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

Abstract

BackgroundThe aim of this study was to evaluate the value of CA15-3 for the diagnostic integration of molecular imaging findings performed with hybrid positron emission tomography and computed tomography (PETCT) technology.MethodsWe retrospectively selected 45 patients with a median age of 60 years (range 39–85 years) and a previous history of breast cancer (BC) who had already been treated with surgery and other treatments. Three measurements of CA15-3 were collected within 1 year before PETCT examination, at 6–9 months 3–6 months and 0–3 months before PETCT. The prolonged clinical outcome or imaging follow-up was used to define disease relapse. An increase in tumor marker value was compared with PETCT findings and disease relapse. Sensitivity and specificity for both tests were calculated with respect to clinical outcome.ResultsDisease relapse was detected in 16 out of 45 BC patients. CA15-3 and PETCT showed 75% sensitivity with a specificity percentage of 76% for CA15-3 and 79% for PETCT. Serum CA15-3 expression levels were significantly higher in BC patients with multiple metastatic sites with hepatic involvement. Analysis of serial CA15-3 serum levels showed an increase in CA15-3 3–6 months before PETCT could identify BC patients at risk for relapse (AUC = 0.81). Moreover, patients receiving anti-hormonal or chemotherapy medications with negative PETCT and positive CA15-3 relapsed after a median time of 158 days compared to patients who were negative for both tests and who were free from disease for at least 1 year.ConclusionsOur results showed that serial increases in CA15-3 can be used to predict positive PETCT results in BC patients during follow-up. Increased levels of CA15-3 may be considered an early warning sign in patients needing accurate molecular imaging investigations, as they are at higher risk of recurrence. In cases of elevated levels, multiple lesions or liver involvement may exist. Also, patients receiving chemotherapeutic or anti-hormonal treatment who have negative PETCT scans and increased CA15-3 serum levels should be considered at risk for relapse, because the CA15-3-linked biochemical signal of the presence of a tumor can predict positive metabolic imaging.

Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up 18F-FDG PET/CT Scans in Oncology Patients

“…Moreover, our results showed that follow-up 18 F-FDG PET/CT scans with other different indications, including prior clinical suspicion of tumor recurrence, prior rising tumor marker or abnormal laboratory tests suggesting recurrence, prior rising tumor markers or abnormal laboratory tests, therapy response assessment of recurrence, intratherapy assessment of recurrence, and follow-up scanning to assess the previous equivocal response, led to a change in the management of patients in 20%-40% of scan times. Previous studies also evaluated the value of 18 F-FDG PET/CT imaging after rising tumor markers or clinical suspicion of tumor recurrence, concluding that 18 F-FDG PET/CT is a good noninvasive imaging modality in these 2 settings to confirm or rule out tumor recurrences (4,12,29,30). Also, multiple studies confirmed the value of 18 F-FDG PET/CT scan in the therapy assessment setting after chemoradiation therapy in several cancer types (31)(32)(33).…”

SDN Biobank: Bioresource of Human Samples Associated with Functional and/or Morphological Bioimaging Results for the Study of Oncological, Cardiological, Neurological, and Metabolic Diseases

“…The mission coincides with the institutional role (recognized by the Italian Ministry of Health) of the IRCCS SDN, which is to optimize and improve scientific knowledge in the field of in vivo and in vitro diagnostic integration [1,2]. The IRCCS SDN is equipped with cutting-edge technologies that include positron emission tomography with integrated computed tomography (PET/CT) and PET with integrated magnetic resonance imaging (PET/MRI).…”

Potential Use of Biomarkers to Augment Clinical Decisions for the Early Detection of Breast Cancer

“…Early studies suggested that it had limited sensitivity in the diagnosis of breast cancer, 28 but a recent study evaluating the value of CA15-3 for the diagnostic integration of molecular imaging findings performed with hybrid PET/CT technology, found that serial increases in CA15-3 could be used to predict positive PET/CT results. 38 Following early clinical data supporting the use of the tumor marker CA27.29 in monitoring therapeutic response, 39 Recently, panels of autoantibodies discovered by Drs Anderson and LaBaer have led to the exciting prospect of a screening test that incorporates many autoantibodies, each with a specificity of 80-90 %. 39 In order to increase the predictive value of tumor-specific autoantibodies for use as immunodiagnostics, this research has focused on testing multiple antigens in parallel.…”