|
1
|
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. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
|
2
|
ÇINAR A, ALAGÖZ E, AYAN A, UÇGUN A. Kolorektal kanseri olan hastaların ameliyat sonrası klinik yönetiminde fluorine-18 fluorodeoxyglucose pozitron emisyon tomografisi/bilgisayarlı tomografi’nin tanısal önemi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.969726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Kolorektal kanser, erken tespitinde cerrahi kür sağlanabilen yaygın bir kanser türüdür. Bu kanser tipinde tedaviye yanıtın erken belirlenmesi yaşam süresini olumlu etkilemektedir. Çalışmamızda kolorektal kanseri olan hastaların, ameliyat sonrasındaki klinik yönetimlerinde F-18 FDG PET/BT’nin tanısal önemini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Haziran 2016 ve Ocak 2020 tarihleri arasında 168 hasta kolorektal kanser yönetimi amacıyla bölümümüze yönlendirilmiştir. Bu hastaların hepsi primer kolon tümörleri için ameliyat edilmişlerdi. Sistemik tedavi öncesinde ve sonrasında tedavi yanıtının değerlendirilmesi amacıyla bazal ve ardışık F-18 FDG PET/BT incelemesi yapılmıştır. F-18 FDG PET/BT taramaları sırasıyla analiz edilmiştir.
Bulgular: Hastalar primer tümör lokalizasyonlarına göre gruplandırıldı. Toplam 168 hastanın 55’inde sağ kolonda, 33’ünde sol kolonda, 14’ünde transvers kolonda, 61’inde rektosigmoid kolonda ve 5’inde çekumda primer tümör saptandı. Lokal rekürrens 57 hastada saptanmış olup 33’ü erkek (%57.9) ve 24’ü (%42.1) kadındı. Lokal rekürrense ait ortalama SUVmaks 8.97±3.42 g/ml olarak saptandı. Ek olarak çıkan kolon grubunda 2 hastada (%1.20) yeni tümöral odak gözlendi.
Sonuç: Kolorektal kanserli hastalarda, yapılabiliyorsa kolon rezeksiyonu tedavide ilk aşamadır. Küratif cerrahi sonrası ilk iki yıl içinde, hastaların yaklaşık %40’ında rekürrens görülebilmektedir. Rekürrensin erken tespiti, hastaların yaşam süresini iyileştirmektedir.
Collapse
Affiliation(s)
- Alev ÇINAR
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Engin ALAGÖZ
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Aslı AYAN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA GÜLHANE HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Aybüke UÇGUN
- University of Health Sciences, Gulhane Training & Research Hospital
| |
Collapse
|
|
3
|
Monteil J, Le Brun-Ly V, Cachin F, Zasadny X, Seitz JF, Mundler O, Selvy M, Smith D, Rullier E, Lavau-Denes S, Lades G, Labrunie A, Lecaille C, Valli N, Leobon S, Terrebonne E, Deluche E, Tubiana-Mathieu N. Comparison of 18FDG-PET/CT and conventional follow-up methods in colorectal cancer: A randomised prospective study. Dig Liver Dis 2021; 53:231-237. [PMID: 33153929 DOI: 10.1016/j.dld.2020.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A surveillance program was performed in colorectal cancer (CRC) patients after surgery, to diagnose asymptomatic recurrence. AIMS To assess whether 18-FDG positron emission tomography/CT (PET/CT) improved the detection of recurrence during a 3-year follow-up. METHODS A multicentre, two-arm randomised prospective trial comparing different 36-month follow-up strategies. Complete colonoscopy was performed at baseline and after 3 years and clinical exams with imaging every 3 months. The conventional arm (A) received carcinoembryonic antigen, liver echography, and alternated between lung radiography and computed tomography (CT) scans. The experimental arm (B) received PET/CT. RESULTS A total of 365 patients with colon (79.4%) or rectal cancer (20.6%), stages II (48.2%) or III (50.8%), were enroled in this study. At 36 months, intention-to-treat analysis revealed recurrence in 31 (17.2%) patients in arm A and 47 (25.4%) in arm B (p = 0.063). At 3 years, 7 of 31 relapses (22.5%) in arm A were surgically treated with curative intent, compared to 17 of 47 (36.2%) in arm B (p = 0.25). The rates of recurrence and new cancers were higher in arm B than arm A (p = 0.038). CONCLUSIONS PET/CT follow-up every 6 months did not increase the rate of recurrence at 3 years or the rate of surgically treated recurrence compared with conventional follow-up.
Collapse
Affiliation(s)
- Jacques Monteil
- Department of Nuclear Medicine, University Hospital, Limoges, France
| | | | - Florent Cachin
- Department of Nuclear Medicine, Jean Perrin Cancer Institute, Clermont-Ferrand, France
| | - Xavier Zasadny
- Department of Radiotherapy, François Chénieux Clinic, Limoges, France
| | - Jean-François Seitz
- Department of Oncology and Hepato-Gastroenterology, University Hospital La Timone, Marseille, France
| | - Olivier Mundler
- Department of Nuclear Medicine, University Hospital La Timone, Marseille, France
| | - Marie Selvy
- Department of Digestive Surgery and Oncology, Estaing Hospital, Clermont-Ferrand, France
| | - Denis Smith
- Department of Digestive Oncology, University Hospital Saint André, Bordeaux, France
| | - Eric Rullier
- Department of Digestive Surgery, University Hospital Saint André, Bordeaux, France
| | | | - Guillaume Lades
- Department of Nuclear Medicine, University Hospital, Limoges, France
| | - Anais Labrunie
- Department of Biostatistics and Clinical Research, University Hospital, Limoges, France
| | - Cedric Lecaille
- Department of Gastroenterology and Digestive Oncology, Bordeaux Nord Polyclinic, Bordeaux, France
| | - Nathalie Valli
- Department of Nuclear Medicine, Bordeaux Nord Polyclinic, Bordeaux, France
| | - Sophie Leobon
- Department of Medical Oncology, University Hospital, Limoges, France
| | - Eric Terrebonne
- Department of Gastroenterology and Digestive Oncology, University Hospital Haut-Lévêque, Bordeaux, France
| | - Elise Deluche
- Department of Medical Oncology, University Hospital, Limoges, France.
| | | |
Collapse
|
|
4
|
Ragheb SR, Sharara SM. Can PET/CT detect recurrence in post-operative colorectal carcinoma patients with elevated CEA level? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00170-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
PET is considered to be the most sensitive and specific modality for the detection of recurrent colorectal cancer. This study is to assess the role of F18-FDG PET/CT in post-operative assessment in a patient with colorectal cancer with elevated CEA level to rule out local recurrence and/or metastasis and hence guiding the clinician to the proper management strategy.
Results
This study was performed on 45 patients who underwent surgical resection of the colon and/or rectal cancer; they were referred for PET/CT assessment at least 3 months after surgical resection. F18-FDG PET/CT sensitivity and specificity in detecting the recurrence and/or metastasis were 96.9 % and 83.3%, respectively. The positive predictive value was 94.2% while the negative predictive value was 90%.
Conclusion
For post-operative detection of loco-regional recurrence and metastasis in patients with colorectal cancer and elevated CEA level, 18F-FDG PET/CT can be considered as an efficient diagnostic imaging tool due to its high sensitivity and specificity which extensively affect further management.
Collapse
|
|
5
|
Application and Indication of Carcinoembryonic Antigen Triggered 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Detection of Relapse of Colorectal Cancer Patients After Curative Therapy. J Comput Assist Tomogr 2017; 41:719-725. [PMID: 28481810 DOI: 10.1097/rct.0000000000000601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to explore the characteristics of patients with colorectal cancer (CRC) following curative therapy that may benefit from fluorine-18-2-uoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) scanning, evaluate the application of carcinoembryonic antigen (CEA)-triggered F-FDG PET/CT scanning, and provide referential indicators. METHODS This retrospective study included 56 CRC patients who received a PET/CT scan as a primary examination because of rising CEA levels after curative therapy and who had not received any other radiological examinations previously. RESULTS The rate of recurrence or metastasis was 75.0% by PET/CT scan but was 69.6% with follow-up treatment. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 94.9%, 70.6%, 87.5%, 88.1%, and 85.7%, respectively. TNM (tumor, node, metastasis) stage, body mass index, and CEA level were significant prognostic factors. CONCLUSIONS Positron emission tomography/CT can be selectively applied as a primary examination in CRC patients with asymptomatic elevation of CEA. High CEA levels, increased body mass index, and advanced TNM staging are risk factors for relapse.
Collapse
|
|
6
|
Vallam KC, Guruchannabasavaiah B, Agrawal A, Rangarajan V, Ostwal V, Engineer R, Saklani A. Carcinoembryonic antigen directed PET-CECT scanning for postoperative surveillance of colorectal cancer. Colorectal Dis 2017; 19:907-911. [PMID: 28444968 DOI: 10.1111/codi.13695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/13/2017] [Indexed: 12/23/2022]
Abstract
AIM During the follow-up of surgically resected colorectal cancer (CRC), positron emission tomography-contrast-enhanced computed tomography (PET-CECT) is indicated for asymptomatic elevation of carcinoembryonic antigen (CEA) > 5 ng/ml and no obvious site of recurrence on clinical examination and basic imaging. As an institutional policy, a PET-CECT scan was performed at our institute whenever (1) CEA levels rose above 5 ng/ml and (2) CEA values were doubled (even if the CEA level was < 5 ng/ml). Our aim was to correlate the range of CEA elevation with recurrence rates and to evaluate the diagnostic utility of PET-CECT scanning in this setting. METHOD We retrospectively analysed all cases where a PET-CECT scan was performed for elevated CEA levels during surveillance visits after complete resection of the primary tumour followed by adjuvant therapy. This study was conducted from 1 January 2013 to 31 July 2015. RESULTS In all, 104 patients underwent a PET-CECT scan for rising CEA values, and 62 patients (59.6%) were found to have recurrent disease. At CEA levels < 5, 5.1-10, 10.1-15, 15.1-50 and > 50 ng/ml, disease recurred in 10%, 45%, 70%, 94% and 100% patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of the PET-CECT scan were 92.7%, 95.2%, 96.2% and 90.9%, respectively. Elevation of CEA levels during follow-up was indicative of recurrence in 68% of the secretors and 45% of the non-secretors (based on baseline CEA status). CONCLUSION In the setting of rising CEA levels during follow-up of patients with CRC, a PET-CECT scan is a valuable tool to detect recurrence, irrespective of the baseline CEA secretor status. The likelihood of recurrence of disease was directly proportional to the value of the raised CEA level.
Collapse
Affiliation(s)
- K C Vallam
- Department of Surgical Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, India
| | - B Guruchannabasavaiah
- Department of Surgical Oncology, Caritas Cancer Institute, Thellakom, Kottayam, Kerala, India
| | - A Agrawal
- Department of Nuclear Medicine, Tata Memorial Centre, Parel, Mumbai, India
| | - V Rangarajan
- Department of Nuclear Medicine, Tata Memorial Centre, Parel, Mumbai, India
| | - V Ostwal
- Department of Medical Oncology, Tata Memorial Centre, Parel, Mumbai, India
| | - R Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India
| | - A Saklani
- Department of GI Oncology, Tata Memorial Centre, Parel, Mumbai, India
| |
Collapse
|
|
7
|
Role of Positron Emission Tomography/Computed Tomography. Updates Surg 2016. [DOI: 10.1007/978-88-470-5767-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
8
|
Petrillo A, Fusco R, Catalano O. Imaging Modalities. Updates Surg 2016. [DOI: 10.1007/978-88-470-5767-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
|
9
|
A General Cutoff Level Combined With Personalized Dynamic Change of Serum Carcinoembryonic Antigen Can Suggest Timely Use of FDG PET for Early Detection of Recurrent Colorectal Cancer. Clin Nucl Med 2015. [DOI: 10.1097/rlu.0000000000000900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
|
10
|
Gade M, Kubik M, Fisker RV, Thorlacius-Ussing O, Petersen LJ. Diagnostic value of (18)F-FDG PET/CT as first choice in the detection of recurrent colorectal cancer due to rising CEA. Cancer Imaging 2015; 15:11. [PMID: 26263901 PMCID: PMC4534082 DOI: 10.1186/s40644-015-0048-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/06/2015] [Indexed: 02/08/2023] Open
Abstract
Background The diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) as the first imaging approach in the evaluation of rising carcinoembryonic antigen (CEA) is not clear. The objective of this study was to investigate the value of 18F-FDG PET/CT in patients with colorectal cancer (CRC) and suspected recurrence based on rising CEA. Methods A total of 73 patients with CRC were referred to PET/CT after radical surgery. Generally, all patients were scheduled to follow a CT-based post-surgical follow-up regimen. In the case of rising CEA, 18F-FDG PET/CT was performed in most patients with contrast-enhanced CT. The PET/CT images were independently reviewed by two readers. The presence or absence of recurrence was based on histology and/or standardized clinical follow-up. Results Among 35 patients who had confirmed recurrence of CRC, PET/CT demonstrated recurrence with a sensitivity of 85.7 %, a specificity of 94.7 %, a positive predictive value of 93.8 %, and a negative predictive value of 87.8 %. The SUVmax ranged from 1.3 to 19.9. The mean time since the last postoperative imaging and PET/CT was 8 months (median 4 months). CEA values at referral ranged from 1.5 to 164.0 μg/L (median 5.6 μg/L). The diagnostic properties of PET/CT were analyzed in subgroups of patients with a single rising CEA sample (30 patients, 41 %), 31 patients (43 %) with two or more consecutive increases, and 12 patients (16 %) with persistently elevated values. Conclusions 18F-FDG PET/contrast-enhanced CT has high diagnostic accuracy in the diagnosis of recurrent CRC, even in patients in a conventional CT-based follow-up program.
Collapse
Affiliation(s)
- Michael Gade
- The Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
| | - Magdalena Kubik
- The Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.
| | - Rune V Fisker
- The Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark. .,The Department of Radiology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
| | - Ole Thorlacius-Ussing
- The Department of Gastrointestinal Surgery, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark. .,The Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Lars J Petersen
- The Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark. .,The Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
|
11
|
Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve JL, Mitry E, Alberini JL, Lièvre A. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis 2015; 47:443-54. [PMID: 25766918 DOI: 10.1016/j.dld.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/11/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a routine imaging modality for many malignancies and its use is currently increasing. In the present review article, we will summarize the evidence for FDG-PET/CT use in digestive cancers (excluding neuroendocrine tumours), and review the existing recommendations. While PET/CT is nowadays considered to be an important tool in the initial workup of oesophageal and anal cancers, new data are emerging regarding its use in assessing therapeutic efficacy, radiotherapy treatment planning, and detection of recurrence in case of isolated tumour marker elevation. Moreover, PET/CT may help decision making by detecting distant metastatic sites especially in potentially resectable metastatic colorectal cancer and, to a lesser extent, in localized gastric and pancreatic cancers. Finally, incidental focal colonic FDG uptakes require exploration by colonoscopy, as they are often associated with premalignant or malignant lesions.
Collapse
Affiliation(s)
- Mathieu Gauthé
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France.
| | - Marion Richard-Molard
- Institut Curie, René Huguenin Hospital, Department of Radiation Therapy, Saint-Cloud, France
| | - Wulfran Cacheux
- Institut Curie, Department of Medical Oncology, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, France; University of Rouen, Rouen, France
| | - Jean-Louis Jouve
- Department of Gastroenterology, Dijon University Hospital, University of Burgundy, INSERM U866, Dijon, France
| | - Emmanuel Mitry
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Jean-Louis Alberini
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Astrid Lièvre
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| |
Collapse
|
|
12
|
Abstract
OBJECTIVE CT remains the imaging modality of choice in the diagnosis of colorectal cancer (CRC) and anal cancer. However, advances in imaging have expanded the role of MRI and PET/CT. This article focuses on the evolving role of FDG PET/CT in the diagnosis, radiation therapy planning, therapy assessment, and posttherapy monitoring of CRC and anal cancer. CONCLUSION FDG PET/CT is a valuable imaging modality that impacts the clinical management of patients with CRC and those with anal cancer.
Collapse
|
|
13
|
Jafferbhoy S, Chambers A, Mander J, Paterson H. Selective Use of (18)F-Fluorodeoxyglucose-Positron Emission Tomography and Computed Tomography in the Management of Metastatic Disease from Colorectal Cancer: Results from a regional centre. Sultan Qaboos Univ Med J 2015; 15:e52-e57. [PMID: 25685386 PMCID: PMC4318607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 06/28/2014] [Accepted: 07/10/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Computed tomography (CT) scans are routinely used for primary staging and disease surveillance in patients with colorectal cancer. However, these scans have limited sensitivity in some organs and can only detect lesions with morphological changes, whereas (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) scans are able to detect areas of metabolic change before morphological changes appear. The aim of this study was to evaluate the impact of (18)F-FDG-PET/CT scans over conventional imaging during preoperative work-ups or follow-ups in a selected group of patients. METHODS This retrospective cohort study, which took place between July 2009 and May 2011, assessed 1,043 patient records from the South East Scotland Cancer Network colorectal cancer database. A total of 102 patients who underwent (18)F-FDG-PET/CT scans in addition to conventional imaging were included in the study. These patients had potentially resectable metastases, equivocal findings on CT scans and elevated carcinoembryonic antigen levels with negative conventional imaging. RESULTS Of the 102 patients included in the study, 22 underwent a preoperative (18)F-FDG-PET/CT scan and 80 underwent a follow-up 18F-FDG-PET/CT scan. In the preoperative scan group, the (18)F-FDG-PET/CT scan had a major impact on 16 patients (72.75%) and no impact on six patients (27.25%). In the follow-up scan group, the (18)F-FDG-PET/CT scan had a major impact on 51 (63.75%), a minor impact on four (5%), no impact on 22 (27.5%) and a negative impact on three (3.75%) patients. CONCLUSION The results of this study demonstrated that (18)F-FDG-PET/CT scans have a considerable effect on disease management when undertaken among indicated colorectal cancer patients.
Collapse
|
|
14
|
18 F-FDG PET/contrast enhanced CT in the standard surveillance of high risk colorectal cancer patients. Eur J Radiol 2014; 83:2224-2230. [DOI: 10.1016/j.ejrad.2014.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/16/2014] [Accepted: 08/27/2014] [Indexed: 12/16/2022]
|
|
15
|
Dogan I, Karyagar S, Karyagar SS, Kahraman C, Alver A. Relationship between pretreatment levels of serum Cyfra 21.1, CEA and PET metabolic parameters in NSCLC. Ann Nucl Med 2014; 28:829-35. [PMID: 24990528 DOI: 10.1007/s12149-014-0877-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE No investigation has been conducted on the association between PET findings and serum Cyfra 21.1 and CEA levels in nonsmall cell lung cancers (NSCLC). The purpose of this study is to find out if the serum levels of Cyfra 21.1 and CEA are related to metabolic parameters by FDG PET in patients with NSCLC who had not received treatment. METHODS Seventy-six NSCLC patients, who were admitted for initial staging by FDG PET/CT, were included in the study. Serum Cyfra 21.1 and CEA levels were assayed by enzyme-linked immunosorbent assay. FDG-PET images were analyzed with visual and quantitative methods. Standard uptake values (SUV), metabolic tumor volumes (MTV) and total lesion glycolysis were calculated for primary lesion (T) and whole-body lesions (primary and metastatic) (WB). RESULTS Serum Cyfra 21.1 and CEA level was significantly higher in patients with locoregionally advanced disease (p < 0.05, p < 0.05, respectively) and metastatic disease (p < 0.01, p < 0.05, respectively) compared to those with localized disease. The serum ln-Cyfra-21.1 was significantly correlated with all volumetric tumor parameters (p < 0.001) and slightly with ln-SUVmean.WB (p < 0.05). There was no relationship between CEA levels and any PET metabolic parameters (p > 0.05). In multiple linear regression analysis incorporating ln-MTV.WB and ln-SUVmean.WB as independents, ln-MTV.WB correlated significantly and positively with ln-Cyfra-21.1 (β = 0.744, p < 0.001), whereas ln-SUVmean.WB did not significantly predict ln-Cyfra-21.1 (β = 0.019, p > 0.05). CONCLUSION This study demonstrates the existence of a significant relationship between total tumor burden and the serum Cyfra 21.1 level in NSCLC patients who had not received treatment. However, it requires further confirmation in operated NSCLC patients.
Collapse
Affiliation(s)
- Ismail Dogan
- Department of Nuclear Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey,
| | | | | | | | | |
Collapse
|
|
16
|
Zhang Y, Feng B, Zhang GL, Hu M, Fu Z, Zhao F, Zhang XL, Kong L, Yu JM. Value of 18F-FDG PET-CT in surveillance of postoperative colorectal cancer patients with various carcinoembryonic antigen concentrations. World J Gastroenterol 2014; 20:6608-6614. [PMID: 24914384 PMCID: PMC4047348 DOI: 10.3748/wjg.v20.i21.6608] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/20/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the value of positron emission tomography (PET)/computerized tomography (CT) in surveillance of colorectal cancer (CRC) patients with different carcinoembryonic antigen (CEA) concentrations.
METHODS: One hundred and six postoperative CRC patients who had suspected recurrence or metastasis and received fluorodeoxyglucose (FDG) PET/CT within one week were included in this study. The final diagnosis was confirmed by histological examination or clinical follow-up over at least six months.
RESULTS: The sensitivity, specificity, and accuracy of FDG PET/CT were 95.2%, 82.6%, and 92.5%, and 94.8%, 81.4% and 92.8%, respectively, in the case- and lesion-based analyses. The sensitivity and accuracy of FDG PET/CT significantly differed from CT in both analyses (χ2 = 8.186, P = 0.004; χ2 =6.201, P = 0.013; χ2 =13.445, P = 0.000; χ2 =11.194, P = 0.001). In the lesion-based analysis, the sensitivity, specificity, and accuracy of FDG PET/CT in the abnormal CEA group were 97.8%, 82.6%, and 95.6%, compared with 81.3%, 80%, and 80.6% for patients with normal CEA levels. In case-based analysis, the sensitivity, specificity, and accuracy of FDG PET/CT were 97.2%, 77.8%, and 95% in abnormal CEA group. Only in lesion-based analysis, the sensitivity and accuracy of FDG PET/CT in the abnormal CEA group were significantly superior to those in the normal CEA group (χ2 =6.432, P = 0.011; χ2 =7.837, P = 0.005). FDG PET/CT changed the management in 45.8% of patients with positive scans.
CONCLUSION: FDG PET/CT showed superior diagnostic value and is an advisable option in surveillance of postoperative CRC patients with a vague diagnosis.
Collapse
|
|
17
|
Does CEA and CA 19-9 combined increase the likelihood of 18F-FDG in detecting recurrence in colorectal patients with negative CeCT? Nucl Med Commun 2014; 35:598-605. [DOI: 10.1097/mnm.0000000000000107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
18
|
F-18 FDG PET/CT in the assessment of patients with unexplained CEA rise after surgical curative resection for colorectal cancer. Int J Colorectal Dis 2013; 28:1699-705. [PMID: 23846517 DOI: 10.1007/s00384-013-1747-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE We evaluated the role of quantitative assessment by maximum standardized uptake value (SUVmax) on F-18 fluorodeoxyglucose [F-18]FDG positron emission tomography/computed tomography (PET/CT) in stratifying colorectal cancer (CRC) patients with unexplained carcinoembryonic antigen (CEA) rise after surgical curative resection. MATERIAL AND METHODS Forty asymptomatic patients (mean age, 64 ± 12 years) with previous CRC and current serum CEA levels >5 ng/ml underwent [F-18] FDG PET/CT 13 ± 3 months after complete surgical resection. The SUVmax was registered on anastomosis and peri-anastomotic tissue lesions, if present. The patients were followed for 24 ± 9 months thereafter. Re-intervention, evidence of newly discovered distant metastases, and death were recognized as main events and constituted surrogate end points. The receiver-operator-curve (ROC) analysis was performed to estimate the optimal SUVmax cut-off to predict patients at high risk of main events. PET/CT results were then related to disease outcome (overall survival; OS). RESULTS The mean SUVmax at the anastomotic site was 6.2 ± 3 (range 2.6-15). At multivariate logistic regression analysis, the anastomotic SUVmax remained as the only significant contributor to the prediction of the events (p = 0.004; OR 1.97). The ROC analysis recognized that the optimal threshold of SUVmax to differentiate patients was 5.7. A worse OS was observed in patients presenting with a SUVmax greater than 5.7 as compared to those having lesser (median survival: 16 vs. 31 months; p = 0.002). CONCLUSIONS The quantitative assessment by SUVmax on [F-18]FDG PET/CT may be helpful in patients presenting with unexplained CEA rise after curative resection of CRC, by identifying those at risk of main events.
Collapse
|
|
19
|
Lu YY, Chen JH, Chien CR, Chen WTL, Tsai SC, Lin WY, Kao CH. Use of FDG-PET or PET/CT to detect recurrent colorectal cancer in patients with elevated CEA: a systematic review and meta-analysis. Int J Colorectal Dis 2013; 28:1039-47. [PMID: 23407908 DOI: 10.1007/s00384-013-1659-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2013] [Indexed: 02/04/2023]
Abstract
AIM The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to assess the diagnostic performance of FDG-PET or PET/CT in the detection of recurrent colorectal cancer (CRC) rising in patients with elevated CEA. MATERIALS AND METHODS The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity and specificity and positive and negative likelihood ratios, and summary receiver-operating characteristic curves in the detection of recurrent CRC in patients with elevated CEA. RESULTS Eleven studies with a total of 510 patients met the inclusion criteria. One hundred and six patients (106/510 = 20.8%) had true-negative FDG-PET (PET/CT) results in detection of recurrent CRC when rising CEA. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET in the detection of tumor recurrence in CRC patients with elevated CEA were 90.3% (95% CI, 85.5-94.0%), 80.0% (95% CI, 67.0-89.6%), 2.88 (95% CI, 1.37-6.07), and 0.12 (95% CI, 0.07-0.20), respectively. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET/CT in the detection of tumor recurrence in CRC patients with elevated CEA were 94.1% (95% CI, 89.4-97.1%), 77.2% (95% CI, 66.4-85.9%), 4.70 (95% CI, 0.82-12.13), and 0.06 (95% CI, 0.03-0.13), respectively. CONCLUSIONS Whole-body FDG-PET and PET/CT are valuable imaging tools for the assessment of patients with suspected CRC tumor recurrence based on the increase of CEA.
Collapse
Affiliation(s)
- Yu-Yu Lu
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | | | | | | |
Collapse
|
|
20
|
Peng NJ, Hu C, King TM, Chiu YL, Wang JH, Liu RS. Detection of resectable recurrences in colorectal cancer patients with 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography. Cancer Biother Radiopharm 2013; 28:479-87. [PMID: 23713869 PMCID: PMC3715809 DOI: 10.1089/cbr.2012.1382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the usefulness of 2-[(18)F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the early detection of resectable recurrences of colorectal cancer (CRC) and the impacts on the clinical disease management. METHODS FDG-PET/CT was performed on patients with elevated serum carcinoembryonic antigen (CEA) levels >5 ng/mL (Group 1) or suspicious recurrences without rise in serum CEA levels (Group 2). The results were analyzed on the basis of histological data, disease progression, and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 6 months of the FDG-PET/CT scan. Resectable recurrences and changes in management were calculated based on medical records. RESULTS In our study, 128 consecutive FDG-PET/CT analyses (n=49 in Group 1 and n=79 in Group 2) were performed on 96 recruited patients. Recurrences were proven in 63. The overall sensitivity, specificity, and accuracy of FDG-PET/CT were 98.4%, 89.2%, and 93.8%, respectively, and were 100%, 88.9%, and 95.9% in Group 1 and 96.9% and 89.4% and 92.4% in Group 2, respectively. Surgical resections were performed in 38.7% (12/31) of Group 1 patients and 53.1% (17/32) of Group 2 patients. FDG-PET/CT induced changes in planned management in 48.4% (62/128) of all patients, which included 63.3% (31/49) of Group 1 patients and 39.2% (31/79) of Group 2 patients (p=0.008). After a follow-up, 3.4% (1/29) of patients who underwent surgical resection of recurrent lesions and 34.3% (11/34) patients who did not undergo resection died at the end of study (p=0.004). CONCLUSIONS The surgical resection of limited recurrent disease, as determined by FDG-PET/CT, improves the survival of CRC patients. FDG-PET/CT should be performed not only in patients with elevated serum CEA levels, but also in those in whom recurrences are suspected to improve the early detection of resectable disease.
Collapse
Affiliation(s)
- Nan-Jing Peng
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
| | | | | | | | | | | |
Collapse
|
|
21
|
Amin A, Reddy A, Wilson R, Jha M, Miranda S, Amin J. Unnecessary surgery can be avoided by judicious use of PET/CT scanning in colorectal cancer patients. J Gastrointest Cancer 2013; 43:594-8. [PMID: 22552946 DOI: 10.1007/s12029-012-9391-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM This study aims to determine the role of positron emission tomography (PET)/computed tomography (CT) in changing the management plan in patients with metastatic or recurrent colorectal cancer (CRC) and to evaluate the role of PET/CT in patients with an unexplained rise in carcinoembryonic antigen (CEA). MATERIALS AND METHODS A total of 60 consecutive patients with CRC, who had PET/CT, were identified between 2008 and 2010. All patients had CT scans prior to the PET/CT. Data were collected from clinic letters, CT and PET CT reports and pathology results and cross-checked with the patient's notes. RESULTS Patients were aged between 43 and 85 years [33 males, 27 females]. CEA was raised in 37 patients and normal in 23. Results of PET/CT were compared with that of CT scan and 33 out of the 60 patients (55%) had PET/CT results which were different to that of CT scan and 27 patients (45%) had similar PET/CT and CT results. PET scan appropriately altered the management in 23/60 patients (38%) and avoided unnecessary surgery in 14 patients. PET/CT had a sensitivity of 86% and specificity of 84%. In patients with an unexplained rise in CEA, PET/CT was positive in only one out of ten (10%) patients. CONCLUSION PET/CT is valuable in deciding the management outcome in patients with metastatic or recurrent colorectal cancer. Unnecessary surgery might be avoided by careful use of PET/CT scanning in colorectal cancer patients. PET/CT might not be of value in patients with an unexplained rise in CEA.
Collapse
|
|
22
|
Culverwell AD, Chowdhury FU, Scarsbrook AF. Optimizing the role of FDG PET-CT for potentially operable metastatic colorectal cancer. ACTA ACUST UNITED AC 2013; 37:1021-31. [PMID: 22371087 DOI: 10.1007/s00261-012-9855-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent treatment advances now allow a realistic chance of cure in selected patients with metastatic colorectal carcinoma (CRC). Accurate pre-treatment staging is crucial to ensure appropriate management by identification of patients with more advanced disease who will not benefit from surgery. (18)Fluorine 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography (PET-CT) has a firmly established role in staging, restaging, and recurrence detection of a range of tumors. This article will review the role of PET-CT in patients with CRC with a particular emphasis on optimizing the technique in patients with potentially operable metastatic disease.
Collapse
Affiliation(s)
- A D Culverwell
- Department of Clinical Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | |
Collapse
|
|
23
|
Ozkan E, Soydal C, Araz M, Aras G. Serum carcinoembryonic antigen measurement, abdominal contrast-enhanced computed tomography, and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of colorectal cancer recurrence: a correlative study. Nucl Med Commun 2012; 33:990-4. [PMID: 22842225 DOI: 10.1097/mnm.0b013e32835632ad] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the correlative role of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in carcinoembryonic antigen (CEA) measurement and contrast-enhanced abdominal computed tomography (ceCT) in the detection of colorectal cancer (CRC) recurrence. MATERIALS AND METHODS A total of 96 patients (40 female, 56 male; mean age, 60.6 ± 12 years) with a previous diagnosis of CRC underwent 18F-FDG PET/CT on suspicion of recurrence and were evaluated retrospectively. Inclusion criteria were accepted as the presence of increased serum CEA levels or positive findings on abdominal ceCT or both. 18F-FDG PET/CT findings were compared with histopathological findings and/or clinical follow-up data as the gold standard. Patients were divided into three groups: group 1, with increased CEA levels and normal abdominal ceCT; group 2, with normal CEA levels and positive ceCT; and group 3, with increased CEA levels and positive ceCT. RESULTS Whereas sensitivities of CEA, ceCT, and 18F-FDG PET/CT in the three patient groups were calculated as 91, 67, and 96%, specificities were 13, 51, and 62%, respectively. There were 35, 14, and 46 patients in groups 1, 2, and 3, respectively. In separate analyses conducted on the groups, sensitivity of 18F-FDG PET/CT was computed as 100 and 100% and specificity as 88 and 80% for groups 1 and 2. In group 3, which comprised four patients with secondary malignancies, sensitivity and specificity of 18F-FDG PET/CT were 94 and 16%, respectively. CONCLUSION 18F-FDG PET/CT has an additional role in the detection of CRC recurrence with a higher sensitivity compared with CEA and ceCT alone, and 18F-FDG PET/CT is especially more successful in patients with isolated elevated CEA levels or positive ceCT findings without accompanying CEA elevation.
Collapse
Affiliation(s)
- Elgin Ozkan
- Department of Nuclear Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | | | | |
Collapse
|
|
24
|
Liong SY, Kochhar R, Renehan AG, Manoharan P. Utility of 18-fluorodeoxyglucose positron emission/computed tomography in the management of recurrent colorectal cancer. ANZ J Surg 2012; 82:729-36. [DOI: 10.1111/j.1445-2197.2012.06237.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Sue Y. Liong
- Department of Clinical Radiology; The Christie; Manchester; UK
| | - Rohit Kochhar
- Department of Clinical Radiology; The Christie; Manchester; UK
| | | | | |
Collapse
|
|
25
|
Utility of low dose 18F-FDG PET-CT in patients with suspected colorectal carcinoma recurrence using conventional diagnostic methods. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2012.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
|
26
|
Laparoscopic Diagnosis and Laparoscopic Hyperthermic Intraoperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei Detected by CT Examination. Gastroenterol Res Pract 2012; 2012:741202. [PMID: 22956941 PMCID: PMC3432358 DOI: 10.1155/2012/741202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/10/2012] [Accepted: 05/18/2012] [Indexed: 11/24/2022] Open
Abstract
Background. Patients with early stage of pseudomyxoma peritonei (PMP) are sometimes difficult to diagnose the primary sites and intraperitoneal spread of tumor and to perform a cytological study. Methods. Patients without a definitive diagnosis and with unknown extent of peritoneal spread of tumor underwent laparoscopy. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) was administered as part of the same intervention. The results of treatment were evaluated at the time of second-look laparotomy (SLL) as a subsequent intervention. Results. Eleven patients were managed by diagnostic laparoscopy followed by laparoscopic HIPEC (LHIPEC). The operation time of laparoscopic examination and LHIPEC was 177 ± 26 min (range 124–261 min). No intraoperative complication was experienced. The peritoneal carcinomatosis index (PCI) score by laparoscopic observation was 16.5 ± 6.4 (range 0–30). One patient with localized pseudomyxoma peritonei (PMP) mucocele did not received LHIPEC; the other 10 patients with peritoneal metastases (PM) were treated with LHIPEC. After LHIPEC, ascites disappeared in 2 cases and decreased in the amount in the other 8 cases. Nine patients underwent SLL and cytoreductive surgery (CRS) combined with HIPEC. The duration between LHIPEC and SLL ranged from 40 to 207 days (97 ± 40 days). The PCI at the SLL ranged from 4 to 27 (12.9 ± 7.1). The PCI at the time of SLL decreased as compared to PCI at the time of diagnostic laparotomy in 7 of 9 patients. Median follow-up period is 22 months (range 7–35). All 11 patients are alive. Conclusion. The early results suggest that laparoscopic diagnosis combined with LHIPEC is useful to determine the surgical treatment plan and reduce the tumor burden before definitive CRS at SLL.
Collapse
|
|
27
|
Choi EK, Yoo IR, Park HL, Choi HS, Han EJ, Kim SH, Chung SK, O JH. Value of Surveillance (18)F-FDG PET/CT in Colorectal Cancer: Comparison with Conventional Imaging Studies. Nucl Med Mol Imaging 2012; 46:189-95. [PMID: 24900059 DOI: 10.1007/s13139-012-0145-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the value of PET/CT for detecting local or distant recurrence in patients who undergo surgery for colorectal cancer (CRC) and to compare the accuracy of PET/CT to that of conventional imaging studies (CIS). METHODS Tumor surveillance PET/CT scans done between March 2005 and December 2009 of disease-free patients after surgery with or without adjuvant chemotherapy for CRC were retrospectively studied. CIS (serial enhanced CT from lung base to pelvis and plain chest radiograph) were performed within 1 month of PET/CT. We excluded patients with distant metastasis on initial staging, a known recurrent tumor, and a lack of follow-up imaging. The final diagnosis was based on at least 6 months of follow-up with colonoscopy, biopsy, and serial imaging studies in combination with carcinoembryonic antigen levels. RESULTS A total of 262 PET/CT scans of 245 patients were included. Local and distant recurrences were detected in 27 cases (10.3%). On case-based analysis, the overall sensitivity, specificity, and accuracy were 100, 97.0, and 97.3% for PET/CT and 85.1, 97.0, and 95.8% for CIS, respectively. On lesion-based analysis, PET/CT detected more lesions compared to CIS in local recurrence and lung metastasis. PET/CT and CIS detected the same number of lesions in abdominal lymph nodes, hepatic metastasis, and peritoneal carcinomatosis. PET/CT detected two more metachronous tumors than did CIS in the lung and thyroid gland. CONCLUSION PET/CT detected more recurrences in patients who underwent surgery for CRC than did CIS and had the additional advantage of evaluating the entire body during a single scan.
Collapse
Affiliation(s)
- Eun Kyoung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ie Ryung Yoo
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ; Department of Nuclear Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seochogu Banpodong 505, Seoul, 137-701 Korea
| | - Hye Lim Park
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Su Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ji Han
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoon Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Kyo Chung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun O
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
|
28
|
The role of 18F-FDG PET/CT in detecting colorectal cancer recurrence in patients with elevated CEA levels. Nucl Med Commun 2012; 33:395-402. [PMID: 22367859 DOI: 10.1097/mnm.0b013e32834f7dbe] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In this study we aimed to define the success of fluorine-18 (18F) fluorodeoxyglucose (FDG) PET/computed tomography (PET/CT) in detecting recurrent disease in our patient group with colorectal cancer (CRC) and elevated carcinoembryonic antigen (CEA) levels. MATERIAL AND METHOD Patients who had a previous diagnosis of CRC were searched retrospectively in our PET center database. Seventy-six 18F-FDG PET/CT studies between October 2006 and December 2010 of 69 patients (25 women, 44 men; mean age: 61.61 ± 4.1 years) with elevated CEA levels were evaluated. 18F-FDG PET/CT findings and concurrent abdominopelvic contrast-enhanced computed tomography (ceCT) findings were compared with histopathological findings and/or clinical follow-up data as the 'gold standard'. RESULTS In the patient-based analysis, the sensitivity and specificity of 18F-FDG PET/CT in the detection of disease recurrence were calculated as 97 and 61%, respectively. A statistically significant difference was found in frequencies of positive and negative 18F-FDG PET/CT findings between patients with or without recurrent disease by gold standard (P<0.05). There was no correlation between patients' serum CEA levels and lesions' maximum standardized uptake values (P=0.85). The sensitivity and specificity of ceCT were computed as 51 and 60%, respectively. In the evaluation of separate patient groups, although the sensitivity and specificity of 18F-FDG PET/CT were calculated as 100 and 60% in the group whose CEA level elevation was less than two-fold (5-9.9 ng/ml), these were 100 and 75% in the group with CEA elevation less than three-fold (10-14.9 ng/ml) and 95 and 62% in the group with elevation more than three-fold (≥ 15 ng/ml). The sensitivity and specificity of 18F-FDG PET/CT were computed as 98 and 85% in the lesion-based evaluation. The sensitivity and specificity of ceCT were 73 and 86%, respectively. CONCLUSION 18F-FDG PET/CT is a safe imaging method that can be used in the determination of CRC recurrence in patients with elevated CEA levels, regardless of the CEA level.
Collapse
|
|
29
|
Taha Ali TF. Usefulness of PET–CT in the assessment of suspected recurrent colorectal carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
|
|
30
|
Sanli Y, Kuyumcu S, Ozkan ZG, Kilic L, Balik E, Turkmen C, Has D, Isik G, Asoglu O, Kapran Y, Adalet I. The utility of FDG-PET/CT as an effective tool for detecting recurrent colorectal cancer regardless of serum CEA levels. Ann Nucl Med 2012; 26:551-8. [PMID: 22644560 DOI: 10.1007/s12149-012-0609-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/01/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE Tumor recurrence of colorectal cancers (CRC) is generally followed up by analyses of the serum carcinoembryonic antigen (CEA) levels. However, recent evidence suggests that tumor recurrence can also be visualized by 18F-fluoro-deoxyglucose emission tomography/computed tomography (FDG-PET/CT) in patients with normal CEA levels. We retrospectively evaluated the diagnostic performance of FDG-PET/CT in patients with suspected recurrence of CRC by comparing PET/CT performance in patients with normal CEA levels with PET/CT performance in patients with elevated CEA levels. METHODS A total of 235 patients with CRC who had been treated with surgery and/or chemotherapy/radiotherapy underwent PET/CT for the detection of tumor recurrence. The patients [96 females and 139 males; age (mean ± SD) 59.9 ± 12.6 years; range 18-85] were divided into 2 groups based on whether their CEA levels were normal (<5 ng/ml) (Group 1, n = 118) or elevated (>5 ng/ml) (Group 2, n = 117). All of the patients had suspected recurrence based on raised CEA levels, clinical symptoms, and/or tumor detection using other imaging modalities. RESULTS Of the 235 patients, 172 (73.1 %) had disease recurrence confirmed by a pathological examination (either biopsy or surgical exploration) or clinical follow-up studies. The FDG-PET/CT study yielded a true positive in detecting recurrence in 169 (71.9 %) patients, a true negative in 53 (22.5 %) patients, a false negative in 3 (1.2 %) patients and a false positive in 10 (4.2 %) patients. CRC recurrence was detected in 64.4 % (76/118) and 88 % (103/117) patients in Group 1 and Group 2 with FDG-PET/CT, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the FDG-PET/CT study for establishing recurrence were 100, 84, 89.4, 100 and 93.2 %, respectively, for Group 1; by contrast, these parameters were 97.1, 84.6, 98, 78.5 and 95.7 %, respectively, for Group 2. The number of patients with hepatic and extra-hepatic metastases, such as lung and abdominal lymph node metastasis, detected with FDG-PET/CT was significantly different in Group 1 than in Group 2; however, the number of patients with local recurrence and peritoneal implants detected with FDG-PET/CT was not different between the two groups. CONCLUSIONS FDG-PET/CT can accurately detect tumor recurrence in patients with suspected recurrent CRC, even for patients with normal CEA levels.
Collapse
Affiliation(s)
- Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
31
|
Ochoa-Figueroa MA, Uña-Gorospe J, Allende-Riera A, Cárdenas-Negro JC, Muñoz-Iglesias J, Cabello-García D, De Sequera-Rahola M, Martínez-Gimeno E. Utility of low dose (18)F-FDG PET-CT in patients with suspected colorectal carcinoma recurrence in conventional diagnostic methods. Rev Esp Med Nucl Imagen Mol 2011; 31:249-56. [PMID: 23067526 DOI: 10.1016/j.remn.2011.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 09/18/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy of (18)F-FDG PET-CT in the diagnosis of recurrence of colorectal cancer (CRC) in patients with elevated values of carcinoembryonic antigen (CEA) and/or signs of recurrence in the multidetector CT (MDCT), and to demonstrate that good results can be obtained applying the ALARA principles. MATERIAL AND METHODS A retrospective study of 54 patients with suspected CRC, who underwent an (18)F-FDG PET-CT, administering a mean dose of 222 MBq (6 mCi) of (18)F-FDG, from 07/2007 to 01/2011 was carried out. Seven patients were excluded, thus studying 47 (27 males, 20 females, mean age 63 years). Recurrence was confirmed by histopathology study in 14 cases and by clinical evolution in 33. The patients were divided into 4 groups. A: patients with elevation of CEA and suspected recurrence in the MDCT. B: elevation of CEA, without suspicious lesions in the MDCT. C: normal levels of CEA and positive MDCT. D: normal levels of CEA and uncertain MDCT. RESULTS We found sensitivity, specificity, PPV, NPV and overall accuracy of 91%, 69%, 89%, 75% and 85% respectively. For group A, we found 100% sensitivity, in group B, 75% sensitivity with 100% specificity%, for C, sensitivity was 89% with 71% specificity. Finally, in group D, sensitivity was 100% and specificity 60%, respectively. CONCLUSION Applying a low dose, the (18)F-FDG PET-CT has high diagnostic performance in patients with suspicion of CRC, approaching in a higher grade the ALARA criteria.
Collapse
Affiliation(s)
- M A Ochoa-Figueroa
- Departamento de Medicina Nuclear, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | | | | | | | | | | | | | | |
Collapse
|