Breast cancer recurrence diagnosis suspected on tumor marker rising

Abstract

BACKGROUND: Breast cancer recurrence is often suspected on tumor marker rising in asymptomatic patients. The value of fluorine-18 fluorodeoxyglucose (18FDG)-positron emission tomography/computed tomography (PET/CT) imaging to detect recurrence and its subsequent impact on patient management were retrospectively assessed. METHODS: PET/CT scans were performed on 228 asymptomatic patients (mean, 60.8 years; range, 30-91 years) presenting with rising CA 15-3 and/or CEA serum levels. RESULTS: PET/CT scans were positive in 181 patients (79.5%) and normal in 47 patients, whereas 187 true recurrences were diagnosed. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT imaging for detection of breast cancer recurrence were 93.6%, 85.4%, 96.7%, 74.5%, and 92.1%, respectively. When compared with the standard workup available in 67 patients, PET/CT imaging had a higher sensitivity and accuracy (94.5% vs 33% and 94% vs 48%, respectively). Recurrences were confirmed by pathology, conventional imaging techniques, or radiological and clinical follow-up beyond 1 year (mean, 34 months; range, 12-67 years) in 32, 130, and 25 patients, respectively. The diagnosis of recurrence led to a treatment modification in 123 patients (54%). CONCLUSIONS: 18FDG-PET/CT imaging is an efficient technique to detect breast cancer recurrence suspected on tumor marker rising in asymptomatic patients. It may thus contribute to improve patient management, providing an earlier diagnosis with complete whole-body staging as a ''one-stop shop'' procedure.

CA15-3 is a useful serum tumor marker for diagnostic integration of hybrid positron emission tomography with integrated computed tomography during follow-up of breast cancer patients

“…Conversely, the EGTM, in agreement with the National Academy of Clinical Biochemistry guidelines and the European Association for Nuclear Medicine, suggests that increasing levels of serum tumor markers may often precede clinical or radiological signs of disease recurrence [18,19]. In addition to these recommendations, a growing number of scientific papers have re-evaluated the value of increased CA15-3 serum levels for early detection of recurrence, showing that serum determination of CA15-3 improves the diagnostic accuracy of PETCT [20-23]. …”

Relationship between computed tomography morphology and prognosis of patients with stage I non-small cell lung cancer

“…Computed tomography (CT) is considered an efficacious method for the diagnosis of asymptomatic patients with recurrent breast cancer, providing earlier diagnosis with complete whole-body staging as a “one-stop shop” procedure 8. Currently, the accuracy of CT screening for early lung cancer detection in heavy smokers is being examined by several randomized trials 9–11.…”

Is a comparative clinical trial for breast cancer tumor markers to monitor disease recurrence warranted? A value of information analysis

“…For example, we assume that confirmatory tests are 100% specific and sensitive. Given the relative accuracy of these confirmatory techniques [43,44], we felt that using a more complex decision model would result in relatively minor changes in our results, at the cost of adding substantially more computational burden.…”