Elsevier

Surgical Oncology

Volume 22, Issue 2, June 2013, Pages 139-143
Surgical Oncology

Review
18FDG PET-CT for diagnosis of distant metastases in breast cancer patients. A meta-analysis

https://doi.org/10.1016/j.suronc.2013.03.001Get rights and content

Abstract

Background

We performed a meta-analysis to evaluate the value of 18FDG PET-CT for diagnosis of distant metastases in breast cancer patients.

Methods

Studies about PET-CT were systematically searched in the MEDLINE and EMBASE databases. We calculated sensitivities, specificities, likelihood ratios, and constructed summary receiver operating characteristic curves for PET-CT. We also compared the performance of PET-CT with that of conventional imaging by analyzing studies that had also used conventional imaging on the same patients.

Results

Across 8 PET-CT studies (748 patients), sensitivity and specificity of PET-CT were 0.96 (95% confidence interval [CI] = 0.90–0.98) and 0.95 (95% CI = 0.92–0.97). Across 6 comparative studies (664 patients), sensitivity and specificity of PET-CT were 0.97 (95% CI = 0.84–0.99) and 0.95 (95% CI = 0.93–0.97), and of conventional imaging were 0.56 (95% CI = 0.38–0.74) and 0.91 (95% CI = 0.78–0.97), respectively.

Conclusions

Compared with conventional imaging, 18FDG PET-CT has higher sensitivity for diagnosis of distant metastases in breast cancer patients.

Introduction

Breast cancer is the most common non-skin cancer, and the second leading cause of cancer death in women [1]. About 40% of advanced breast cancer patients will develop distant metastases within 5 years after the initial diagnosis [2], [3]. Early diagnosis of distant metastases is crucial for the choice of an adequate therapeutic strategy.

Conventional imaging (such as chest radiography, abdominal ultrasonography, and bone scan) is widely used to diagnose distant metastases in breast cancer patients. If additional suspicious lesions were found, computed tomography or magnetic resonance imaging was performed. However, conventional imaging is difficult to distinguish potential distant lesions from benign findings, with only a sensitivity of about 40% [4], [5]. Integrated PET-CT could provide more anatomical details and allow better correlation of the PET images. 18FDG PET-CT is expected to become a standard method for distant metastases in breast cancer patients [6]. Now many studies about 18FDG PET-CT for diagnosis of distant metastases in breast cancer patients have been reported. But results from these studies are controversial because of the limited sample size of single studies. Here, we performed a meta-analysis to evaluate the accuracy of 18FDG PET-CT for diagnosis of distant metastases in breast cancer patients and to compare its accuracy against conventional imaging.

Section snippets

Literature search

Two investigators (L.S.W and W.D.Z) performed a systematic literature search of the MEDLINE and EMBASE databases to identify relevant studies in human subjects (last update October 30, 2012), with the following combination of search terms: (a) breast neoplasm OR breast cancer OR breast carcinoma; (b) distant metastases OR staging; and (c) PET OR positron emission tomography. There was no language restriction on the initial search. The scope of literature search was enlarged on the basis of the

Literature identification

On the basis of the computer search and extensive cross-checking of reference lists, a total of 13 potentially articles about PET-CT for distant metastases in breast cancer patients were retrieved from Pubmed and Embase. After the enlarged search on the basis of the reference lists of all 13 potentially articles, no additional article was found. Of these articles, four articles [11], [12], [13], [14] were excluded because totals of true positives, false positives, true negatives, and false

Discussion

The early diagnosis of distant metastases is crucial for choosing the most effective management and evaluating the treatment outcome in breast cancer patients. In this meta-analysis, we obtained summary estimates of sensitivity and specificity, and constructed the HSROC curve of 18FDG PET-CT. We considered 7 PET-CT studies (594 patients) for inclusion in this meta-analysis. And the pooled sensitivity and specificity of PET-CT were 0.96 and 0.95. Across 6 comparative studies (664 patients),

Conflict of interest statement

The authors declare that they have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing their contribution.

Authorship statement

Guarantor of the integrity of the study: Shengying Wang.

Study concepts: Shengying Wang.

Study design: Shikai Hong, Junhong Li, Shengying Wang.

Definition of intellectual content: Shikai Hong, Junhong Li, Shengying Wang.

Literature research: Shikai Hong, Junhong Li, Shengying Wang.

Clinical studies: Shikai Hong, Junhong Li, Shengying Wang.

Data acquisition: Shikai Hong, Junhong Li, Shengying Wang.

Data analysis: Shikai Hong, Junhong Li, Shengying Wang.

Statistical analysis: Shikai Hong, Junhong Li,

Acknowledgment

No external found was received in this study.

References (28)

  • A.C. Voogd et al.

    Dutch Study Group on Local Recurrence after Breast Conservation (BORST). Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients

    Cancer

    (1999)
  • J. Dose et al.

    Comparison of fluorodeoxyglucose positron emission tomography and “conventional diagnostic procedures” for the detection of distant metastases in breast cancer patients

    Nucl Med Commun

    (2002)
  • H. Schirrmeister et al.

    Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures

    Eur J Nucl Med

    (2001)
  • D. Fuster et al.

    Preoperative staging of large primary breast cancer with [18F] fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures

    J Clin Oncol

    (2008)
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