The use and abuse of cea test in clinical practice

Abstract

Charts of 437 patients having plasma carcinoembryonic antigen determinations during the period January 1, 1976 through April 30, 1976 were reviewed to determine whether CEA results led to clinical decisions altering management patterns. Data analysis disclosed that CEA test results did not result in any change in management in 167 patients with non‐neoplastic disease. Most had single determinations. In 270 patients with neoplastic disease, CEA results led to changes in management in one patient with lung cancer and two patients with colon cancer, which may have altered prognosis. In a fourth patient, CEA results led to discovery of unresectable pancreatic cancer at laparotomy. Cost benefit analysis indicated a CEA test cost of $5,047 0.50 per patient benefitted in 299 patients eligible for analysis. We conclude that maximal benefit to the patient results from serial CEA test use in follow‐up of colon cancer patients after curative therapy.

Measurement of a monoclonal-antibody-defined antigen (CA 19-9) in the sera of patients with malignant and nonmalignant diseases comparison with carcinoembryonic antigen

“…Sera from 730 patients were analyzed for both CEA and CA19-9. Of these, 417 specimens were received in our laboratory for the analysis of CEA and the remaining 3 In 67 of these patients, 2 to 3 follow-up specimens were also analyzed for both CA19-9 and CEA during the 6month study. Data were analyzed using an ad hoc boolean computer program to determine sensitivity (positivity in disease), specificity (negativity in health), predictive values (probability of disease in positive or negative test), and efficiency (percent of patients correctly classified) for both CEA and C A I 9-9.14…”

The CEA Second-Look Trial: a randomised controlled trial of carcinoembryonic antigen prompted reoperation for recurrent colorectal cancer

“…CEA rose, on average, 4 months prior to clinical evidence of recurrence16 and there were reports of the use of serial serum CEA assays to detect asymptomatic recurrences in the belief that curative resection would be possible more frequently 15–17. Several groups used CEA in this way, and found low false-positive rates8 21 and the resectability rate of recurrence was higher than when clinical criteria were used to prompt reoperation 8. In the largest published experience of CEA in a postoperative monitoring role8 15 recurrent tumour, which was resectable, was found in 70% in whom reoperation was prompted by a rise in the serum CEA compared with a quarter of patients undergoing second-look laparotomy prompted by clinical indications.…”

“…Even if efficacy of CEA-detected recurrence was accepted, there was still the unresolved question of effectiveness: if more patients were detected and there were more instances of resectable recurrence, did that lead to better survival and patient benefit? The conflicting interpretations of observational data resulted in calls for trials15 21 22 including one within a 1981 NIH Consensus Statement 20…”

Carcinoembryonic antigen and recurrent colorectal cancer.

“…Of those patients undergoing laparotomy on the basis of a raised serum carcinoembryonic antigen, 85-90% prove to have abdominal recurrent disease and most of the remainder are found to have extra-abdominal metastases within a year or so of true carcinoembryonic antigen rise. '2[22][23][24][25] Thus it would appear that serum carcinoem-…”