Review18FDG PET-CT for diagnosis of distant metastases in breast cancer patients. A meta-analysis
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.
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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.
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These authors contributed equally to this work as first author.