Evaluation of recurrent disease in the re-staging of colorectal cancer by 18F-FDG PET/CT: Use of CEA and CA 19-9 in patient selection

Agostino Chiaravalloti, Alessandro Fiorentini, Erika Palombo, Davide Rinino, Annamaria Lacanfora, Roberta Danieli, Carmen Di Russo, Daniele Di Biagio, Ettore Squillaci, Orazio Schillaci

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Abstract

The aim of the present retrospective study was to evaluate the sensitivity and specificity of fluorodeoxyglucose (18F.FDG) positron emission tomography/computed tomography (PET/CT) in assessing the recurrence of colorectal cancer (CRC) with regard to carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA 19.9). 18F.FDG PET/CT was performed in 100 patients for the re.staging of CRC. Therapy was discontinued prior to the examination. The mean (± standard deviation) CEA value (measured ~30 days prior to PET/CT examination) was 23.71 (±107) ng/ml, whereas the CA 19.9 value was 72 (±190.3) U/ml. Differences in CEA and CA 19.9 values in patients with scans that were positive or negative for recurrence were analyzed by means of a receiver operating characteristic (ROC) curve. ROC curves were used for the calculation of the sensitivity and specificity of 18F.FDG PET/CT for the CEA and CA 19.9 levels. The results of the 18F.FDG PET/CT were found to be associated with the CEA level (P=0.001), but not with the CA 19.9 level (P=0.43). PET/CT was positive for recurrence in 60 patients (60.0%), whose mean CEA and CA 19.9 values were 33.07±136.7 ng/ml and 75.24±192.3 U/ml, respectively. PET/CT was negative for recurrence in 40 patients (40.0%), whose mean CEA and CA 19.9 values were 10.15±30 ng/ml and 67.76±190 U/ml, respectively. On the basis of ROC curve analysis, the best compromise between sensitivity and specificity was achieved for CEA levels of 3.5 ng/ml [sensitivity, 80%; 95% confidence interval (CI), 67.89%; and specificity, 60%; 95% CI, 45.78%]. The study concluded that the detection of recurrence by 18F.FDG PET/CT in patients treated for CRC is associated with CEA, but not CA 19.9 serum levels. Moreover, 18F.FDG PET/CT should be recommended in patients with suspected CRC recurrence even when they present with CEA levels below the normal cut.off.

Original languageEnglish
Pages (from-to)4209-4213
Number of pages5
JournalOncology Letters
Volume12
Issue number5
DOIs
Publication statusPublished - Nov 1 2016

Keywords

  • Carbohydrate antigen 19-9
  • Carcinoembryonic antigen
  • Colorectal cancer
  • Positron emission tomography
  • Recurrence

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Chiaravalloti, A., Fiorentini, A., Palombo, E., Rinino, D., Lacanfora, A., Danieli, R., Di Russo, C., Di Biagio, D., Squillaci, E., & Schillaci, O. (2016). Evaluation of recurrent disease in the re-staging of colorectal cancer by 18F-FDG PET/CT: Use of CEA and CA 19-9 in patient selection. Oncology Letters, 12(5), 4209-4213. https://doi.org/10.3892/ol.2016.5143