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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (6): 1071-1077. doi: 10.19723/j.issn.1671-167X.2019.06.017

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Diagnostic value of 18F-FDG PET/CT and tumor markers (CEA, CA19-9, CA24-2) in recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma

Xu-chu ZHANG,Jian-hua ZHANG,Rong-fu WANG(),Yan FAN,Zhan-li FU,Ping YAN,Guang-yu ZHAO,Yan-xia BAI   

  1. Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
  • Received:2017-10-24 Online:2019-12-18 Published:2019-12-19
  • Contact: Rong-fu WANG E-mail:rongfu_wang@163.com

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Abstract:

Objective: To evaluate the diagnostic value of 18F-FDG PET/CT and tumor markers (CEA,CA19-9,CA24-2) in detection for recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma.Methods: Fifty-five patients were enrolled in this study. All of the patients were tested with serum CEA within 2 weeks when they underwent 18F-FDG PET/CT scan, and some patients were tested with serum CA19-9 and CA24-2 simultaneously. According to the pathology and clinical results of their follow-up, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT and tumor markers were calculated based on different divided groups, respectively.Results: According to the pathology and the results of their clinical follow-up, the sensitivity of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 95.74%, 68.09%, 28.57%, 40.00% and 74.47%, respectively. The specificity of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 75.00%, 50.00%, 66.67%, 71.43% and 50.00%, respectively. The positive predictive value of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 95.74%, 88.89%, 85.71%, 88.89% and 89.74%, respectively. The negative predictive value of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 75.00%, 26.67%, 11.42%, 17.24%, 25.00%, respectively. The accuracy of 18F-FDG PET/CT, CEA, CA19-9, CA24-2 and the combination of those three tumor markers were 92.73%, 65.47%, 32.65%, 44.68% and 70.91%, respectively. There were 2 cases of false positive and 2 cases of false negative in 18F-FDG PET/CT.Conclusion: 18F-FDG PET/CT has high value in detecting recurrence and metastasis of postoperative colorectal carcinoma. Tumor markers have the positive value to imply the recurrence and metastasis of postoperative colorectal carcinoma and are useful to indicate when to perform the 18F-FDG PET/CT. The combination of tumor markers could improve the diagnostic efficiency to some extent.

Key words: Colorectal neoplasms, Positron emission tomography computed tomography, Biomarkers, tumor, Neoplasm recurrence, local, Neoplasm metastasis

CLC Number: 

  • R735.5

Table 1

The results of PET/CT, pathology and the group of tumor markers"

PET/CT Pathology CEA (n=55) CA19-9 (n=49) CA24-2 (n=47) Combination of tumor markers (n=55)
Elevated Normal Elevated Normal Elevated Normal Elevated Normal
Positive Positive 30 15 12 28 16 22 33 12
Positive Negative 1 1 1 1 1 1 1 1
Negative Negative 3 3 1 4 1 4 3 3
Negative Positive 2 0 0 2 0 2 2 0

Table 2

The efficiency of detection in PET/CT and tumor markers for recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma/%"

Testing items Sensitivity Specificity PPV NPV Accuracy
PET/CT (n=55) 95.74 75.00 95.74 75.00 92.73
CEA (n=55) 68.09 50.00 88.89 26.67 65.45
CA19-9 (n=49) 28.57 66.67 85.71 11.42 32.65
CA24-2 (n=47) 40.00 71.43 88.89 17.24 44.68
Combination of tumor markers (n=55) 74.47 50.00 89.74 25.00 70.91

Table 3

The efficiency of detection in PET/CT of tumor markers elevated group and normal group for recurrence and metastasis of postoperative colorectal moderately differentiated adenocarcinoma/%"

Group Sensitivity Specificity PPV NPV Accuracy
Elevated CEA (n=36) 93.75 75.00 96.77 60.00 91.67
Normal CEA (n=19) 100.00 75.00 93.75 100.00 94.74
Elevated CA19-9 (n=14) 100.00 50.00 92.31 100.00 92.86
Normal CA19-9 (n=35) 93.33 80.00 96.55 66.67 91.43
Elevated CA24-2 (n=18) 100.00 50.00 94.12 100.00 94.44
Normal CA24-2 (n=29) 91.67 80.00 95.56 66.67 89.66
Elevated tumor markers (n=39) 94.29 75.00 97.06 60.00 92.31
Normal tumor markers (n=16) 100.00 75.00 92.31 100.00 93.75

Figure 1

A patient of postoperation of rectum carcinoma, enlarged lymph node was showed near the right internal iliac artery, with normal tumor markers (CEA 1.86 μg/L, CA19-9 24.93 U/mL, CA24-2 18.13 U/mL) Marked 18F-FDG uptake on the enlarged lymph node near the right internal iliac artery."

Figure 2

A patient of postoperation of right colon carcinoma, cystic-solid lesion was found on the right annex region with considerate uptake of 18F-FDG, CEA 5.83 μg/L, CA19-9<0.60 U/mL, CA24-2 5.3 U/mL Marked 18F-FDG uptake on the right annex region was showed."

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