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

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

doi:10.3892/ol.2016.5143

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

Authors:
- 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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Affiliations: Department of Biomedicine and Prevention, Nuclear Medicine Unit, University Tor Vergata, I-00133 Rome, Italy
Published online on: September 15, 2016 https://doi.org/10.3892/ol.2016.5143
Pages: 4209-4213

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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.

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