Mittal 2011.

Study characteristics
Patient sampling	Country India Study design Retrospective Setting Hospital Dates of data collection N/R Population (n) 73 Inclusion criteria Histologically proven postoperative CRC resection undergoing PET/CT and conventional imaging to detect suspected recurrence triggered by a rising CEA Exclusion criteria N/R Participants included (n) 73
Patient characteristics and setting	Age range 25 ‐ 80 Smoking status N/R Site of primary tumour Colorectal Stage of primary tumour N/R Perioperative investigations done to ensure no residual disease N/R Chemotherapy/radiotherapy? No Recurrences (n) 38 Site of recurrences N/R
Index tests	CEA timing Within 7 ‐ 10 days of imaging CEA technique Electro‐chemiluminescent immunoassay CEA threshold 3 µg/L Definition of positive 1 elevated value Which CEA value (s) used? At point of recurrence
Target condition and reference standard(s)	Reference standard PET/CT
Flow and timing	Timing of CEA vs reference standard (days) within 7‐10 days of CEA
Comparative
Notes
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Did the study avoid inappropriate exclusions?	No
		High	Low
DOMAIN 2: Index Test All CEA thresholds
If a threshold was used, was it pre‐specified?	Yes
Is the same method and instrument used for all CEA measurements?	Yes
Is there an estimation of reproducibility of the method, for example the % coefficient of variation at specific concentrations?	No
Is there an indication of method accuracy, for example, is there evidence of participation in an external quality assessment and proficiency testing scheme?	No
		Low	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
		Low	Low
DOMAIN 4: Flow and Timing
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
Was the index test repeated prior to the reference standard?	No
Was the the timing between index test(s) and reference standard ascertainable?	Yes
Did all patients receive a reference standard?	Yes
		Low