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Use of FDG-PET or PET/CT to detect recurrent colorectal cancer in patients with elevated CEA: a systematic review and meta-analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to assess the diagnostic performance of FDG-PET or PET/CT in the detection of recurrent colorectal cancer (CRC) rising in patients with elevated CEA.

Materials and methods

The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity and specificity and positive and negative likelihood ratios, and summary receiver-operating characteristic curves in the detection of recurrent CRC in patients with elevated CEA.

Results

Eleven studies with a total of 510 patients met the inclusion criteria. One hundred and six patients (106/510 = 20.8 %) had true-negative FDG-PET (PET/CT) results in detection of recurrent CRC when rising CEA. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET in the detection of tumor recurrence in CRC patients with elevated CEA were 90.3 % (95 % CI, 85.5–94.0 %), 80.0 % (95 % CI, 67.0–89.6 %), 2.88 (95 % CI, 1.37–6.07), and 0.12 (95 % CI, 0.07–0.20), respectively. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET/CT in the detection of tumor recurrence in CRC patients with elevated CEA were 94.1 % (95 % CI, 89.4–97.1 %), 77.2 % (95 % CI, 66.4–85.9 %), 4.70 (95 % CI, 0.82–12.13), and 0.06 (95 % CI, 0.03–0.13), respectively.

Conclusions

Whole-body FDG-PET and PET/CT are valuable imaging tools for the assessment of patients with suspected CRC tumor recurrence based on the increase of CEA.

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References

  1. Siegel R, Ward E, Brawley O et al (2011) Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 61:212–236

    Article  PubMed  Google Scholar 

  2. Goldberg RM (2006) Intensive surveillance after stage II or III colorectal cancer: is it worth it? J Clin Oncol 24:330–331

    Article  PubMed  Google Scholar 

  3. Parker SL, Tong T, Bolden S et al (1997) Cancer statistics, 1997. CA Cancer J Clin 47:5–27

    Article  PubMed  CAS  Google Scholar 

  4. Obrand DI, Gordon PH (1997) Incidence and patterns of recurrence following curative resection of colon cancer. Dis Colon Rectum 40:15–24

    Article  PubMed  CAS  Google Scholar 

  5. Vernava AM III, Longo WE, Virgo KS et al (1994) Current follow-up strategies after resection of colon cancer. Results of a survey of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum 37:573–583

    Article  PubMed  Google Scholar 

  6. Carriquiry LA, Pineyro A (1999) Should carcinoembryonic antigen be used in the management of patients with colorectal cancer? Dis Colon Rectum 42:921–929

    Article  PubMed  CAS  Google Scholar 

  7. Mitchell EP (1998) Role of carcinoembryonic antigen in the management of advanced colorectal cancer. Semin Oncol 25:12–20

    PubMed  CAS  Google Scholar 

  8. Moss AA (1989) Imaging of colorectal carcinoma. Radiology 170:308–310

    PubMed  CAS  Google Scholar 

  9. Tempero M, Brand R, Holdeman K et al (1995) New imaging techniques in colorectal cancer. Semin Oncol 22:448–471

    PubMed  CAS  Google Scholar 

  10. Ruhlmann J, Schomburg A, Bender H et al (1997) Fluorodeoxyglucose whole-body positron emission tomography in colorectal cancer patients studied in routine daily practice. Dis Colon Rectum 40:1195–1204

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  12. Flamen P, Stroobants S, Van Cutsem E et al (1999) Additional value of whole-body positron emission tomography with fluorine-18-2-fluoro-2-deoxy-d glucose in recurrent colorectal cancer. J Clin Oncol 17:894–901

    PubMed  CAS  Google Scholar 

  13. 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 

  14. 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 

  15. Liu FY, Chen JS, Changchien CR et al (2005) Utility of 2-fluoro-2-deoxy-d-glucose positron emission tomography in managing patients of colorectal cancer with unexplained carcinoembryonic antigen elevation at different levels. Dis Colon Rectum 48:1900–1912

    Article  PubMed  Google Scholar 

  16. 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 

  17. Kalff V, Hicks RJ, Ware RE et al (2002) The clinical impact of (18)F-FDG-PET in patients with suspected or confirmed recurrence of colorectal cancer: a prospective study. J Nucl Med 43:492–499

    PubMed  Google Scholar 

  18. Chen LB, Tong JL, Song HZ et al (2007) (18)FDG-PET/CT in detection of recurrence and metastasis of colorectal cancer. World J Gastroenterol 13:5025–5029

    PubMed  Google Scholar 

  19. Chen YK, Yeh CL, Tsui CC et al (2011) F-18 FDG-PET for evaluation of bone marrow involvement in non-Hodgkin lymphoma: a meta-analysis. Clin Nucl Med 36:553–559

    Article  PubMed  CAS  Google Scholar 

  20. Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12:1293–1316

    Article  PubMed  CAS  Google Scholar 

  21. Zamora J, Abraira V, Muriel A et al (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31

    Article  PubMed  Google Scholar 

  22. Imdahl A, Reinhardt MJ, Nitzsche EU et al (2000) Impact of 18F-FDG-positron emission tomography for decision making in colorectal cancer recurrences. Langenbecks Arch Surg 385:129–134

    Article  PubMed  CAS  Google Scholar 

  23. Staib L, Schirrmeister H, Reske SN et al (2000) Is (18)F-fluorodeoxyglucose positron emission tomography in recurrent colorectal cancer a contribution to surgical decision making? Am J Surg 180:1–5

    Article  PubMed  CAS  Google Scholar 

  24. Hung GU, Shiau YC, Tsai SC et al (2001) Value of 18F-fluoro-2-deoxyglucose positron emission tomography in the evaluation of recurrent colorectal cancer. Anticancer Res 21:1375–1378

    PubMed  CAS  Google Scholar 

  25. Imbriaco M, Akhurst T, Hilton S et al (2000) Whole-body FDG-PET in patients with recurrent colorectal carcinoma. A comparative study with CT. Clin Positron Imaging 3:107–114

    Article  PubMed  Google Scholar 

  26. Choi MY, Lee KM, Chung JK et al (2005) Correlation between serum CEA level and metabolic volume as determined by FDG-PET in postoperative patients with recurrent colorectal cancer. Ann Nucl Med 19:123–129

    Article  PubMed  Google Scholar 

  27. Lee JH, Park SG, Jee KN et al (2010) Performance of FDG-PET/CT in postoperative colorectal cancer patients with a suspected recurrence and a normal CEA level. Nucl Med Commun 31:576–582

    PubMed  Google Scholar 

  28. Sarikaya I, Bloomston M, Povoski SP et al (2007) FDG-PET scan in patients with clinically and/or radiologically suspicious colorectal cancer recurrence but normal CEA. World J Surg Oncol 5:64–71

    Article  PubMed  Google Scholar 

  29. 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 

  30. Libutti SK, Alexander HR Jr, Choyke P et al (2001) A prospective study of 2-[18F] 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 

  31. Shen YY, Liang JA, Chen YK et al (2006) Clinical impact of 18F-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 

  32. Kyoto Y, Momose M, Kondo C et al (2010) Ability of 18F-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 

  33. Metser U, You J, McSweeney S et al (2010) Assessment of tumor recurrence in patients with colorectal cancer and elevated carcinoembryonic antigen level: FDG-PET/CT versus contrast-enhanced 64-MDCT of the chest and abdomen. AJR Am J Roentgenol 194:766–771

    Article  PubMed  Google Scholar 

  34. Mittal BR, Senthil R, Kashyap R et al (2011) 18F-FDG-PET-CT in evaluation of postoperative colorectal cancer patients with rising CEA level. Nucl Med Commun 32:789–793

    Article  PubMed  Google Scholar 

  35. Ozkan E, Soydal C, Araz M et al (2012) The role of 18F-FDG-PET/CT in detecting colorectal cancer recurrence in patients with elevated CEA levels. Nucl Med Commun 33:395–402

    Article  PubMed  CAS  Google Scholar 

  36. Sanli Y, Kuyumcu S, Ozkan ZG, et al. (2012) The utility of FDG-PET/CT as an effective tool for detecting recurrent colorectal cancer regardless of serum CEA levels. Ann Nucl Med 26:551–558

    Google Scholar 

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Acknowledgment

This study was supported by grants (DMR-101-061 and DMR-101-080) from China Medical University Hospital and the Taiwan Department of Health Clinical Trial and Research Center and for Excellence (DOH102-TD-B-111-004) as well as the Taiwan Department of Health Cancer Research Center for Excellence (DOH102-TD-C-111-005).

Conflicts of interest

No potential conflicts of interest were disclosed.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Yu-Yu Lu, Shih-Chuan Tsai & Wan-Yu Lin

  2. Biostatistics Center and Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan

    Jin-Hua Chen

  3. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Chun-Ru Chien

  4. Department of Surgery, China Medical University Hospital, Taichung, Taiwan

    William Tzu-Liang Chen

  5. Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Chun-Ru Chien, William Tzu-Liang Chen, Wan-Yu Lin & Chia-Hung Kao

  6. Department of Nuclear Medicine and PET Center, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan

    Chia-Hung Kao

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  1. Yu-Yu Lu
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Correspondence to Chia-Hung Kao.

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All authors read and approved the final manuscript.

Wan-Yu Lin and Chia-Hung Kao contributed equally to this work.

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Lu, YY., Chen, JH., Chien, CR. et al. 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 28, 1039–1047 (2013). https://doi.org/10.1007/s00384-013-1659-z

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