Scar or recurrent rectal cancer. Positron emission tomography is more helpful for diagnosis than immunoscintigraphy

We used positron emission tomography and fludeoxyglucose F 18 to assess metabolic activity of a pelvic mass in 18 patients who had suspected recurrent rectal cancer. Computed tomography could not differentiate tumor from scar. All patients presenting increased uptake of fludeoxyglucose F 18 by the mass were proved by histologic studies to suffer from recurrent tumor. Six of seven patients with low fludeoxyglucose uptake had nonmalignant lesions. Using immunoscintigraphy in 14 patients with elevated carcinoembryonic antigen levels, only four of ten recurrences could be identified by increased antibody accumulation in the mass. On the other hand, two of four benign lesions were interpreted as being recurrent tumor because of high uptake. Therefore, only positron emission tomography seems to be a useful diagnostic tool in the differentiation of recurrent rectal cancer and scar by providing information about the metabolic activity of a mass.