Skip to main content

Advertisement

SpringerLink
Log in

F-18 FDG PET/CT in the assessment of patients with unexplained CEA rise after surgical curative resection for colorectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chua TC, Liauw W, Chu F et al (2012) Viewing metastatic colorectal cancer as a curable chronic disease. Am J Clin Oncol 35:77–80

    Article  PubMed  Google Scholar 

  2. Domati F, Rossi G, Benatti P et al (2011) Long-term survey of patients with curable colorectal cancer with specific reference to the quality of life. Intern Emerg Med 6:529–535

    Article  PubMed  Google Scholar 

  3. Jemal A, Tiwari RC, Murray T et al (2004) Cancer Statistics, 2004. CA Cancer J Clin 54:8–29

    Article  PubMed  Google Scholar 

  4. Bipat S, Niekel MC, Comans EF et al (2012) Imaging modalities for the staging of patients with colorectal cancer. Neth J Med 70:26–34

    PubMed  CAS  Google Scholar 

  5. Shen YY, Liang JA, Chen YK et al (2006) Clinical impact of F-18-FDG-PET in the suspicion of recurrent colorectal cancer based on asymptomatically elevated serum level of carcinoembryonic antigen (CEA) in Taiwan. Hepatogastroenterology 53:348–350

    PubMed  Google Scholar 

  6. Dias AR, Nahas SC, Camargo EE et al (2007) Recent evidences of the use of F-18-fluorodeoxyglucose positron emission tomography in the management of colorectal cancer. J Surg Educ 64:114–119

    Article  PubMed  Google Scholar 

  7. Lu YY, Chen JH, Chien CR, et al. (2013) 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 Feb 14. [Epub ahead of print]

  8. Giorgetti A, Sorace O, Pisani P et al (2000) Accuracy of qualitative and semiquantitative analysis of 18FDG positron emission tomography scans in the evaluation of primary and metastatic lesions. Clin Positron Imaging 3:182

    Article  PubMed  Google Scholar 

  9. Kelley RK, Van Bebber SL, Phillips KA et al (2011) Personalized medicine and oncology practice guidelines: a case study of contemporary biomarkers in colorectal cancer. J Natl Compr Canc Netw 9:13–25

    PubMed  Google Scholar 

  10. Rockall TA, McDonald PJ (1999) Carcinoembryonic antigen: its value in the follow-up of patients with colorectal cancer. Int J Colorectal Dis 14:73–77

    Article  PubMed  CAS  Google Scholar 

  11. Brethauer SA, Magrino TJ, Riffenburgh RH et al (2002) Management of recurrent colorectal carcinoma. Color Dis 4:246–253. doi:10.1046/j.1463-1318.2002.00327.x

    Article  Google Scholar 

  12. Even-Sapir E, Parag Y, Lerman H et al (2004) Detection of recurrence in patients with rectal cancer: PET/CT after abdominoperineal or anterior resection. Radiology 232:815–822. doi:10.1148/radiol.2323031065

    Article  PubMed  Google Scholar 

  13. Mainenti PP, Iodice D, Segreto S et al (2011) Colorectal cancer and 18FDG-PET/CT: what about adding the T to the N parameter in loco-regional staging? World J Gastroenterol 17:1427–1433

    Article  PubMed  Google Scholar 

  14. Wiggers T, Mannaerts GH, Marinelli AW et al (2003) Surgery for locally recurrent rectal cancer. Colorectal Dis 5:504–507

    Article  PubMed  CAS  Google Scholar 

  15. Kyoto Y, Momose M, Kondo C et al (2010) Ability of F-18-FDG PET/CT to diagnose recurrent colorectal cancer in patients with elevated CEA concentrations. Ann Nucl Med 24:395–401

    Article  PubMed  CAS  Google Scholar 

  16. Shreve PD, Anzai Y, Wahl RL (1999) Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 19:61–77

    Article  PubMed  CAS  Google Scholar 

  17. Quirce Pisano R, Banzo Marraco I, Jiménez-Bonilla JF et al (2008) Potential sources of diagnostic pitfall and variants in FDG-PET/CT. Rev Esp Med Nucl 27:130–159

    Article  PubMed  CAS  Google Scholar 

  18. Culverwell AD, Scarsbrook AF, Chowdhury FU (2011) False-positive uptake on 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) in oncological imaging. Clin Radiol 66:366–382

    Article  PubMed  CAS  Google Scholar 

  19. MERCURY Study Group, Shihab OC, Taylor F, Bees N et al (2011) Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer. Brit J Surg 98:1798–1804

    Article  PubMed  CAS  Google Scholar 

  20. Patel UB, Taylor F, Blomqvist L et al (2011) Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience. J Clin Oncol 29:3753–3760

    Article  PubMed  Google Scholar 

  21. Willett C, Tepper JE, Cohen A et al (1984) Local failure following curative resection of colonic adenocarcinoma. Int J Radiat Oncol Biol Phys 10:645–651

    Article  PubMed  CAS  Google Scholar 

  22. Pilipshen SJ, Heilweil M, Quan SH et al (1984) Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 53:1354–1362

    Article  PubMed  CAS  Google Scholar 

  23. Read TE, Mutch MG, Chang BW et al (2002) Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 195:33–40

    Article  PubMed  Google Scholar 

  24. Hasegawa J, Nishimura J, Yamamoto S et al (2011) Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning. Int J Colorectal Dis 26:875–880

    Article  PubMed  Google Scholar 

  25. Petersen S, Freitag M, Hellmich G et al (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13:160–163

    Article  PubMed  CAS  Google Scholar 

  26. Flanagan FL, Dehdashti F, Ogunbiyi OA et al (1998) Utility of FDGPET for investigating unexplained plasma CEA elevation in patients with colorectal cancer. Ann Surg 227:319–323

    Article  PubMed  CAS  Google Scholar 

  27. Maldonado A, Sancho F, Cerdan J et al (2000) FDG-PET in the detection of recurrence in colorectal cancer based on rising CEA level. Experience in 72 patients. Clin Positron Imaging 3:170

    Article  PubMed  Google Scholar 

  28. Flamen P, Hoekstra OS, Homans F et al (2001) Unexplained rising carcinoembryonic antigen (CEA) in the postoperative surveillance of colorectal cancer: the utility of positron emission tomography (PET). Eur J Cancer 37:862–869

    Article  PubMed  CAS  Google Scholar 

  29. Libutti SK, Alexander HR Jr, Choyke P et al (2001) A prospective study of 2-[F-18] fluoro-2-deoxy-d-glucose/positron emission tomography scan, 99mTc-labeled arcitumomab (CEA-scan), and blind second-look laparotomy for detecting colon cancer recurrence in patients with increasing carcinoembryonic antigen levels. Ann Surg Oncol 8:779–786

    Article  PubMed  CAS  Google Scholar 

  30. Zervos EE, Badgwell BD, Burak WE Jr et al (2001) Fluorodeoxyglucose positron emission tomography as an adjunct to carcinoembryonic antigen in the management of patients with presumed recurrent colorectal cancer and nondiagnostic radiologic workup. Surgery 130:636–643

    Article  PubMed  CAS  Google Scholar 

  31. Smeets P, Ham H, Ceelen W et al (2010) Differentiation between peri-anastomotic inflammatory changes and local recurrence following neoadjuvant radiochemotherapy surgery for colorectal cancer using visual and semiquantitative analysis of PET-CT data. Q J Nucl Med Mol Imaging 54:327–332

    PubMed  CAS  Google Scholar 

  32. Simo M, Lomena F, Setoain J et al (2002) FDG-PET improves the management of patients with suspected recurrence of colorectal cancer. Nucl Med Commun 23:975–982

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Mrs. Di Leo A., Mr. Leggiadro F., Mr. Tempone A., and Mr. Volpicelli F. for their valuable contribution in performing the studies.

Disclosures

The authors have indicated that they have no financial conflicts of interest and that the work was not funded.

Author information

Authors and Affiliations

  1. Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico di Basilicata (CROB), Rionero in Vulture, Italy

    S. Giacomobono, R. Gallicchio, D. Capacchione, G. Lettini, L. Molinari, A. Cammarota & G. Storto

  2. Istituto di Biostrutture e Bioimmagini, Consiglio Nazionale delle Ricerche (CNR), Naples, Italy

    A. Nardelli & P. Mainenti

  3. University of Texas, Southwestern, Dallas, USA

    D. Gattozzi

  4. Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro di Riferimento Oncologico di Basilicata (CROB), Via P. Pio 1, 85028, Rionero in Vulture, Italy

    G. Storto

Authors
  1. S. Giacomobono
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Gallicchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Capacchione
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Nardelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Gattozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Lettini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L. Molinari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Mainenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Cammarota
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Storto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Storto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Giacomobono, S., Gallicchio, R., Capacchione, D. et al. 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 28, 1699–1705 (2013). https://doi.org/10.1007/s00384-013-1747-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1747-0

Keywords

Search

Navigation