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Comparison of Immunoscintigraphy and Computerized Tomography in Identifying Colorectal Cancer: Individual Lesion Analysis¹

Departments of General Oncologic Surgery [R. M. C., J. D. B.], Diagnostic Radiology [D. M. Y., L. E. W.], Anatomic Pathology [J. M. E.], and Biostatistics [T. O-M.], City of Hope National Medical Center, Duarte, California 91010

Monoclonal antibody scintigraphy with ¹¹¹In-ZCE025 was used in presurgical staging of 45 patients prior to abdominal exploration for primary, recurrent or metastatic colorectal carcinoma. A total of 186 lesions were identified, of which 147 were evaluated by abdominal surgery and pathology. Sensitivity was 40.5% (49 of 121) for immunoscintigraphy (IS), 61.2% (74 of 121) for computerized tomography (CT), and 72.7% (88 of 121) for IS and CT combined. The positive predictive value was 83.1% (49 of 59) for IS and 88.1% (74 of 84) for CT. Sensitivity of IS was 100% (23 of 23) for primary tumors, 17.7% (11 of 62) for hepatic metastases, and 41.7% (15 of 36) for extrahepatic abdominal metastases. Of the 50 hepatic lesions evaluated by single-proton emission computerized tomography, 11 were localized by IS. Only one was visualized by planar scintigraphy. Sensitivity of CT was 87% (20 of 23) for primary tumors, 67.7% (42 of 62) for hepatic metastases, and 33.3% (12 of 36) for extrahepatic abdominal metastases. Sensitivity of IS combined with CT was 72.6% (45 of 62) for hepatic and 55.6% (20 of 36) for extrahepatic abdominal metastases. Of 24 malignant lesions measured by the pathologist to be <3.0 cm (maximum dimension), 7 (29.2%) were detected by IS and 3 (12.5%) by CT. Of 28 malignant lesions >3.0 cm, 23 (82.1%) were detected by IS and 24 (85.7%) by CT. Overall, IS and CT complemented each other in presurgical staging of colorectal carcinoma. IS was of greater value for identification of extrahepatic and small metastases. CT was more effective for identification of hepatic metastases.

¹ This work was supported in part by grants from the National Institutes of Health (RO1 CA42329, PO1 CA43904, and 5P30 CA33572).

² To whom requests for reprints should be addressed, at National Cancer Institute of Canada, 200-10 Alcorn Avenue, Toranto, Canada M4V 3B1.

Received 2/ 7/91. Accepted 7/17/91.