Retrospective Study
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World J Gastroenterol. Jun 7, 2014; 20(21): 6608-6614
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6608
Value of 18F-FDG PET-CT in surveillance of postoperative colorectal cancer patients with various carcinoembryonic antigen concentrations
Yan Zhang, Bin Feng, Guo-Li Zhang, Man Hu, Zheng Fu, Fen Zhao, Xiao-Li Zhang, Li Kong, Jin-Ming Yu
Yan Zhang, Jin-Ming Yu, Graduate school of Tianjin Medical University, Tianjin 300070, China
Yan Zhang, Guo-Li Zhang, Man Hu, Li Kong, Jin-Ming Yu, Department of Radiation Oncology, Shandong Tumor Hospital and Institute (Shandong Academy of Medical Sciences), Jinan 250117, Shandong Province, China
Zheng Fu, Jin-Ming Yu, Department of Nuclear Medicine, Shandong Tumor Hospital and Institute (Shandong Academy of Medical Sciences), Jinan 250117, Shandong Province, China
Fen Zhao, Jin-Ming Yu, Medical College, Shandong University, Jinan 250012, Shandong Province, China
Bin Feng, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan 250031, Shandong Province, China
Xiao-Li Zhang, School of Medicine and Life Sciences, University of Jinan, Jinan 250022, Shandong Province, China
Author contributions: Zhang Y, Kong L and Yu JM designed the study; Feng B, Zhang GL, Fu Z, Zhao F and Zhang XL collected the data and performed data analysis; Zhang Y wrote the paper; Hu M revised the paper.
Correspondence to: Jin-Ming Yu, MD, Department of Radiation Oncology, Shandong Tumor Hospital and Institute (Shandong Academy of Medical Sciences), 440# Jiyan Road, Jinan 250117, Shandong Province, China. sdyujinming@126.com
Telephone: +86-531-67626782 Fax: +86-531-67623817
Received: November 5, 2013
Revised: February 20, 2014
Accepted: March 12, 2014
Published online: June 7, 2014
Processing time: 213 Days and 16.8 Hours
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.

Keywords: Colorectal cancer; Carcinoembryonic antigen; Fluorodeoxyglucose positron emission tomography/computed tomography; Recurrence; Metastasis

Core tip: In this paper, fluorodeoxyglucose (FDG) positron emission tomography (PET)/computerized tomography (CT) showed an excellent diagnostic performance and its sensitivity and accuracy were significantly superior to those of CT. FDG PET/CT changed the management in some metastatic patients who might obtain the chance for a second remission. The study also showed that FDG PET/CT was effective similarly in the patients with normal and abnormal carcinoembryonic antigen (CEA) levels but had a tendency to increase with the CEA level. FDG PET/CT was an advisable option for surveillance of postoperative colorectal cancer (CRC) patients with a vague diagnosis and should be recommended in surveillance of post-operative CRC patients even with normal CEA.