Diagnostic efficacy of 18F-FDG-PET or PET/CT in breast cancer with suspected recurrence

Abstract

The early detection of suspiciously recurrent breast cancer is of significant importance. The aim of the present meta-analysis was to evaluate the overall diagnostic accuracy of fluorine-18 fluorodeoxyglucose (F-FDG)-PET or PET/computed tomography (CT) for the detection of relapse in suspected recurrent breast cancer. Medline, Embase, Web of Science, and Cochrane databases were searched for articles on suspiciously recurrent breast cancer and F-FDG-PET or PET/CT up to 10 January 2016. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC) were calculated. A meta-regression analysis was carried out to explore potential sources of heterogeneity. A total of 26 studies with 1752 patients with suspiciously recurrent breast cancer were included for the analysis; among these, 56.8% because of elevation of tumor markers, in 33.9%, there was suspicion on conventional imaging modalities, and in 9.4%, suggestive clinical symptoms or physical examinations were found. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of F-FDG-PET or PET/CT were 0.90 [95% confidence interval (CI), 0.88-0.90], 0.81 (95% CI, 0.78-0.84), 4.64 (95% CI, 3.50-6.14), 0.12 (95% CI, 0.08-0.16), and 46.52 (95% CI, 29.44-73.51), respectively. In addition, the overall AUC of F-FDG-PET or PET/CT was 0.9358. Meta-regression analysis showed that type of imaging modality (PET over PET/CT) might be a potential source of heterogeneity (P=0.0799). Furthermore, a subgroup analysis indicated that PET/CT appeared to harbor more specificity in the diagnosis of recurrent breast cancer (0.823 vs. 0.796, P=0.035). The increased AUC suggested increased accuracy of PET/CT over PET (0.9477 vs. 0.9111). F-FDG-PET, and in particular F-FDG-PET/CT, seemed to be a more valuable supplement to current surveillance techniques to detect relapse in suspected recurrent breast cancer patients.