Premium
Carcinoembryonic antigen directed PET − CECT scanning for postoperative surveillance of colorectal cancer
Author(s) -
Vallam K. C.,
Guruchannabasavaiah B.,
Agrawal A.,
Rangarajan V.,
Ostwal V.,
Engineer R.,
Saklani A.
Publication year - 2017
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13695
Subject(s) - medicine , carcinoembryonic antigen , colorectal cancer , asymptomatic , positron emission tomography , pet ct , adjuvant , radiology , nuclear medicine , gastroenterology , cancer
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.