The role of 18F-FDG PET/CT in detecting colorectal cancer recurrence in patients with elevated CEA levels

Introduction In this study we aimed to define the success of fluorine-18 (F-18) 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 F-18-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. F-18-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 F-18-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 F-18-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 F-18-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 F-18-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 F-18-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. Nucl Med Commun 33:395-402 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.