Carcinoembryonic antigen immunoscintigraphy complements mammography in the diagnosis of breast carcinoma

David M. Goldenberg, Hani Abdel-Nabi, Cynthia L. Sullivan, Aldo Serafini, David Seldin, Bruce Barron, Lamk Lamki, Bruce Line, William A. Wegener

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19 Citations (Scopus)

Abstract

BACKGROUND. An adjunctive noninvasive test that is predictable and highly specific for breast carcinoma would complement the high false-positive rate of mammography in certain patients. METHODS. This prospective, multicenter study evaluated the accuracy, safety, and immunogenicity of carcinoembryonic antigen (CEA) antibody imaging in women with known or suspected breast carcinoma. Scintigraphic breast images were obtained approximately 3-8 hours after the administration of technetium 99m (99Tc) labeled anti-CEA Fab' and correlated with histopathology. RESULTS. The 99Tc labeled anti-CEA Fab' detected tumor CEA expression in 46 of 49 women (94%) initially entered with known primary breast carcinoma regardless of histology or serum CEA levels. In women scheduled for biopsy confirmation of mammographic and physical examination findings, 104 99Tc labeled anti-CEA Fab' studies had a sensitivity of 61% (17 of 28 cases) and a specificity of 91% (69 of 76 cases). In total, 99Tc labeled anti-CEA Fab' detected 52 of 62 invasive ductal carcinomas, 5 of 5 invasive lobular carcinomas, and 3 of 6 noninvasive tumors (2 ductal carcinomas in situ and 1 intracystic papillary carcinoma). Tumor size significantly affected sensitivity (P = 0.041), with 11 of 14 missed lesions ≤ T1, and proliferative histology significantly affected specificity (P = 0.012), with 5 of 7 false-positive tumors being premalignant. In 50 breast carcinoma patients, 99Tc labeled anti-CEA Fab' also demonstrated axillary lymph node involvement regardless of serum CEA levels, with a sensitivity of 80% when more than three lymph nodes were positive. No immune response of other meaningful side effects occurred. CONCLUSIONS. 99Tc labeled anti-CEA Fab' had high specificity and positive predictive values for breast carcinoma and the majority of false-positive studies were associated with an increased risk of malignancy. Improved imaging techniques, including dedicated gamma cameras for breast and axillary lymph node imaging, will likely improve the test's sensitivity for smaller lesions. (C) 2000 American Cancer Society.

Original languageEnglish
Pages (from-to)104-115
Number of pages12
JournalCancer
Volume89
Issue number1
DOIs
Publication statusPublished - Jul 1 2000

Keywords

  • Antibodies
  • Arcitumomab
  • Breast carcinoma
  • Carcinoembryonic antigen
  • CEA- Scan
  • Diagnosis
  • Imaging
  • Immunoscintigraphy
  • Mammography

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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  • Cite this

    Goldenberg, D. M., Abdel-Nabi, H., Sullivan, C. L., Serafini, A., Seldin, D., Barron, B., Lamki, L., Line, B., & Wegener, W. A. (2000). Carcinoembryonic antigen immunoscintigraphy complements mammography in the diagnosis of breast carcinoma. Cancer, 89(1), 104-115. https://doi.org/10.1002/1097-0142(20000701)89:1<104::AID-CNCR15>3.0.CO;2-E