Introduction
Materials and methods
Literature search
Selection of studies
Data extraction
Quality assessment
Statistical analysis
Results
Literature search and study design characteristics
Reference | Average age (range) | Patient selection | Study design | Sample patient | Evaluation patient/lesiona
| Recurrent/metastatic patient/lesiona
| Verification bias | Non-invasive imaging modality |
---|---|---|---|---|---|---|---|---|
Yilmaz et al. (2007) | 50 (30–73) | NA | Retrospective | 27 | 27 | 10 | Considerable | US, MRI |
Bongers et al. (2004) | 55 (31–90) | NA | Retrospective | 54 | 54/110a
| 31/42a
| No | SPECT |
Schmidt et al. (2008) | 55 (24–79) | Consecutive | Prospective | 33 | 33/263a
| 186a
| Limited | MRI, PET |
Radan et al. (2006) | 59 (32–79) | Consecutive | Retrospective | 46 | 46/171a
| 30/153a
| Considerable | PET |
Ternier et al. (2006) | 60 (32–82) | Consecutive | Prospective | 103 | 103 | 52 | Considerable | US, CT |
Rissanen et al. (1993) | NA | Consecutive | Prospective | 883 | 69 | 55 | Limited | US |
Bruneton et al. (1986) | NA | NA | Prospective | 60 | 60 | 22 | No | US |
Lee et al. (1993) | (31–77) | NA | Prospective | 40 | 10 | 9 | Limited | SPECT |
Gilles et al. (1993) | 57 (40–75) | NA | Prospective | 26 | 26 | 14 | Limited | MRI |
Dehdashti et al. (1995) | 54 (26–71) | NA | NA | 53 | 21 | 19 | Limited | PET |
Melani et al. (1995) | NA | NA | NA | 20 | 20 | 7 | No | MRI |
Hagay et al. (1996) | 57 (28–79) | NA | Prospective | 111 | 111/118a
| 42/46a
| Considerable | CT |
Winehouse et al. (1999) | 58 (41–79) | Consecutive | Prospective | 58 | 58 | 16 | No | US |
Rieber et al. (1997) | 52 (32–81) | NA | NA | 140 | 140 | 19 | Considerable | MRI |
Drew et al. (1998) | 58 (50–65) | NA | NA | 105 | 105 | 63 | Considerable | MRI |
Muüller et al. (1998) | (28–72) | NA | NA | 67 | 67 | 10 | Considerable | MRI |
Moon et al. (1998) | 55 (30–80) | NA | Retrospective | 57 | 57/80a
| 29/41a
| Considerable | PET |
Cwikla et al. (1998) | 58 (46–79) | NA | Prospective | 18 | 18 | 8/9a
| Considerable | SPECT |
Hathaway et al. (1999) | (45–71) | Consecutive | Retrospective | 10 | 10 | 9 | Considerable | PET, MRI |
Qayyum et al. (2000) | 60 (29–85) | Consecutive | Retrospective | 50 | 48 | 27 | Considerable | MRI |
Stuhrmann et al. (2000) | 47 (23–86) | NA | Prospective | 77 | 25/28a
| 17a
| Limited | US |
Bäz et al. (2000) | 59 (30–83) | NA | Prospective | 38 | 38 | 10 | No | US |
Eubank et al. (2001) | 49 (26–75) | Consecutive | Retrospective | 73 | 40 | 20 | Considerable | PET, CT |
Kim et al. (2001) | 46 (28–62) | NA | Prospective | 27 | 27/61a
| 17/48a
| Considerable | PET |
Belli et al. (2002) | NA | NA | NA | 40 | 40 | 22 | Limited | MRI |
Liu et al. (2002) | (38–65) | NA | NA | 30 | 30/50a
| 28/38a
| Limited | PET |
Goerres et al. (2003) | 57 (32–76) | NA | Prospective | 49 | 32 | 14 | Limited | MRI, PET |
Suárez et al. (2002) | 58 (35–80) | NA | NA | 45 | 38 | 26 | Considerable | PET |
Kamel et al. (2003) | 55 (30–79) | Consecutive | NA | 86 | 118a
| 88a
| Considerable | PET |
Gallowitsch et al. (2003) | 58 (45–71) | NA | Retrospective | 62 | 62 | 34 | Considerable | CT, SPECT, PET |
Siggelkow et al. (2003) | NA | NA | NA | 57 | 57 | 35 | Considerable | PET |
Eubank et al. (2004) | 49 (23–85) | Consecutive | Retrospective | 125 | 61 | 17 | Considerable | PET |
De Cicco et al. (2004) | 52 (30–75) | NA | NA | 40 | 40/44a
| 24a
| No | SPECT |
Shin et al. (2005) | 49 (32–67) | Consecutive | Retrospective | 1,968 | 1,968 | 34 | No | US |
Weir et al. (2005) | 52 (30–88) | Consecutive | Retrospective | 221 | 40a
| 18 | No | PET |
Lamuraglia et al. (2005) | 50 (44–70) | NA | Prospective | 10 | 10 | 3 | No | US |
Preda et al. (2006) | 53 (40–72) | Consecutive | Retrospective | 93 | 93 | 10 | Considerable | MRI |
Wolfort et al. (2006) | NA | Consecutive | Retrospective | 171 | 23 | 16 | Considerable | CT, PET |
Piperkova et al. (2007) | 55 (30–80) | NA | Retrospective | 49 | 257a
| 226a
| Considerable | CT, PET |
Rajkovaca et al. (2007) | NA | NA | NA | 28 | 28 | 19 | Limited | SPECT |
Usmani et al. (2007) | 47 (22–77) | Consecutive | NA | 26 | 26 | 18 | No | SPECT |
Haug et al. (2007) | 50 (28–73) | Consecutive | NA | 118 | 34 | 25 | Considerable | CT, PET |
Riebe et al. (2007) | NA | NA | NA | 27 | 27 | 11 | Considerable | US |
Author | TP | FP | FN | TN | Reason to perform US | Type of probe | Probe frequency | Contrast agent | Contrast dose | Image interpretation | Criteria for the presence of recurrent or metastatic lesions |
---|---|---|---|---|---|---|---|---|---|---|---|
Yilmaz et al. (2007) | 9 | 2 | 1 | 15 | Evaluated for locoregional recurrence | Linear | 7.5 MHz | No contrast | No contrast | NA | Yes |
Ternier et al. (2006) | 45 | 14 | 7 | 37 | Suspicion of recurrence | Real time | 10–13 MHz | No contrast | No contrast | Blind | Yes |
Rissanen et al. (1993) | 50 | 5 | 5 | 9 | Suspicion of recurrence | Real time | 7.5 MHz | No contrast | No contrast | Blind | Yes |
Bruneton et al. (1986) | 16 | 1 | 6 | 37 | Follow-up of breast cancer | NA | 5.7 MHz | No contrast | No contrast | NA | Yes |
Winehouse et al. (1999) | 15 | 14 | 1 | 28 | Suspicion of recurrence | Pulsed repetition | 800–1,000 kHz | Levovist | 8 ml | NA | Yes |
Stuhrmann et al. (2000) | 16 | 6 | 1 | 5 | Suspicion of recurrence | Linear | 5–10 MHz | Levovist | 4 g | Not blind | Yes |
Bäz et al. (2000) | 10 | 1 | 0 | 27 | Suspicion of recurrence | Linear | 10–7.5 MHz | Levovist | 3.2 g | Blind | Yes |
Shin et al. (2005) | 24 | 33 | 10 | 1,901 | Suspicion of recurrence | Linear | 5–12 MHz | No contrast | No contrast | Not blind | Yes |
Lamuraglia et al. (2005) | 2 | 0 | 1 | 7 | Suspicion of recurrence | NA | 9–14 MHz | Sonovue | 4.8 ml | NA | Yes |
Riebe et al. (2007) | 10 | 5 | 1 | 11 | Follow-up of breast cancer | NA | NA | No contrast | No contrast | Blind | Yes |
Author | TP | FP | FN | TN | Reason to perform CT | Technical | Slice thickness (mm) | Contrast agent | Contrast dose (ml) | Image interpretation | Criteria for the presence of recurrent or metastatic lesions |
---|---|---|---|---|---|---|---|---|---|---|---|
Radan et al. (2006) | 14 | 9 | 6 | 8 | TM evaluated | Helical | 4.25 | Non-ionic contrast | NA | Not blind | Yes |
Ternier et al. (2006) | 47 | 5 | 5 | 46 | Suspicion of recurrence | Helical | 3 | Non-ionic contrast | 100 | Blind | Yes |
Hagay et al. (1996) | 42 | 11 | 4 | 61 | Suspicion of recurrence | Helical | 5 | Iodinated contrast | 150 | Blind | Yes |
Eubank et al. (2001) | 8 | 3 | 12 | 17 | Suspicion of recurrence | Spiral | 5–7 | Iodinated contrast | 150 | Blinded | Yes |
Gallowitsch et al. (2003) | 28 | 9 | 5 | 15 | Follow-up of breast cancer | Spiral | 3–5 | Jopamiro | 300 | Blinded | NA |
Wolfort et al. (2006) | 9 | 0 | 4 | 7 | Suspicion of recurrence | NA | NA | NA | NA | NA | NA |
Piperkova et al. (2007) | 198 | 18 | 28 | 13 | Restaging | NA | 3.75 | Non-ionic contrast | NA | Blind | Yes |
Haug et al. (2007) | 23 | 2 | 2 | 7 | With surgically resected breast cancer | NA | 5 | Non-ionic contrast | 120 | Blind | Yes |
Author | TP | FP | FN | TN | Reason to perform MRI | Coil | Strength field (T) | Contrast agent | Contrast dose (mmol/kg) | Image interpretation | Criteria for the presence of recurrent or metastatic lesions |
---|---|---|---|---|---|---|---|---|---|---|---|
Yilmaz et al. (2007) | 10 | 0 | 0 | 17 | Evaluated for locoregional recurrence | A special dual breast coil | 1.0 | Magnevist | 0.2 | NA | Yes |
Schmidt et al. (2008) | 172 | 11 | 14 | 66 | Suspicion of recurrence | Multiple phased array surface coil | 1.5 | Gd-DTPA | 0.2 | Blinded | Yes |
Gilles et al. (1993) | 14 | 1 | 0 | 11 | Had been treated for breast cancer | Surface coil | 1.5 | Gd-DTPA | 0.1 | Blind | Yes |
Melani et al. (1995) | 7 | 1 | 0 | 12 | Suspicion of recurrence | NA | NA | Gd-DTPA | 0.15 | Blind | Yes |
Rieber et al. (1997) | 19 | 5 | 0 | 116 | Suspicion of local recurrent disease | Bilateral breast surface coil | 1.5 | Gd-DTPA | 0.15 | Not blind | Yes |
Drew et al. (1998) | 63 | 3 | 0 | 39 | Routine screening for local recurrence | NA | 1.5 | Gd-DTPA | NA | NA | Yes |
Muüller et al. (1998) | 10 | 2 | 0 | 55 | Performed following end of treatments | A mamma double coil | 1.5 | Gd-DTPA | 0.1 | NA | Yes |
Qayyum et al. (2000) | 26 | 1 | 1 | 20 | Suspicion of recurrence | A flexible surface coil | 1.5 | No contrast | No contrast | Blind | Yes |
Belli et al. (2002) | 22 | 2 | 0 | 16 | Suspicion of recurrence | NA | 1.5 | Gd-DTPA | NA | Blind | Yes |
Goerres et al. (2003) | 11 | 1 | 3 | 17 | Evaluated for locoregional recurrence | Breast surface coil | 1.5 | Gd-DTPA | 0.1 | Blinded | Yes |
Preda et al. (2006) | 9 | 7 | 1 | 76 | Suspicion of recurrence | Two-channel phased array bilateral dedicated coil | 1 | Gd-DTPA | 0.2 | Not blind | Yes |
Author | TP | FP | FN | TN | Reason to perform SPECT | Scanner | Delay image (min) | Contrast agent | Contrast dose (MBq) | Collimator | Image interpretation | Criteria |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Bongers et al. (2004) | 30 | 3 | 1 | 21 | Suspicion of recurrence | A single head gamma camera | 10 | 99mTc-tetrofosmin | 700 | A high-resolution collimator | Blinded | Yes |
Lee et al. (1993) | 8 | 0 | 1 | 1 | Suspicion of recurrence | An Anger camera | 120 | 201Ti-chloride | 3 mCi | A high-resolution collimator | Blinded | Yes |
Cwikla et al. (1998) | 8 | 3 | 1 | 23 | Suspicion of recurrence | NA | NA | 99mTc-MIBI | NA | A high-resolution collimator | Blinded | Yes |
Gallowitsch et al. (2003) | 97 | 7 | 11 | 20 | Follow-up of breast cancer | A double head camera | 180 | 99mTc-MDP | 740 | A LEUHR collimator | NA | Yes |
De Cicco et al. (2004) | 21 | 8 | 3 | 12 | Suspicion of recurrence | A single-head gamma camera | 5 | 99mTc-sestamibi | 740 | A high-resolution collimator | NA | Yes |
Rajkovaca et al. (2007) | 17 | 2 | 2 | 7 | Suspicion of recurrence | NA | NA | 99mTc-sestamibi | NA | A high-resolution collimator | NA | Yes |
Usmani et al. (2007) | 18 | 1 | 3 | 11 | Suspicion of recurrence | A double head camera | 5–10 | 99mTc-MIBI | 740–1,000 | A high-resolution collimator | Blind | Yes |
Author | TP | FP | FN | TN | Reason to perform PET | Fast hour (h) | FDG-dose | Range | Method | Image interpretation | Criteria |
---|---|---|---|---|---|---|---|---|---|---|---|
Schmidt et al. (2008) | 170 | 8 | 16 | 69 | Suspicion of recurrence | >6 | 202–378 MBq | Whole-body format | SUV | Blind | Yes |
Radan et al. (2006) | 151 | 5 | 2 | 13 | TM evaluated | >4 | 370–666 MBq | Whole-body format | SUV | Not blind | Yes |
Dehdashti et al. (1995) | 17 | 0 | 2 | 2 | Suspicion of recurrence | >4 | 370 MBq | Whole-body format | SUV | Blinded | Yes |
Moon et al. (1998) | 27 | 6 | 2 | 22 | Suspicion of recurrence | >6 | 370–555 MBq | A Whole-body mode | Visualization | Not blinded | Yes |
Hathaway et al. (1999) | 9 | 0 | 0 | 1 | Suspicion of recurrence | >4 | 260–370 MBq | Whole-body format | SUV | Blinded | Yes |
Kim et al. (2001) | 46 | 2 | 2 | 11 | Suspicion of recurrence | >12 | 370–555 MBq | From the buttom to cerebellum | Visualization SUV | NA | Yes |
Liu et al. (2002) | 35 | 2 | 3 | 10 | Suspicion of recurrence | >4 | 370 MBq | From the bladder level to the head | Visualization | Not blind | Yes |
Goerres et al. (2003) | 14 | 5 | 0 | 13 | Suspicion of recurrence | >4 | 386 MBq | From the pelvic to the head | SUV | Blinded | Yes |
Suárez et al. (2002) | 24 | 3 | 2 | 9 | TM evaluated | >4 | NA | Whole-body format | NA | Blinded | NA |
Kamel et al. (2003) | 85 | 5 | 3 | 25 | Suspicion of recurrence | >4 | 300–400 MBq | From head to pelvic floor | SUV | Blinded | Yes |
Gallowitsch et al. (2003) | 33 | 5 | 1 | 23 | Follow-up of breast cancer | >12 | 200 MBq | From the base of the skull to the thigh | Visualization | Blinded | Yes |
Siggelkow et al. (2003) | 31 | 3 | 4 | 35 | TM evaluated or suspicion of recurrence | >4 | NA | Whole-body format | Visualization | Blinded | Yes |
Eubank et al. (2004) | 16 | 4 | 1 | 40 | Suspicion of recurrence | >4 | 244–400 MBq | From the neck to the buttom of liver | SUV | Not blind | Yes |
Weir et al. (2005) | 8 | 2 | 1 | 16 | Suspicion of recurrence | >6 | 555 MBq | Whole-body format | NA | NA | NA |
Wolfort et al. (2006) | 13 | 0 | 1 | 7 | Suspicion of recurrence | NA | NA | NA | NA | NA | NA |
Piperkova et al. (2007) | 221 | 2 | 5 | 29 | Restaging | >4 | 10–15 mCi | From the mid-thigh to the base of the skull | SUV | Blind | Yes |
Haug et al. (2007) | 24 | 1 | 1 | 8 | With surgically resected breast cancer | >6 | 200 MBq | From the base of the skull to the middle of the femora | SUV | Blind | Yes |
Publication bias, heterogeneity and cutoff effect
Likelihood ratio | I2 index (%) | ||
---|---|---|---|
χ
2
|
p
| ||
Sensitivity | |||
US | 15.48 | 0.079 | 41.9 |
CT | 31.51 | 0.000 | 77.8 |
MRI | 22.13 | 0.014 | 54.8 |
SPECT | 2.66 | 0.85 | 0.0 |
PET | 23.24 | 0.108 | 31.1 |
Specificity | |||
US | 159.69 | 0.000 | 94.4 |
CT | 39.99 | 0.000 | 82.5 |
MRI | 11.38 | 0.328 | 12.2 |
SPECT | 8.72 | 0.19 | 31.2 |
PET | 15.58 | 0.483 | 0 |
Modality | AUC | Q* index | ρ value |
---|---|---|---|
US | 0.9251 | 0.8593 | 0.0890 |
CT | 0.8596 | 0.7904 | 0.6510 |
MRI | 0.9718 | 0.9228 | 0.9470 |
SMM | 0.9386 | 0.8757 | 0.9390 |
PET | 0.9604 | 0.9051 | 0.1390 |
Pooled sensitivity, pooled specificity and DORs
Modality | Sensitivity (%) | Specificity (%) | Diagnostic OR |
---|---|---|---|
US | 0.8570 (0.8040–0.8990) | 0.9620 (0.9540–0.9700) | 40.9280 (18.2940–91.5670) |
CT | 0.8480 (0.8110–0.8810) | 0.7530 (0.6920–0.8070) | 13.6200 (4.8870–37.9540) |
MRI | 0.9500 (0.9230–0.9700) | 0.9290 (0.9020–0.9500) | 131.7800 (70.9310–244.8100) |
SMM | 0.9000 (0.8530–0.9370) | 0.7980 (0.7150–0.8660) | 29.4190 (14.8800 –58.1640) |
PET | 0.9530 (0.9370–0.9650) | 0.8630 (0.8240–0.8950) | 106.8800 (68.1040–167.7300) |