Positron emission tomography for unexplained elevation of serum squamous cell carcinoma antigen levels during follow‐up for patients with cervical malignancies

Abstract

BACKGROUND During follow‐up for patients with cervical carcinoma, elevation of serum squamous cell carcinoma antigen (SCC‐Ag) levels in the absence of detectable recurrent lesions presents a diagnostic and therapeutic challenge. In the current prospective study, the authors evaluated the use of fluorine‐18‐labeled fluoro‐2‐deoxy‐D‐glucose (FDG) positron emission tomography (PET) to detect disease recurrence in this setting. METHODS Women with cervical carcinoma who experienced complete responses to primary treatment or salvage therapy and who had no evidence of recurrent disease as detected by conventional methods but had serum SCC‐Ag levels ≥ 2.0 ng/mL on 2 consecutive occasions were eligible for the study. PET was performed within 2 weeks after the completion of conventional studies for the assessment of recurrence. RESULTS Twenty‐seven consecutive patients were registered for the current study. PET findings were positive for 19 patients: 14 who had a distant lesion or lesions, 2 who had a local lesion or lesions, and 3 who had both local and distant lesions. Of these 19 patients, 17 were confirmed to have recurrent disease; the remaining two were found to be free of disease but had severe anthracosis in the PET‐positive mediastinal lymph nodes. Seven of the eight patients with negative PET findings were not found to have recurrent disease on follow‐up. Overall, PET detected FDG‐avid lesions in 17 (94%; P < 0.001) of the 18 patients with recurrent disease. Seven of these 18 patients received therapy with curative intent; complete control was achieved in 6, four of whom currently are alive and free of disease. The addition of PET in the current setting curbed the use of futile curative therapy and significantly increased overall survival for patients in the current cohort compared with a historical group of 30 consecutive patients who had elevated SCC‐Ag levels as a first sign of recurrence. CONCLUSIONS PET expedited the detection of recurrent cervical carcinoma in patients with unexplained elevation of SCC‐Ag levels. Such expedited detection may have positive effects on patient survival. Cancer 2004. © 2004 American Cancer Society.

Clinical Value of Serum HMGB1 Levels in Early Detection of Recurrent Squamous Cell Carcinoma of Uterine Cervix: Comparison with Serum SCCA, CYFRA21-1, and CEA Levels

“…Previous studies have reported that increasing serum SCCA can precede the clinical diagnosis of relapse in 46-92% of cases (19)(20)(21). However, it is still a matter of debate whether serum SCCA assay may represent a prognostic variable and be useful for earlier diagnosis of relapse (22,23). Most reports found CYFRA 21-1 to be a less sensitive serum tumor marker for squamous cell cervical cancer than SCCA (24)(25)(26).…”

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Liver, Bladder, Cervical, and Gastric Cancers

“…Nevertheless, further investigation is needed to determine whether SCC monitoring is really useful or not in clinical practice. It has been reported in a small series of patients with recurrent cervical cancer that the addition of positron emission tomography to SCC monitoring significantly increased overall survival compared with a historical group of patients who had elevated SCC concentrations as a first sign of recurrent disease (443 ). …”

Performance of FDG-PET/CT for diagnosis of recurrent uterine cervical cancer

“…Several authors have investigated the usefulness of PET for postoperative or post-therapy surveillance of patients with cervical cancer and found that the sensitivity, specificity, and accuracy were 86-100%, 60-94%, and 70-97%, respectively (Table 4) [12][13][14][15][16][17][18][19]. These studies revealed that false-negative cases included local recurrence in the retrovesical region, pelvic recurrence, lung metastasis, peritoneal dissemination, pelvic LN metastasis, and para-aortic LN metastasis, whereas false-positive cases were due to inflammatory lesions, physiological uptake, and postoperative change.…”

“…There have been several studies of FDG-PET [12][13][14][15][16][17][18][19] and only two reports of integrated FDG-PET/CT [20,21] describing their usefulness for the diagnosis of recurrent uterine cervical cancers. Chung et al [20] and Sironi et al [21] discussed the diagnostic accuracy of PET/CT, but did not compare PET/CT interpretation with PET-alone interpretation.…”