Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2016; 26(03): 405-410
DOI: 10.4103/0971-3026.190412
Nuclear Med

Efficacy of 18F-FDG PET/CT in investigation of elevated CEA without known primary malignancy

Simon Sin-man Wong
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
,
Wong L Yu
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
,
Ki Wang
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
,
Anil T Ahuja
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
Also available at
  PDF Download Permissions and Reprints

Abstract

Aim: To evaluate the efficacy of 18flurodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) in investigating patients with elevated carcinoembryonic antigen (CEA) and without known primary malignancy, and the impact of PET/CT findings on patient management. Setting and Design: PET/CT scans done in a tertiary hospital between December 2007 and February 2012 for elevated CEA in patients without known primary malignancy were retrospectively reviewed. Materials and Methods: The PET/CT findings, patients' clinical information, level of CEA, histological diagnosis, and subsequent management were retrieved by the electronic patient record for analysis. Statistical Analysis: Data were analyzed using SPSS version 19. Results: One hundred and one PET/CT scans were performed for patients with elevated CEA. Fifty-eight of these were performed for patients with known primary malignancy and were excluded; 43 PET/CT scans were performed for patients without known primary malignancy and were included. Thirty-three (77%) had a positive PET/CT. Among the 32 patients with malignancy, 15 (47%) suffered from lung cancer and 8 (25%) suffered from colorectal cancer. The sensitivity (97%), specificity (82%), positive predictive value (94%), negative predictive value (90%), and accuracy (93%) were calculated. Thirty (91%) patients had resultant change in management. The mean CEA level for patients with malignancy (46.1 ng/ml) was significantly higher than those without malignancy (3.82 ng/ml) (P < 0.05). In predicting the presence of malignancy, a CEA cutoff at 7.55 ng/ml will achieve a sensitivity of 91% and a specificity of 73%. Conclusion: PET/CT, in our study population, appears to be sensitive, specific, and accurate in investigating patients with elevated CEA and without known primary malignancy. In addition to diagnosis of underlying primary malignancy, PET/CT also reveals occult metastases which would affect patient treatment options.Its role in investigating patients with elevated CEA and without known primary, compared with other investigation modalities, remains to be studied.

Keywords

Biological - carcinoembryonic antigen - neoplasms - positron emission tomography - tomography - tumor markers - unknown primary - X-ray computed


Publication History

Article published online:
30 July 2021

© 2016. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 van Kouwen MC, Oyen WJ, Nagengast FM, Jansen JB, Drenth JP. FDG-PET scanning in the diagnosis of gastrointestinal cancers. Scand J Gastroenterol Suppl 2004:85-92.
  • 2 Regelink G, Brouwer J, de Bree R, Pruim J, van der Laan BF, Vaalburg W, et al. Detection of unknown primary tumours and distant metastases in patients with cervical metastases: Value of FDG-PET versus conventional modalities. Eur J Nucl Med Mol Imaging 2002;29:1024-30.
  • 3 Wong WL, Sonoda LI, Gharpurhy A, Gollub F, Wellsted D, Goodchild K, et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers--An audit and review of published studies. Clin Oncol (R Coll Radiol) 2012;24:190-5.
  • 4 Fülöp M, Kásler M, Remenár E, Lengyel Z, Borbély K. [The role of PET-CT in detecting unknown primary tumour in patients with cervical lymph node metastases]. Magy Onkol 2012;56:84-92.
  • 5 Wartski M, Le Stanc E, Gontier E, Vilain D, Banal A, Tainturier C, et al. In search of an unknown primary tumour presenting with cervical metastases: Performance of hybrid FDG-PET-CT. Nucl Med Commun 2007;28:365-71.
  • 6 Lu YY, Chen JH, Chien CR, Chen WT, Tsai SC, Lin WY, 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 2013;28:1039-47.
  • 7 Choi MY, Lee KM, Chung JK, Lee DS, Jeong JM, Park JG, et al. Correlation between serum CEA level and metabolic volume as determined by FDG PET in postoperative patients with recurrent colorectal cancer. Ann Nucl Med 2005;19:123-9.
  • 8 Koch M, McPherson TA. Carcinoembryonic antigen levels as an indicator of the primary site in metastatic disease of unknown origin. Cancer 1981;48:1242-4.
  • 9 Fernandez-Cotarelo MJ, Guerra-Vales JM, Colina F, de la Cruz J. Prognostic factors in cancer of unknown primary site. Tumori 2010;96:111-6.
  • 10 Ruibal Morell A. CEA serum levels in non-neoplastic disease. Int J Biol Markers 1992;7:160-6.
  • 11 Loewenstein MS, Zamcheck N. Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states. Cancer 1978;42(3 Suppl):1412-8.
  • 12 Lee JY, Lee DC, Lee JW. Serum carcinoembryonic antigen is associated with non-alcoholic fatty liver disease in healthy Korean non-smokers. Clin Chem Lab Med 2013;51:1499-504.
  • 13 White CS, Flukinger T, Jeudy J, Chen JJ. Use of a computer-aided detection system to detect missed lung cancer at chest radiography. Radiology 2009;252:273-81.