Skip to main content
Top
Published in: Annals of Nuclear Medicine 6/2010

01-07-2010 | Original Article

Prevalence of positive FDG-PET findings in patients with high CEA levels

Authors: Tsuyoshi Suga, Yuji Nakamoto, Tsuneo Saga, Tatsuya Higashi, Tadashi Hara, Koichi Ishizu, Hidemitsu Nishizawa, Kaori Togashi

Published in: Annals of Nuclear Medicine | Issue 6/2010

Login to get access

Abstract

Objective

The purpose of this study was to evaluate the prevalence of positive findings of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-d-glucose (FDG) in patients with high serum CEA levels.

Methods

A total of 303 patients who had undergone an FDG-PET scan in our institution with high serum CEA levels were analyzed. The prevalence of positive PET findings was evaluated with regard to a previous history of malignancy, absolute value of CEA levels, and the time course of CEA levels (an increasing or decreasing pattern, a change divided by time (ΔCEA) and doubling time of CEA).

Results

Of 303 patients, 232 were confirmed to have malignancy, and the patient-based sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET were 87, 86, 95, 66, and 86%, respectively. There was no statistically significant difference in positive rates according to the history of previous malignancy. The prevalence of PET-positive cases was higher with an increase in absolute CEA levels, and more than 90% of the patients were positive when CEA levels were more than 20 ng/ml. The ΔCEA was significantly higher and the doubling time was significantly shorter in patients with positive results than those with negative results.

Conclusions

A high value of serum CEA levels was correlated with a higher prevalence of positive PET findings. FDG-PET scans would be justified in patients with high serum CEA levels, regardless of whether there was or was not a previous history of malignancy.
Literature
1.
go back to reference Goldenberg DM, Neville AM, Carter AC, Go VL, Holyoke ED, Isselbacher KJ, et al. CEA (carcinoembryonic antigen): its role as a marker in the management of cancer. J Cancer Res Clin Oncol. 1981;101:239–42.CrossRefPubMed Goldenberg DM, Neville AM, Carter AC, Go VL, Holyoke ED, Isselbacher KJ, et al. CEA (carcinoembryonic antigen): its role as a marker in the management of cancer. J Cancer Res Clin Oncol. 1981;101:239–42.CrossRefPubMed
2.
go back to reference Stockley RA, Shaw J, Whitfield AG, Whitehead TP, Clarke CA, Burnett D. Effect of cigarette smoking, pulmonary inflammation, and lung disease on concentrations of carcinoembryonic antigen in serum and secretions. Thorax. 1986;41:17–24.CrossRefPubMed Stockley RA, Shaw J, Whitfield AG, Whitehead TP, Clarke CA, Burnett D. Effect of cigarette smoking, pulmonary inflammation, and lung disease on concentrations of carcinoembryonic antigen in serum and secretions. Thorax. 1986;41:17–24.CrossRefPubMed
3.
go back to reference Fukuda I, Yamakado M, Kiyose H. Influence of smoking on serum carcinoembryonic antigen levels in subjects who underwent multiphasic health testing and services. J Med Syst. 1998;22:89–93.CrossRefPubMed Fukuda I, Yamakado M, Kiyose H. Influence of smoking on serum carcinoembryonic antigen levels in subjects who underwent multiphasic health testing and services. J Med Syst. 1998;22:89–93.CrossRefPubMed
4.
go back to reference Blackburn GF, Shah HP, Kenten JH, Leland J, Kamin RA, Link J, et al. Electrochemiluminescence detection for development of immunoassays and DNA probe assays for clinical diagnostics. Clin Chem. 1991;37:1534–9.PubMed Blackburn GF, Shah HP, Kenten JH, Leland J, Kamin RA, Link J, et al. Electrochemiluminescence detection for development of immunoassays and DNA probe assays for clinical diagnostics. Clin Chem. 1991;37:1534–9.PubMed
5.
go back to reference Kim Y, Lee S, Park S, Jeon H, Lee W, Kim JK, et al. Gastrointestinal tract cancer screening using fecal carcinoembryonic antigen. Ann Clin Lab Sci. 2003;33:32–8.PubMed Kim Y, Lee S, Park S, Jeon H, Lee W, Kim JK, et al. Gastrointestinal tract cancer screening using fecal carcinoembryonic antigen. Ann Clin Lab Sci. 2003;33:32–8.PubMed
6.
go back to reference Shen YY, Liang JA, Chen YK, Tsai CY, Kao CH. 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. 2006;53:348–50.PubMed Shen YY, Liang JA, Chen YK, Tsai CY, Kao CH. 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. 2006;53:348–50.PubMed
7.
go back to reference Suárez M, Pérez-Castejón MJ, Jiménez A, Domper M, Ruiz G, Montz R, et al. Early diagnosis of recurrent breast cancer with FDG-PET in patients with progressive elevation of serum tumor markers. Q J Nucl Med. 2002;46:113–21.PubMed Suárez M, Pérez-Castejón MJ, Jiménez A, Domper M, Ruiz G, Montz R, et al. Early diagnosis of recurrent breast cancer with FDG-PET in patients with progressive elevation of serum tumor markers. Q J Nucl Med. 2002;46:113–21.PubMed
8.
go back to reference de Groot JW, Links TP, Jager PL, Kahraman T, Plukker JT. Impact of 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in patients with biochemical evidence of recurrent or residual medullary thyroid cancer. Ann Surg Oncol. 2004;11:786–94.CrossRefPubMed de Groot JW, Links TP, Jager PL, Kahraman T, Plukker JT. Impact of 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in patients with biochemical evidence of recurrent or residual medullary thyroid cancer. Ann Surg Oncol. 2004;11:786–94.CrossRefPubMed
9.
go back to reference Kitano H, Magata Y, Tanaka A, Mukai T, Kuge Y, Nagatsu K, et al. Performance assessment of O-18 water purifier. Ann Nucl Med. 2001;15:75–8.CrossRefPubMed Kitano H, Magata Y, Tanaka A, Mukai T, Kuge Y, Nagatsu K, et al. Performance assessment of O-18 water purifier. Ann Nucl Med. 2001;15:75–8.CrossRefPubMed
10.
go back to reference Brown RS, Fisher SJ, Wahl RL. Autoradiographic evaluation of the intra-tumoral distribution of 2-deoxy-d-glucose and monoclonal antibodies in xenografts of human ovarian adenocarcinoma. J Nucl Med. 1993;34:75–82.PubMed Brown RS, Fisher SJ, Wahl RL. Autoradiographic evaluation of the intra-tumoral distribution of 2-deoxy-d-glucose and monoclonal antibodies in xenografts of human ovarian adenocarcinoma. J Nucl Med. 1993;34:75–82.PubMed
11.
go back to reference Brown RS, Leung JY, Fisher SJ, Frey KA, Ethier SP, Wahl RL. Intratumoral distribution of tritiated-FDG in breast carcinoma: correlation between Glut-1 expression and FDG uptake. J Nucl Med. 1996;37:1042–7.PubMed Brown RS, Leung JY, Fisher SJ, Frey KA, Ethier SP, Wahl RL. Intratumoral distribution of tritiated-FDG in breast carcinoma: correlation between Glut-1 expression and FDG uptake. J Nucl Med. 1996;37:1042–7.PubMed
12.
go back to reference Brown RS, Leung JY, Kison PV, Zasadny KR, Flint A, Wahl RL. Glucose transporters and FDG uptake in untreated primary human non-small cell lung cancer. J Nucl Med. 1999;40:556–65.PubMed Brown RS, Leung JY, Kison PV, Zasadny KR, Flint A, Wahl RL. Glucose transporters and FDG uptake in untreated primary human non-small cell lung cancer. J Nucl Med. 1999;40:556–65.PubMed
13.
go back to reference Higashi K, Clavo AC, Wahl RL. Does FDG uptake measure proliferative activity of human cancer cells? In vitro comparison with DNA flow cytometry and tritiated thymidine uptake. J Nucl Med. 1993;34:414–9.PubMed Higashi K, Clavo AC, Wahl RL. Does FDG uptake measure proliferative activity of human cancer cells? In vitro comparison with DNA flow cytometry and tritiated thymidine uptake. J Nucl Med. 1993;34:414–9.PubMed
14.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
15.
go back to reference Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313–27.CrossRefPubMed Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313–27.CrossRefPubMed
16.
go back to reference Guadagni F, Ferroni P, Carlini S, Mariotti S, Spila A, Aloe S, et al. A re-evaluation of carcinoembryonic antigen (CEA) as a serum marker for breast cancer: a prospective longitudinal study. Clin Cancer Res. 2001;7:2357–62.PubMed Guadagni F, Ferroni P, Carlini S, Mariotti S, Spila A, Aloe S, et al. A re-evaluation of carcinoembryonic antigen (CEA) as a serum marker for breast cancer: a prospective longitudinal study. Clin Cancer Res. 2001;7:2357–62.PubMed
17.
go back to reference Tondini C, Hayes DF, Gelman R, Henderson IC, Kufe DW. Comparison of CA15-3 and carcinoembryonic antigen in monitoring the clinical course of patients with metastatic breast cancer. Cancer Res. 1988;48:4107–12.PubMed Tondini C, Hayes DF, Gelman R, Henderson IC, Kufe DW. Comparison of CA15-3 and carcinoembryonic antigen in monitoring the clinical course of patients with metastatic breast cancer. Cancer Res. 1988;48:4107–12.PubMed
18.
go back to reference Mroczko B, Kozłowski M, Groblewska M, Łukaszewicz M, Nikliński J, Jelski W, et al. The diagnostic value of the measurement of matrix metalloproteinase 9 (MMP-9), squamous cell cancer antigen (SCC) and carcinoembryonic antigen (CEA) in the sera of esophageal cancer patients. Clin Chim Acta. 2008;389:61–6.CrossRefPubMed Mroczko B, Kozłowski M, Groblewska M, Łukaszewicz M, Nikliński J, Jelski W, et al. The diagnostic value of the measurement of matrix metalloproteinase 9 (MMP-9), squamous cell cancer antigen (SCC) and carcinoembryonic antigen (CEA) in the sera of esophageal cancer patients. Clin Chim Acta. 2008;389:61–6.CrossRefPubMed
19.
go back to reference Aide N, Huchet V, Switsers O, Heutte N, Delozier T, Hardouin A et al. Influence of CA 15-3 blood level and doubling time on diagnostic performances of 18F-FDG PET in breast cancer patients with occult recurrence. Nucl Med Commun. 2007;28:267–72. Aide N, Huchet V, Switsers O, Heutte N, Delozier T, Hardouin A et al. Influence of CA 15-3 blood level and doubling time on diagnostic performances of 18F-FDG PET in breast cancer patients with occult recurrence. Nucl Med Commun. 2007;28:267–72.
20.
go back to reference Chen YK, Hsieh DS, Liao CS, Bai CH, Su CT, Shen YY, et al. Utility of FDG-PET for investigating unexplained serum AFP elevation in patients with suspected hepatocellular carcinoma recurrence. Anticancer Res. 2005;25:4719–25.PubMed Chen YK, Hsieh DS, Liao CS, Bai CH, Su CT, Shen YY, et al. Utility of FDG-PET for investigating unexplained serum AFP elevation in patients with suspected hepatocellular carcinoma recurrence. Anticancer Res. 2005;25:4719–25.PubMed
21.
go back to reference Murakami M, Miyamoto T, Iida T, Tsukada H, Watanabe M, Shida M, et al. Whole-body positron emission tomography and tumor marker CA125 for detection of recurrence in epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16(Suppl 1):99–107.CrossRefPubMed Murakami M, Miyamoto T, Iida T, Tsukada H, Watanabe M, Shida M, et al. Whole-body positron emission tomography and tumor marker CA125 for detection of recurrence in epithelial ovarian cancer. Int J Gynecol Cancer. 2006;16(Suppl 1):99–107.CrossRefPubMed
22.
go back to reference Jiménez-Bonilla J, Maldonado A, Morales S, Salud A, Zomeño M, Román J, et al. Clinical impact of 18F-FDG-PET in the suspicion of recurrent ovarian carcinoma based on elevated tumor marker serum levels. Clin Positron Imaging. 2000;3:231–6.CrossRefPubMed Jiménez-Bonilla J, Maldonado A, Morales S, Salud A, Zomeño M, Román J, et al. Clinical impact of 18F-FDG-PET in the suspicion of recurrent ovarian carcinoma based on elevated tumor marker serum levels. Clin Positron Imaging. 2000;3:231–6.CrossRefPubMed
23.
go back to reference Chang WC, Hung YC, Kao CH, Yen RF, Shen YY, Lin CC. Usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated serum levels of tumor marker. Neoplasma. 2002;49:329–33.PubMed Chang WC, Hung YC, Kao CH, Yen RF, Shen YY, Lin CC. Usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based on asymptomatically elevated serum levels of tumor marker. Neoplasma. 2002;49:329–33.PubMed
24.
go back to reference Chang WC, Hung YC, Lin CC, Shen YY, Kao CH. Usefulness of FDG-PET to detect recurrent cervical cancer based on asymptomatically elevated tumor marker serum levels—a preliminary report. Cancer Invest. 2004;22:180–4.CrossRefPubMed Chang WC, Hung YC, Lin CC, Shen YY, Kao CH. Usefulness of FDG-PET to detect recurrent cervical cancer based on asymptomatically elevated tumor marker serum levels—a preliminary report. Cancer Invest. 2004;22:180–4.CrossRefPubMed
25.
go back to reference Maussier ML, Valenza V, Schinco G, Galli G. AFP, CEA, CA 19-9 and TPA in hepatocellular carcinoma. Int J Biol Markers. 1990;5:121–6.PubMed Maussier ML, Valenza V, Schinco G, Galli G. AFP, CEA, CA 19-9 and TPA in hepatocellular carcinoma. Int J Biol Markers. 1990;5:121–6.PubMed
26.
go back to reference Grazi GL, Mazziotti A, Legnani C, Jovine E, Miniero R, Gallucci A, et al. The role of tumor markers in the diagnosis of hepatocellular carcinoma, with special reference to the des-gamma-carboxy prothrombin. Liver Transpl Surg. 1995;1:249–55.CrossRefPubMed Grazi GL, Mazziotti A, Legnani C, Jovine E, Miniero R, Gallucci A, et al. The role of tumor markers in the diagnosis of hepatocellular carcinoma, with special reference to the des-gamma-carboxy prothrombin. Liver Transpl Surg. 1995;1:249–55.CrossRefPubMed
27.
go back to reference Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.CrossRefPubMed Antoch G, Saoudi N, Kuehl H, Dahmen G, Mueller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.CrossRefPubMed
28.
go back to reference Nakamoto Y, Sakamoto S, Okada T, Senda M, Higashi T, Saga T, et al. Clinical value of manual fusion of PET and CT images in patients with suspected recurrent colorectal cancer. AJR Am J Roentgenol. 2007;188:257–67.CrossRefPubMed Nakamoto Y, Sakamoto S, Okada T, Senda M, Higashi T, Saga T, et al. Clinical value of manual fusion of PET and CT images in patients with suspected recurrent colorectal cancer. AJR Am J Roentgenol. 2007;188:257–67.CrossRefPubMed
Metadata
Title
Prevalence of positive FDG-PET findings in patients with high CEA levels
Authors
Tsuyoshi Suga
Yuji Nakamoto
Tsuneo Saga
Tatsuya Higashi
Tadashi Hara
Koichi Ishizu
Hidemitsu Nishizawa
Kaori Togashi
Publication date
01-07-2010
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 6/2010
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-010-0387-5

Other articles of this Issue 6/2010

Annals of Nuclear Medicine 6/2010 Go to the issue