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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

From the Surgery Branch (SKL, HRA, DLB, KK), Center for Cancer Research, National Cancer Institute, Bethesda, Maryland; and the Departments of Diagnostic Radiology (PC), Nuclear Medicine (SLB, MW, FJ, RDN, JAC), and Positron Emission Tomography (WCE), the Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.

Correspondence: Address correspondence and reprint requests to: Steven K. Libutti, MD, National Institutes of Health/NCI, Building 10, Room 3C428, Bethesda, MD 20892-1502; Fax: 301-402-1788; E-mail: slibutti{at}nih.gov

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.

Key Words: Carcinoembryonic antigen • Positron emission tomography • FDG • Colon cancer recurrence • Radioimmunoscintigraphy

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