Abstract. The aim of the present retrospective study was to evaluate the sensitivity and specificity of fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing the recurrence of colorectal cancer (CRC) with regard to carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). 18 F-FDG PET/CT was performed in 100 patients for the re-staging of CRC. Therapy was discontinued prior to the examination. The mean (± standard deviation) CEA value (measured ~30 days prior to PET/CT examination) was 23.71 (±107) ng/ml, whereas the CA 19-9 value was 72 (±190.3) U/ml. Differences in CEA and CA 19-9 values in patients with scans that were positive or negative for recurrence were analyzed by means of a receiver operating characteristic (ROC) curve. ROC curves were used for the calculation of the sensitivity and specificity of 18 F-FDG PET/CT for the CEA and CA 19-9 levels. The results of the 18 F-FDG PET/CT were found to be associated with the CEA level (P= 0.001), but not with the CA 19-9 level (P= 0.43). PET/CT was positive for recurrence in 60 patients (60.0%), whose mean CEA and CA 19-9 values were 33.07±136.7 ng/ml and 75.24±192.3 U/ml, respectively. PET/CT was negative for recurrence in 40 patients (40.0%), whose mean CEA and CA 19-9 values were 10.15±30 ng/ml and 67.76±190 U/ml, respectively. On the basis of ROC curve analysis, the best compromise between sensitivity and specificity was achieved for CEA levels of 3.5 ng/ml [sensitivity, 80%; 95% confidence interval (CI), 67-89%; and specificity, 60%; 95% CI, 45-78%]. The study concluded that the detection of recurrence by 18 F-FDG PET/CT in patients treated for CRC is associated with CEA, but not CA 19-9 serum levels. Moreover, 18 F-FDG PET/CT should be recommended in patients with suspected CRC recurrence even when they present with CEA levels below the normal cut-off.

Recently, there has been debate regarding the definition of ‘breakthrough pain’ and the patients to whom the term applies, with suggestions made to broaden the definition to include both patients with uncontrolled and controlled baseline pain, rather than only patients with controlled pain. To contribute to this discussion, the authors assessed the occurrence and characteristics of breakthrough pain among patients with controlled and uncontrolled baseline pain.

Sponsorship for article processing charges was provided by Molteni Farmaceutici, Florence, Italy.

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