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Rivista di Medicina Nucleare e Imaging Molecolare

A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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Guest Editors: Freeman L. M., Bombardieri E.

The Quarterly Journal of Nuclear Medicine 2002 June;46(2):88-104

lingua: Inglese

Circulating tumor markers and nuclear medicine imaging modalities: breast, prostate and ovarian cancer

Ugrinska A., Bombardieri E. *, Stokkel M. P. M., Crippa F. *, Pauwels E. K. J.

Department of Radiology Division of Nuclear Medicine Leiden University Medical Centre, Leiden, The Netherlands
* Division of Nuclear Medicine Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy


Clinical oncol­o­gists ­have ­always ­shown ­great inter­est in cir­cu­lat­ing ­tumor mark­ers. There are sev­er­al mark­ers ­that in the clin­i­cal rou­tine are a sig­nal of par­tic­u­lar ­tumor ­types; ­some of ­them are strict­ly tis­sue-spe­cif­ic ­such as pros­tat­ic spe­cif­ic anti­gen (PSA) for pros­tat­ic can­cer, AFP and HCG for ­germ ­cell ­tumors of the tes­tis and ­ovary, oth­ers ­such as CA 15.3, CA125, CEA or cyto­ker­a­tins are ­less spe­cif­ic ­since ­their ele­va­tions can be ­found in dif­fer­ent varie­ties of can­cers ­even if ­they are pref­e­ren­tial­ly asso­ciat­ed to a cer­tain ­tumor ­type, ­thus are con­sid­ered mark­ers for ­breast, ovar­ian can­cer and ­colon aden­o­car­cin­o­ma. The ­most use­ful clin­i­cal appli­ca­tions of ­these param­e­ters is ­their deter­mi­na­tion dur­ing the fol­low-up of the treat­ed ­patients, in ­order to ­detect the ­tumor recur­rence ear­ly, and ­also to eval­u­ate the evo­lu­tion of the dis­ease by mon­i­tor­ing the treat­ment respons­es. During fol­low-up, increas­ing lev­els of ­tumor mark­ers can be ­observed ­even sev­er­al ­months ­before the clin­i­cal dem­on­stra­tion of can­cer recur­rence. The asso­ci­a­tion of ­tumor mark­er ­tests ­with imag­ing modal­ities can ­lead to sev­er­al advan­tag­es: the ­first is to con­firm the diag­no­sis of relaps­es, pos­sibly ­before the appear­ence of the relat­ed clin­i­cal symp­toms due to ­tumor ­growth; the sec­ond is to local­ize the ­sites of ­lesions, ­while ­tumor mark­ers pro­vide ­only a gen­er­al indi­ca­tion of the exis­tence of metas­ta­ses; the ­third is to ­make pos­sible a cor­rect ­whole ­body restag­ing. In the assess­ment of can­cer ­response ­tumor mark­ers are ­often ­very reli­able and ­their chang­es are fast­er ­than the mor­pho­log­i­cal ­ones. Among all the imag­ing modal­ities, nucle­ar med­i­cine ­plays an impor­tant ­role in detect­ing recur­renc­es and met­a­stat­ic local­iza­tions as it is ­able to inves­ti­gate func­tion­al rath­er ­than mor­pho­log­i­cal ­aspects of ­tumors, and pro­vide dif­fer­ent infor­ma­tion in com­par­i­son to mor­pho­log­ic imag­ing. In addi­tion, the scin­ti­graph­ic tech­niques ­offer the pos­sibil­ity to eval­u­ate treat­ment respons­es, con­firm­ing or not the infor­ma­tion from bio­chem­i­cal chang­es. This ­review ­aims to ­show ­some exam­ples (­breast, pros­tate and ovar­ian can­cer) in ­which the com­bi­na­tion of nucle­ar med­i­cine imag­ing modal­ities and ­tumor mark­er ­tests is pro­posed for clin­i­cal prac­tice. The advan­tag­es and ­some crit­i­cal ­aspects are dis­cussed on the ­basis of the clin­i­cal find­ings and the ­most impor­tant clin­i­cal indi­ca­tions are ­described.

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