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

Steven K. Libutti, H. Richard Alexander, Peter Choyke, David L. Bartlett, Stephen L. Bacharach, Millie Whatley, Frederic Jousse, William C. Eckelman, Karen Kranda, Ronald D. Neumann, Jorge A. Carrasquillo

Research output: Contribution to journalArticle

76 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)779-786
Number of pages8
JournalAnnals of Surgical Oncology
Volume8
Issue number10
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Carcinoembryonic Antigen
Fluorodeoxyglucose F18
Positron-Emission Tomography
Colonic Neoplasms
Laparotomy
Prospective Studies
Recurrence
Deoxyglucose
Colonoscopy
Abdomen
Colorectal Neoplasms
Tomography
Magnetic Resonance Imaging
Observation
Pathology

Keywords

  • Carcinoembryonic antigen
  • Colon cancer recurrence
  • FDG
  • Positron emission tomography
  • Radioimmunoscintigraphy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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. / Libutti, Steven K.; Alexander, H. Richard; Choyke, Peter; Bartlett, David L.; Bacharach, Stephen L.; Whatley, Millie; Jousse, Frederic; Eckelman, William C.; Kranda, Karen; Neumann, Ronald D.; Carrasquillo, Jorge A.

In: Annals of Surgical Oncology, Vol. 8, No. 10, 2001, p. 779-786.

Research output: Contribution to journalArticle

Libutti, Steven K. ; Alexander, H. Richard ; Choyke, Peter ; Bartlett, David L. ; Bacharach, Stephen L. ; Whatley, Millie ; Jousse, Frederic ; Eckelman, William C. ; Kranda, Karen ; Neumann, Ronald D. ; Carrasquillo, Jorge A. / 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. In: Annals of Surgical Oncology. 2001 ; Vol. 8, No. 10. pp. 779-786.
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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.",
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author = "Libutti, {Steven K.} and Alexander, {H. Richard} and Peter Choyke and Bartlett, {David L.} and Bacharach, {Stephen L.} and Millie Whatley and Frederic Jousse and Eckelman, {William C.} and Karen Kranda and Neumann, {Ronald D.} and Carrasquillo, {Jorge A.}",
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T1 - 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

AU - Libutti, Steven K.

AU - Alexander, H. Richard

AU - Choyke, Peter

AU - Bartlett, David L.

AU - Bacharach, Stephen L.

AU - Whatley, Millie

AU - Jousse, Frederic

AU - Eckelman, William C.

AU - Kranda, Karen

AU - Neumann, Ronald D.

AU - Carrasquillo, Jorge A.

PY - 2001

Y1 - 2001

N2 - 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.

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KW - Positron emission tomography

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