Pilot, multicenter and prospective trials with an anti-CEA antibody.

In this paper we summarize the investigations performed by our group utilizing an anti-CEA monoclonal antibody (F023C5) labelled with different radionuclides in humans. Since 1983 radioimmunoscintigraphy (RIS) was performed on 51 patients with 64 localizations of colo-rectal carcinoma (pilot study). A multicenter clinical trial in a large number of patients (509 pts of which 284 with gastrointestinal cancer) was subsequently carried out in collaboration with ten nuclear medicine centres. High sensitivity and specificity values were obtained by these studies and many unsuspected lesions were recorded. In order to better define the clinical role of RIS, a prospective study was performed on 59 patients with suspected local relapses of colo-rectal cancer. A comparative evaluation of RIS, CT scan, US and MRI was done. RIS and MRI had the highest accuracy (86%) followed by CT scan (68%) and US (54%).     

Clinical value of radioimmunoscintigraphy in the follow-up of ovarian carcinoma: a prospective study

Twenty-five patients treated with debulking surgery and chemotherapy for ovarian cancer were prospectively studied to evaluate the efficacy of radioimmunoscintigraphy (RIS) in detecting residual tumor before second-look surgery. RIS was performed with the monoclonal antibody OC125 F(ab')2 labelled with I-131 without knowledge of clinical data and compared with subsequent surgical results. Second look showed tumor persistence in 12 patients, mostly characterized by small lesions. The overall diagnostic sensitivity of RIS was 50% and the specificity was 85%. In particular, RIS showed better sensitivity for pelvic tumor localizations than for abdominal sites (73% vs 33%); this was due to the inability of RIS to detect upper abdominal lesions. Therefore, our conclusion is that, at present, RIS cannot substitute surgical second-look in the management of ovarian cancer, however, considering that also ultrasonography, computer tomography and magnetic resonance are not always able to give definite diagnostic evidence in the follow-up of ovarian carcinoma, RIS could be added to these procedures to balance the limitations of each method. In this regard, the best application of RIS could be in the follow-up of patients with marker elevation without clinical evidence of disease, especially in the case of pelvic fibrosis or adhesions due to previous therapy, where the other non-invasive tools can give doubtful diagnostic results.     

Radioimmunoscintigraphy using monoclonal antibodies to CEA, CA 19-9 and CA 125

131I labelled F (ab')2 fragments of monoclonal antibodies against CA 19-9 and CEA ("radioimmunococktail" IMACIS 1) were used in a prospective study (n = 60 patients) and in a retrospective study (n = 32 patients) for the detection of colorectal carcinomas (n = 67) and other gastrointestinal CEA/CA 19-9-producing tumors (n = 32). Sensitivity was 82% and specificity 90%. Immunoscintigraphy proved useful and complementary to CT scan and sonography, especially in the diagnosis of pelvic recurrences and intra-abdominal metastases. In addition, monoclonal antibody OC 125 (IMACIS 2) was used for the detection of ovarian carcinomas (n = 10) and other CA 125 producing tumors. Immunoscintigraphy was positive in all patients (n = 18) suggesting that this radioimmunological approach could be of use in the staging, therapeutic control and earlier diagnosis of recurrent epithelial ovarian carcinoma.     

Anti-CEA and other antibodies in the study of gastrointestinal tumors.

Localization of gastrointestinal tumors by means of labeled monoclonal antibodies is a new, sensitive and suitable technique currently used in several centers. Encouraging results have been documented with several monoclonal antibodies by different authors. This article reviews our experience with radioimmunoscintigraphy in 59 patients with colorectal cancer in follow-up, using 131I and 111In labeled B72.3, and in 16 patients with primary gastrointestinal tumors using 99mTc anti-CEA monoclonal antibody (type F023C5). The sensitivity of both B72.3 and anti-CEA was greater than 70% either for primary tumors and abdominal recurrences or distant metastases except hepatic ones. A significant gradient in antibody uptake was measured on surgical biopsies between tumors and normal tissues allowing a good in vivo contrast for gamma detection. We have defined the impact of some factors affecting in vivo tumor targeting. In fact, pharmacodynamics of MAbs, percentage of injected dose bound to tissues were measured, and in particular antigenic content in tumor nodules was quantified. Furthermore, the results of RIS were compared to those obtained by CT and other imaging modalities.     

CT联合肿瘤标志物与MRI联合肿瘤标志物对于直肠癌患者术前诊断 的准确率与特异性的研究

目的:探讨CT联合肿瘤标志物与MRI联合肿瘤标志物对于直肠癌患者术前诊断的准确率与特异性,为大肠癌的术前诊断提供一定的理论依据。方法:选取我院在2015年01月至2016年01月间收治的86例直肠癌患者以及64例肠道良性病变患者分别作为观察组I组和观察II组的研究对象,另外选取来我院进行健康体检的80例人员作为对照组研究,分别分析CT联合肿瘤标志物与MRI联合肿瘤标志物(CEA、CA125、CA199、CA242、CA724)对大肠癌患者诊断的准确率与特异性之间的差别。结果:观察I组肿瘤标志物水平要明显高于观察II组和对照组,差异显著,具有统计学意义;肿瘤标志物CEA、CA125、CA199、CA242、CA724对大肠癌患者检测的阳性率分别为67.44%(58/86)、26.74%(23/86)、84.88%(73/86)、72.09%(62/86)、33.72%(29/86),肿瘤标志物并联检测对大肠癌的阳性检测率为94.19%(81/86)。CT联合肿瘤标志物对大肠癌的准确率为97.67%(84/86),特异性为94.44%(136/144);MRI联合肿瘤标志物对大肠癌的阳性检测率为100.00%(86/86),特异性为98.61%(142/144)。结论:CT联合肿瘤标志物对大肠癌诊断的准确率与特异性均不如MRI联合肿瘤标志物,因此MRI联合肿瘤标志物可作为大肠癌除病理学鉴定外最佳的诊断方式。     

Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints

The objective of the study was, with multidetector computed tomography (CT) as the reference method, to determine whether bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints detected with magnetic resonance imaging (MRI) and ultrasonography (US), but not with radiography, represent true erosive changes. We included 17 RA patients with at least one, previously detected, radiographically invisible MCP joint MRI erosion, and four healthy control individuals. They all underwent CT, MRI, US and radiography of the 2nd to 5th MCP joints of one hand on the same day. Each imaging modality was evaluated for the presence of bone erosions in each MCP joint quadrant. In total, 336 quadrants were examined. The sensitivity, specificity and accuracy, respectively, for detecting bone erosions (with CT as the reference method) were 19%, 100% and 81% for radiography; 68%, 96% and 89% for MRI; and 42%, 91% and 80% for US. When the 16 quadrants with radiographic erosions were excluded from the analysis, similar values for MRI (65%, 96% and 90%) and US (30%, 92% and 80%) were obtained. CT and MRI detected at least one erosion in all patients but none in control individuals. US detected at least one erosion in 15 patients, however, erosion-like changes were seen on US in all control individuals. Nine patients had no erosions on radiography. In conclusion, with CT as the reference method, MRI and US exhibited high specificities (96% and 91%, respectively) in detecting bone erosions in RA MCP joints, even in the radiographically non-erosive joints (96% and 92%). The moderate sensitivities indicate that even more erosions than are seen on MRI and, particularly, US are present. Radiography exhibited high specificity (100%) but low sensitivity (19%). The present study strongly indicates that bone erosions, detected with MRI and US in RA patients, represent a loss of calcified tissue with cortical destruction, and therefore can be considered true bone erosions.     

Clinical value of (18)F-FDG PET/CT in postoperative monitoring for patients with colorectal carcinoma

Objective: To evaluate the clinical value of ¹⁸F-FDG PET/CT in postoperative monitoring for patients with colorectal carcinoma. Methods: 66 postoperative patients with colorectal carcinoma underwent whole-body FDG PET/CT. The final histopathological and formal clinical follow-up findings were used as gold standard to determine the sensitivity and specificity of FDG PET/CT and enhanced CT of the same periods. Results: The sensitivity and specificity of FDG PET/CT in detecting recurrence are 96.30%, 94.87% (while enhanced CT are 70.37% and 87.18% respectively). The sensitivity and specificity in detecting metastasis are 95.35%, 82.61% (enhanced CT are 61.90%, 75.00%). SUVmax was significantly higher in malignant lesions [range 4.16–22.00, mean ± standard deviation (x ± s) 8.06 ± 4.30] than in benign ones (range1.18–6.25, x ± s 2.82 ± 1.02). Conclusion: At present, whole-body ¹⁸F-FDG PET/CT is an advanced diagnostic imaging technique in detecting loco-regional recurrence and metastasis in postoperative patients with colorectal carcinoma for its higher sensitivity and specificity.     

Immunocytochemical detection of bone marrow micrometastases in colorectal carcinoma patients, using a monoclonal antibody to villin.

The search continues to find methods to more effectively distinguish colorectal carcinoma patients who could be separated into high-risk and low-risk categories. Investigators have reported on the detection of occult micrometastases in bone marrow using antibodies to cytokeratin, which is a marker of epithelial cells but which has no tissue specificity, as opposed to villin, a cytoskeletal protein that is specifically involved in the formation of brush-border microvilli in the small intestine and colon epithelium. Specificity and sensitivity of antibody to villin (ID2C3) and antibody to cytokeratin (A45-B/B3) were first studied in normal bone marrow and in a test system in which cancer cell lines were mixed in normal bone marrow. In a preliminary study including 16 colorectal carcinoma patients, we compared the number of villin-positive cells with cytokeratin-presenting cells. As A45-B/B3, ID2C3 was determined to be sensitive enough to detect one cancer cell in 10(6) hematopoietic cells. Staining of hematopoietic cells with irrelevant antibody and a light staining of megakaryocytes with ID2C3 limited the specificity of the method. In colorectal carcinoma patients, correlation between ID2C3 and A45-B/B3 was 94%. Sensitivity and specificity of ID2C3 antibody to villin were satisfactory. Its clinical relevance must be investigated in further studies.     

Prospective comparative study of ultrasound, CT-scan, scintigraphy and laboratory tests to detect hepatic metastases.

The conventional methods of CT scan (CT), ultrasound (US), scintigraphy (SC), and laboratory tests (LDH, AP, 5-Nt) were prospectively compared in 135 patients with gastrointestinal carcinoma to define the most useful test to detect hepatic metastases. Thirty-six patients (26.7%) had hepatic metastases at laparotomy. Sensitivities were low: 46% for SC, 58% for US, 68% for CT and 63% for LDH. Accuracies ranged from 62% (LDH) to 78% (SC). No significant differences were found. Accurate and efficient detection of hepatic metastases is hampered by the relatively low sensitivity, specificity and accuracy of conventional imaging and laboratory tests.     

Comparison of positron emission tomography/computed tomography imaging and ultrasound in surveillance of head and neck cancer – The 3-year experience of the ENT Department in Poznan

Background

Posttreatment surveillance for the local and regional recurrence of the head and neck squamous cell carcinoma often requires a multimodality techniques that include PET combined with CT, MRI, US.

Aim

The purpose of this study is to compare the diagnostic performance of two imaging techniques (PET/CT and US), and their combined use for the detection of a subclinical regional recurrence in patients after HNSCC treatment.

Materials and methods

83 patients after completion of the HNSCC treatment underwent both US and PET/CT on the mean follow-up of 14 months after initial treatment.

Results

The sensitivity and specificity of PET/CT were 86% and 82%, respectively; US values reached 81% and 87%, respectively. PPV was 79% for PET/CT, and 83% for US. NPV was 89% for PET/CT, and 85% for US. The overall accuracy for PET/CT and US was 84% for both methods.

Conclusion

US could be regarded as complementary to PET/CT as the procedures with highest sensitivity, specificity and NPV for detecting subclinical regional recurrences after HNSCC treatment.     

Imaging Non-Specific Wrist Pain: Interobserver Agreement and Diagnostic Accuracy of SPECT/CT,MRI, CT,Bone Scan and Plain Radiographs

Purpose

Chronic hand and wrist pain is a common clinical issue for orthopaedic surgeons and rheumatologists. The purpose of this study was 1. To analyze the interobserver agreement of SPECT/CT, MRI, CT, bone scan and plain radiographs in patients with non-specific pain of the hand and wrist, and 2. to assess the diagnostic accuracy of these imaging methods in this selected patient population.

Materials and Methods

Thirty-two consecutive patients with non-specific pain of the hand or wrist were evaluated retrospectively. All patients had been imaged by plain radiographs, planar early-phase imaging (bone scan), late-phase imaging (SPECT/CT including bone scan and CT), and MRI. Two experienced and two inexperienced readers analyzed the images with a standardized read-out protocol. Reading criteria were lesion detection and localisation, type and etiology of the underlying pathology. Diagnostic accuracy and interobserver agreement were determined for all readers and imaging modalities.

Results

The most accurate modality for experienced readers was SPECT/CT (accuracy 77%), followed by MRI (56%). The best performing, though little accurate modality for inexperienced readers was also SPECT/CT (44%), followed by MRI and bone scan (38% each). The interobserver agreement of experienced readers was generally high in SPECT/CT concerning lesion detection (kappa 0.93, MRI 0.72), localisation (kappa 0.91, MRI 0.75) and etiology (kappa 0.85, MRI 0.74), while MRI yielded better results on typification of lesions (kappa 0.75, SPECT/CT 0.69). There was poor agreement between experienced and inexperienced readers in SPECT/CT and MRI.

Conclusions

SPECT/CT proved to be the most helpful imaging modality in patients with non-specific wrist pain. The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. We believe it is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of chronic wrist pain.     

螺旋CT三期扫描在肝癌诊断中的价值

目的：探讨肝癌螺旋CT多期扫描影像特征和临床应用价值.方法：对诊断为肝癌的83例患者先行全肝CT平扫,其中73例不论肿瘤大小（包括21例结节型）先作病灶动脉期扫描,再作全肝静脉期扫描,最后进行病灶平衡期扫描.10例仅行动脉期及静脉期扫描.结果：83例中57例为巨块型（68.67%）,16例为结节型（19.27%）,10例为弥漫型（12.04%）.73例中CT平扫、动脉期、静脉期及平衡期病灶的显示率分别为89%、98%、92%、98%.结论：螺旋多期扫描能获得肿瘤在各期增强征象,为肝癌的定性定量诊断提供更多的影像诊断信息;尤其在早期肝癌诊断,动脉期扫描可得到非常重要的诊断依据.     

Stereotactic radiotherapy for liver oligometastases

The liver is the first metastatic site in 15–25% of colorectal cancer patients and one of the first metastatic sites for lung and breast cancer patients.A computed tomography (CT ) scan with contrast medium is a standard procedure for assessing liver lesions but magnetic resonance imaging (MRI) characterizes small lesions better thanks to its high soft-tissue contrast. Positron emission tomography with computed tomography (PET-CT ) plays a complementary role in the diagnosis of liver metastases. Triphasic (arterial, venous and time-delayed) acquisition of contrast-medium CT images is the first step in treatment planning. Since the liver exhibits a relatively wide mobility due to respiratory movements and bowel filling, appropriate techniques are needed for target identification and motion management. Contouring requires precise recognition of target lesion edges. Information from contrast MRI and/or PET-CT is crucial as they best visualize metastatic disease in the parenchyma. Even though different fractionation schedules were reported, doses and fractionation schedules for liver stereotactic radiotherapy (SRT ) have not yet been established. The best local control rates were obtained with BED₁₀ values over 100 Gy. Local control rates from most retrospective studies, which were limited by short follow-ups and included different primary tumors with intrinsic heterogeneity, ranged from 60% to 90% at 1 and 2 years. The most common SRT-related toxicities are increases in liver enzymes, hyperbilirubinemia and hypoalbuminemia. Overall, late toxicity is mild even in long-term follow-ups.     

Radioimmunolocalization of pelvic recurrences from rectosigmoid cancer employing 111In anti-CEA F(ab′)2

Thirty-two immunoscintigraphic studies have been performed in 26 patients previously operated upon for rectosigmoid cancer, for an early detection of pelvic recurrence, employing ¹¹¹In anti-CEA, F(ab′)₂. The sensitivity was 1, specificity 0.76 and accuracy 0.84, leading to a positive predictive value of 0.69 and a negative value of 1. The combined use of a non-imaging surgical probe in 6 of the 10 patients who underwent second look surgery, detecting the ¹¹¹In radioactivity used for RIS, improved diagnostic accuracy, ruling out the presence of tumors in 3 patients with false positive RIS.     

Comprehensive Comparison of Multiple-Detector Computed Tomography and Dynamic Magnetic Resonance Imaging in the Diagnosis of Hepatocellular Carcinoma with Varying Degrees of Fibrosis

Methods841 patients with liver tumor who had liver CT or dynamic MRI examinations followed by surgical resection were included in the study. We defined typical HCC imaging characteristics as early enhancement in the artery phase and early washout in the venous phase. The tumor size was recorded based on pathological examination after surgery. The pathologic fibrosis score was verified by the METAVIR scoring classification.ResultsAmong the 841 patients, 756 underwent liver CT and 204 underwent dynamic liver MRI before surgery. The etiologies of chronic liver disease included hepatitis B virus, hepatitis C virus, hepatitis B and C virus, and non-hepatitis B or C virus. The sensitivity and accuracy of liver CT or MRI for HCC diagnosis was approximately 80%~90%. Liver CT had a diagnostic accuracy for HCC similar to that of dynamic MRI, and liver fibrosis stage did not influence their diagnostic efficacies.ConclusionsThe application of 4-phase dynamic CT and MRI exhibit similar diagnostic accuracy for hepatocellular carcinoma, in tumors of sizes 1 to 2 cm and >2 cm. Liver fibrosis status did not affect the diagnostic accuracy of liver CT or MRI for HCC. The AASLD and EASL restrictions of dynamic imaging studies for HCC diagnosis to cirrhotic patients alone are unnecessary.     

Imaging and movement of iron-oxide-bound antibody microparticles in brain and cerebrospinal fluid.

Therapy with monoclonal antibody conjugates has been proposed for patients with malignant intracranial tumors and meningeal carcinomatosis. One obstacle to successful immunotherapy has been the inability of adequate quantities of antibody to reach and bind malignant cells. The use of superparamagnetic antibody microparticles offers a potential solution to the problem of inadequate antibody delivery. In this report, studies of the imaging characteristics and magnetically-induced movement of iron oxide-bound antibody (IOAb) microparticles [BioMag] are described. 1 mg/ml IOAb was readily visualized using conventional CT scan technique, but produced image artifacts on MRI. Rapid movement of IOAb in vitro was noted to occur in response to a magnetic field gradient. This property was exploited in in vivo studies using laboratory animals. IOAb injected into the intrathecal space of sedated rats could be transported through the CSF and localized to the medial aspect of one cerebral hemisphere or the other, using an external magnet. Construction of specific microparticles may allow for improved delivery of therapeutic substances to specific sites within CSF pathways.     

Confirmation of histology of PET positive lymph nodes recovered by hand-video-assisted thoracoscopy surgery

PET/CT (Positron Emission Tomography-Computed Tomography) is an advanced diagnostic imaging device that combines both PET and an X-ray CT. This study evaluates the effects of PET/CT on detecting primary tumors and metastases, and looks at the therapeutic effect of minimally invasive surgery on esophageal cancer patients. Eighty patients with esophageal cancer were enrolled in the study between January, 2004 and December, 2007, who were randomly divided into two groups of 40, one of which was treated with hand-video-assisted thoracoscopy surgery (HVATS) esophagectomy and one of which was treated with conventional surgery. All patients underwent a PET/CT scan 2-3weeks before their operation, and their cervical, thoracic and upper abdominal lymph nodes were biopsied. All the primary esophageal lesions showed high FDG uptake. The maximum standardized uptake value (SUV) was 3.78-25.64 (11.73±5.32), while the mean SUV was 3.65=16.92 (9.12±4.37). Using 2.5 as the SUV standard, all esophageal lesions were detected by PET/CT image. Of the 80 patients, 53 had lymph nodal metastases, with a total of 142 metastatic lymph nodes, which showed high FDG uptake. The maximum SUV was 2.77-14.63 (7.98±3.25), and the mean SUV was 2.31-12.84 (5.34±3.19). The visual analysis from the PET/CT scan showed a sensitivity of 86.62%, a specificity of 95.85%, a positive predictive value of 93.89%, a negative predictive value of 90.69% and an accuracy of 91.94%. The PET/CT scan showed a high sensitivity and specificity in detecting primary esophageal cancer and lymph nodal metastases. The mean post-surgery life expectancies for patients undergoing HVATS and conventional surgery are 27.93months and 28.05months, respectively. The two groups showed no statistically significant difference. We thus conclude that PET/CT combined with HVATS is a new choice for esophageal carcinoma patients.     

基于微纳技术的循环肿瘤细胞免疫检测新方法北大核心CSCD

本研究旨在探索一种高灵敏度、高特异性检测循环肿瘤细胞(circulating tumor cells, CTCs)的免疫检测新方法,以尽早地检出结直肠癌,提高该疾病的检出率。首先制备含有线性微柱结构的微芯片,通过在其表面孵育氧化石墨烯-链霉亲和素(graphite oxide-streptavidin, GO-SA)及偶联广谱一抗(antibody1, Ab₁),即上皮特异性黏附分子(epithelial cell adhesion molecule, EpCAM)单克隆抗体以捕获CTCs。运用羧基化多壁碳纳米管(carboxylated multi-walled carbon nanotubes, MWCNTs-COOH)与结直肠癌相关抗体,即特异性二抗(antibody 2, Ab₂)偶联制备抗体复合物。在捕获CTCs的微芯片上孵育该抗体复合物,构建以Ab₁-CTCs-Ab₂为主体的超级三明治结构,通过电化学工作站检测并验证其高灵敏度和高特异性。结果发现,在免疫传感器的构建中结合应用微纳技术,极大地提高了CTCs的检测灵敏度和特异性。本研究验证了该免疫传感器应用于临床血样检测的可行性,并通过该免疫传感器对结直肠癌患者外周血中CTCs进行检测和计数。结果表明,基于微纳技术的超级三明治式免疫传感器为CTCs的检测提供了新的途径,对临床工作中的疾病诊断及病情实时监控方面均具有潜在的应用价值。     

18F-2-deoxy-2-fluoro-D-glucose positron emission tomography, computed tomography, and magnetic resonance imaging for the detection of experimental colorectal liver metastases

During the treatment of colorectal liver metastases, evaluation of treatment efficacy is of the utmost importance for decision making. The aim of the present study was to explore the ability of preclinical imaging modalities to detect experimental liver metastases. Nine male Wag/Rij rats underwent a laparotomy with intraportal injection of CC531 tumor cells. On days 7, 10, and 14 after tumor induction, sequential positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging (MRI) scans were acquired of each rat. At each time point, three rats were euthanized and the metastases in the liver were documented histologically. Topographically, the liver was divided into eight segments and the image findings were compared on a segment-by-segment basis with the histopathologic findings. Sixty-four liver segments were analyzed, 20 of which contained tumor deposits. The overall sensitivity of PET, CT, and MRI was 30%, 25%, and 20%, respectively. For the detection of tumors with a histologic diameter exceeding 1 mm (n = 8), the sensitivity of PET, CT, and MRI was 63%, 38%, and 38%, respectively. The overall specificity of PET, CT, and MRI was 98%, 100%, and 93%, respectively. This study showed encouraging detectability and sensitivity for preclinical imaging of small liver tumors and provides valuable information on the imaging techniques for designing future protocols.     

DNA quantification in colorectal carcinoma using flow and image analysis cytometry

Numerous studies using flow cytometry (FCM) have shown that DNA quantification and ploidy classification can provide information of prognostic significance for patients with colorectal carcinoma; recent advances in image analysis cytometry (image cytometry, ICM) provide a new, alternative technique for DNA quantification. This study investigated whether (1) patients with colorectal carcinomas that exhibit a diploid pattern of DNA distribution have improved five-year survival statistics as compared to their non-diploid counterparts and (2) ICM provides quantitative data comparable to that obtained by FCM. DNA quantification and ploidy classification of 27 cases of primary colorectal carcinoma was performed on archival paraffin-embedded tissue by both FCM and ICM; 70% (19) of the tumors were classified as nondiploid by ICM while 56% (15) were similarly classified by FCM. Diploid tumors were associated with Dukes' stage A while nondiploid tumors were associated with Dukes' stage D. The overall five-year survival rate was 75% for patients with ICM diploid tumors and 67% for patients with FCM diploid tumors. The five-year survival was only 53% for patients with nondiploid tumors identified by both techniques. This study confirmed that DNA quantification is an important prognostic indicator for patients with colorectal carcinoma. It also showed that ICM provides data comparable to that of FCM and may be more sensitive.