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The Quarterly Journal of Nuclear Medicine 2003 June;47(2):109-15


language: English

Is there a role for 99mTc-anti-CEA monoclonal antibody imaging in the diagnosis of recurrent colorectal carcinoma?

Fuster D. 1, 4, Maurel J. 2, Muxí A. 1, 4, Setoain X. 1, Ayuso C. 3, Martín F. 1, Ortega M. L. 1, Fuertes S. 1, Pons F. 1, 4

1 Department of Nuclear Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain 2 Department of Medical Oncology, Hospital Clinic, University of Barcelona, Barcelona, Spain 3 Department of Radiology, Hospital Clinic, University of Barcelona, Barcelona, Spain 4 «August Pi iSunyer» Institute of Biomedical Investigation (IDIBAPS)


Aim. To eval­u­ate the use­ful­ness of immu­nos­cin­tig­ra­phy ­with an ­anti-CEA mono­clo­nal anti­body frag­ment ­labelled ­with 99mTc for ear­ly detec­tion of color­ec­tal recur­rence in ­patients ­with ris­ing ser­um CEA lev­els.
Methods. Fifty-one con­sec­u­tive ­patients (27 wom­en, 24 men) ­with color­ec­tal can­cer (­mean age 68.9±10.2 ­years) and ris­ing CEA lev­els (16.2±18.2 ng/ml) ­were pros­pec­tive­ly stud­ied. Two immu­nos­cin­tig­ra­phy stud­ies ­were per­formed in 8 ­patients (n=59). Immunoscintigraphy was per­formed ­after i.v. injec­tion of 925 MBq of ­anti-CEA mono­clo­nal anti­body. Planar imag­es of the tho­rax, abdo­men and pel­vis, as ­well as ­SPECT of the abdo­men and pel­vis ­were ­obtained at 4 and 24 ­hours ­after injec­tion. In all cas­es an abdom­i­nal CT ­scan was pre­vi­ous­ly per­formed. Findings ­were val­i­dat­ed by his­to­path­o­log­i­cal anal­y­sis (28 cas­es) or by imag­ing and clin­i­cal fol­low-up of at ­least 6 ­months fol­low­ing the immu­nos­cin­tig­ra­phy (31 cas­es).
Results. Forty-one ­patients did not ­show recur­rence dur­ing fol­low-up. We ­found 18 cas­es ­with con­firmed diag­no­sis of extra­he­pat­ic abdom­i­nal or pel­vic dis­eases, 11 cas­es ­with liv­er metas­ta­ses, 9 in the tho­rax and 2 in the ­bone. In ­patients ­with pel­vic and extra­he­pat­ic abdom­i­nal dis­ease, immu­nos­cin­tig­ra­phy was pos­i­tive in 18 cas­es (14 ­true pos­i­tive, 4 ­false pos­i­tive). From the 14 ­true pos­i­tive ­only 7 cas­es had ­been detect­ed by CT. Immunoscintigraphy was neg­a­tive in the remain­ing 41 cas­es (37 ­true neg­a­tive, 4 ­false neg­a­tive). Therefore, the sen­si­tiv­ity and spec­i­fic­ity for immu­nos­cin­tig­ra­phy in extra­he­pat­ic abdom­i­nal and pel­vic dis­ease ­were 78% and 90%, respec­tive­ly. CT ­results ­showed a low­er sen­si­tiv­ity of 61% (p<0.05) and spec­i­fic­ity of 83%. Liver metas­ta­ses ­were detect­ed by CT in 9 cas­es, but ­only 2 of ­these ­were iden­ti­fied ­using immu­nos­cin­tig­ra­phy.
Conclusion. Scintigraphy ­with ­anti-CEA mono­clo­nal anti­body frag­ment ­labelled ­with 99mTc is super­i­or to CT for the detec­tion of pel­vic and extra­he­pat­ic abdom­i­nal recur­rence of color­ec­tal can­cer, ­while CT is ­more sen­si­tive in the detec­tion of liv­er and ­lung metas­ta­ses. Immunoscintigraphy has a lim­it­ed use­ful­ness in the detec­tion of dis­tant metas­ta­ses, but it may be help­ful in the diag­no­sis of sus­pect­ed color­ec­tal recur­rence in ­patients ­with non-con­clu­sive CT find­ings, ­when FDG-PET is not avail­able.

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