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.

Abstract

BACKGROUND:

An increasing carcinoembryonic antigen (CEA) level in the absence of disease on imaging studies can present a diagnostic challenge. We evaluated 2-[18F] fluoro-2-deoxy-D-glucose and positron emission tomography (FDG-PET) scan and CEA scan before second-look laparotomy as a means of localizing recurrent colorectal cancer.

METHODS:

Patients underwent computed tomography scan, bone scan, colonoscopy, and magnetic resonance imaging, and those without evidence of disease or resectable disease in the abdomen had FDG-PET and CEA scans. At second-look laparotomy, a surgeon blinded to the results of the FDG-PET and CEA scans performed an exploration and mapped findings. A second surgeon, with knowledge of the FDG-PET and CEA scans, then explored the patient; all lesions were biopsied or resected for pathology.

RESULTS:

In 28 patients explored, disease was found at operation in 26 (94%). Ten had unresectable disease. FDG-PET scans predicted unresectable disease in 90% of patients. CEA scans failed to predict unresectable disease in any patient. In 16 patients found to have resectable disease or disease that could be treated with regional therapy, FDG-PET scan predicted this in 81% and CEA scan in 13%.

CONCLUSIONS:

FDG-PET scan can predict those patients who would likely benefit from a laparotomy. If the FDG-PET scan indicates resectable disease, laparotomy can be considered. However, if the findings predict unresectable disease or the absence of disease, the patient should pursue systemic therapy or continued observation.

• Authors: S K Libutti, H R Alexander Jr, P Choyke, D L Bartlett, S L Bacharach, M Whatley, F Jousse, W C Eckelman, K Kranda, R D Neumann, J A Carrasquillo
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 8 Issue 10 Pg. 779-86 (Dec 2001) ISSN: 1068-9265 [Print] United States
• PMID: 11776491 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Contrast Media
• Organotechnetium Compounds
• Radiopharmaceuticals
• technetium Tc-99m arcitumomab
• Fluorodeoxyglucose F18

Topics

• Adult
• Aged
• Antibodies, Monoclonal
• Colonic Neoplasms (diagnostic imaging)
• Contrast Media
• Female
• Fluorodeoxyglucose F18
• Humans
• Laparotomy (methods)
• Male
• Middle Aged
• Organotechnetium Compounds
• Prospective Studies
• Radiopharmaceuticals
• Recurrence
• Second-Look Surgery
• Sensitivity and Specificity
• Tomography, Emission-Computed (methods)