cancer and had increased tumor markers (CA 15-3 and CEA) after completion of locoregional therapy. FDG-PET/CT data were reviewed for all cases. CA 15-3 and CEA were evaluated both in a continuous and in a quartile (Q) distribution. The Wilcoxon rank-sum test and logistic regression models were used to evaluate the association between increased tumor marker values and the presence (and type) of distant metastases. Results: The median value of CA 15-3 was 35.0 U/mL (IQR, 29.5-43.0) in cases where no distant metastases were detected, and it was 58.9 U/mL (IQR, 40.0-108.0) in cases where metastases were detected (p < 0.001). The median value of CEA was 6.6 U/mL (IQR, 4.4-10.0) in cases of no metastases and 12.4 U/mL (IQR, 6.9-30.0) in cases of metastases (p < 0.001). Increased levels of both tumor markers (Q3 and Q4) were strongly associated with the presence of distant metastases. The association between CA 15-3 and bone/liver metastases was stronger compared with other types of metastases (p heterogeneity between odds ratios [ORs] = 0.03 for Q3 and <0.001 for Q4), while no relevant heterogeneity between ORs emerged for CEA. Conclusion: Increased tumor marker levels detected in asymptomatic breast cancer patients during adjuvant therapies and follow-up are significantly predictive of distant metastases identified on FDG-PET/CT.

Has COVID-19 Affected Cancer Screening Programs? A Systematic Review

“…Both, patients and personnel at hospital sites experience fear and anxiety (5). There has been a marked decline in cancer screening and diagnosis, the development of tumor markers, the use of imaging procedures, biopsies, colonoscopy, gastroscopy, sigmoidoscopy, stool tests, low-dose computed tomography (LDCT), mammography, Pap tests, human papillomavirus (HPV) testing, colposcopy, laparoscopy, and melanoma screening (6,8,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Impact on the long-term prognosis of FDG PET/CT in luminal-A and luminal-B breast cancer

“…It is a recognized useful technique in case of negative or inconclusive conventional imaging results [3][4][5], mainly if there is an increase in tumor markers [6]. Indeed, elevated serum levels of cancer antigen 15.3 (CA 15.3) often lead to PET/CT scan and are associated with an increased risk of FDG avid metastases [7][8][9][10][11]. However, different breast cancer histopathologic features (i.e.…”

Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients

“…Similarly, the CEA values were 6.6 vs. 12.4 U/ml (p < 0.001). Furthermore, CA 15-3 had a significant association with bone/liver metastases compared to other sites of metastasis (30). This opens up other future viable options as staging procedures.…”

“…These tumor markers have been shown to be significantly predictive of distant metastases identified on FDG-PET/CT. In a study by Corso et al, cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) were analyzed in 561 patients (30). The median value of CA 15-3 was 35.0 U/ml in cases where no metastases were detected and was 58.9 U/ml in cases with positive metastases (p < 0.001).…”