False-Positive Elevations of Carcinoembryonic Antigen in Patients With a History of Resected Colorectal Cancer

Routine monitoring of carcinoembryonic antigen (CEA) levels is standard in patients with resected colorectal cancer (CRC). The incidence of false-positives and the upper limits of false-positive elevations have not been previously well characterized. The computerized medical records at Memorial Sloan-Kettering were searched electronically, and then manually confirmed to identify patients who underwent an R0 resection of locoregional CRC between January 2003 and December 2012 and who had an increase in CEA level above the normal range after a normal perioperative CEA level. This search identified 728 patients who met all inclusion criteria. Of these, 358 (49%) were determined to have had a false-positive elevation of CEA level, 335 (46%) had a true-positive elevation of CEA level indicative of recurrent CRC, and 35 (5%) had a true-positive elevation of CEA level indicative of development of a new, non-CRC malignancy. Of those with false elevations, 111 had a single isolated CEA level elevation (median highest CEA level of 5.5 ng/mL; range, 5.1–45.2 ng/mL) with no further abnormal measurements, whereas 247 had CEA elevations on 2 or more readings, with a median highest CEA level of 6.7 ng/mL (range,5.2–34.9 ng/mL). Of these 247 patients with confirmed false-positive CEA level elevations, only 5 (2%) had measurements greater than 15 ng/mL, and no confirmed CEA elevation greater than 35 ng/mL was a false-positive. False-positive CEA test results in the range of 5 to 15 ng/mL are common. Confirmation of CEA elevation in this range prior to initiating imaging studies may be appropriate. False-positive CEA test results greater than 15 ng/mL are rare, and all confirmed CEAs greater than 35 ng/mL were associated with cancer recurrence.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Recognize the high incidence of false-positive elevations of carcinoebryonal antigen (CEA) in patients with a history of resected colorectal cancer (CRC)
  • Identify a level of CEA elevation that would indicate the need for imaging and diagnostic evaluations for possible recurrent disease and a level that would indicate that repeat CEA testing might be beneficial
  • Discuss some of the possible effects of false-positive CEA elevation in patients with resected CRC
Additional information
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Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
06/16/2014
Course expires: 
06/16/2015
Cost:
$0.00
Anya Litvak, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Rona D. Yaeger, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Andrea Cercek, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Nancy E. Kemeny, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Neil Segal, MD, PhD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Martin R. Weiser, MD
Department of Surgery
Memorial Sloan-Kettering Cancer Center
New York, New York
Diane Reidy-Lagunes, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Melissa S. Pessin, MD, PhD
Department of Laboratory Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Zsofia K. Stadler, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York
Leonard Saltz, MD
Gastrointestinal Oncology Service, Department of Medicine
Memorial Sloan-Kettering Cancer Center
New York, New York

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
06/16/2014
Course expires: 
06/16/2015

Price

Cost:
$0.00
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