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.
Highlights
The 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
The daily clinical experiences in monitoring Breast cancer (BC) patients after primary therapy demonstrate that any significant increase in tumor markers, even in the absence of other clinical or instrumental signs of cancer, justifies PETCT examination [14,15]
The European Group on Tumor Markers (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 [20,21,22,23]
Summary
The 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. Breast cancer (BC) is by far the most frequent type of cancer in women worldwide, but it is associated with relatively lower mortality rates, as it ranks fifth in cancer-related deaths overall [1] These data mostly reflect improvements in the treatment of BC recurrences and metastases due to the availability of new drugs and biological therapies [1]. Whole-body PETCT is a very useful diagnostic technology, especially when BC recurrence is suspected in asymptomatic patients with elevated tumor marker levels and negative conventional imaging results [6,7,8] In this case, the early detection of disease relapse greatly improves the chances for successful treatment. Only the European Group on Tumor Markers (EGTM) suggests that an increase in serum CA15-3 often predicts clinical or radiological signs of disease recurrence in BC patients, with an estimated lead time of 2–9 months [10,11,12]
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