Comparison of whole-body PET/PET-CT and conventional imaging procedures for distant metastasis staging in patients with breast cancer: a meta-analysis

Aim: To compare the performance of whole-body PET/PET-CT with that of conventional imaging procedures for the overall assessment of distant metastasis in patients with breast cancer. Materials and Methods: The authors performed a meta-analysis of all available studies of whole-body PET/PET-CT compared with conventional imaging procedures. They calculated sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and constructed summary receiver operating characteristic (ROC) curves using bivariate regression models for whole-body PET/PET-CT and conventional imaging procedures, respectively. Results: Across six studies (609 patients), sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios of whole-body PET/PET-CT were 0.99 (95% confidence interval [CI] = 0.88–1.00), 0.95 (95% CI = 0.89–0.98), 21.1 (95% CI = 8.2–55.5), and 0.02 (95% CI = 0.001–0.13), respectively, and of conventional imaging procedures they were 0.57 (95% CI = 0.37–0.74), 0.88 (95% CI = 0.78–0.94), 4.8 (95% CI = 2.8–8.2) and 0.49 (95% CI = 0.33–0.74), respectively. Conclusion: Compared with conventional imaging procedures, whole-body PET/PET-CT had excellent diagnostic performance for distant metastasis staging in patients with breast cancer.

PET; Breast cancer; Distant metastasis; Meta-analysis.

[1] Smith R.A., Guisti R.: “The epidemiology of breast cancer”. In: Bas-set L.W., Jackson V.P., (eds). Diagnosis of diseases of the breast. Philadelphia: Saunders, 1996, 293.

[2] Halverson K.J., Perez C.A., Kuske R.R., Garcia D.M., Simpson J.R., Fineberg B.: “Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis”. Int. J. Radiat. Oncol. Biol. Phys., 1992, 23, 285.

[3] Voogd A.C., van Tienhoven G., Peterse H.L., Crommelin M.A., Rutgers E.J., van de Velde C.J., et al.: “Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch Study Group on Local Recurrence after Breast Conservation (BORST)”. Cancer, 1999, 85, 437.

[4] van Tienhoven G., Voogd A.C., Peterse J.L., Nielsen M., Andersen K.W., Mignolet F., et al.: “Prognosis after treatment for locoregional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group”. Eur. J. Cancer, 1999, 35, 32.

[5] Dose J., Bleckmann C., Bachmann S., Bohuslavizki K.H., Berger J., Jenicke L., 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, 23, 857.

[6] Schirrmeister H., Kühn T., Guhlmann A., Santjohanser C., Hörster T., Nüssle K., 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, 28, 351.

[7] Mahner S., Schirrmacher S., Brenner W., Jenicke L., Habermann C.R., Avril N., Dose-Schwarz J.: “Comparison between positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-Dglucose, conventional imaging and computed tomography for staging of breast cancer”. Ann. Oncol., 2008, 19, 1249.

[8] Fuster D., Duch J., Paredes P., Velasco M., Muñoz M., Santamaría G., 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, 26, 4746.

[9] Whiting P., Rutjes A.W., Reitsma J.B., Bossuyt P.M., Kleijnen J.: “The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews”. BMC Med. Res. Methodol., 2003, 3, 25.

[10] Chu H., Cole S.R.: “Bivariate meta-analysis of sensitivity and specificity with sparse data: a general linear mixed model approach”. J. Clin. Epidemiol., 2006, 59, 1331.

[11] Reitsma J.B., Glas A.S., Rutjes A.W., Scholten R.J., Bossuyt P.M., Zwinderman A.H.: “Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews”. J. Clin. Epidemiol., 2005, 58, 982.

[12] Jaeschke R., Guyatt G.H., Sackett D.L.: “Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group”. JAMA, 1994, 271, 703.

[13] Gallowitsch H.J., Kresnik E., Gasser J., Kumnig G., Igerc I., Mikosch P., Lind P.: “F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging”. Invest. Radiol., 2003, 38, 250.

[14] Garami Z., Hascsi Z., Varga J., Dinya T., Tanyi M., Garai I., et al.: “The value of 18-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan”. Eur. J. Surg. Oncol., 2012, 38, 31.

[15] Dose-Schwarz J., Mahner S., Schirrmacher S., Jenicke L., Müller V., Habermann C.R., Brenner W.: “Detection of metastases in breast cancer patients: comparison of FDG PET with chest X-ray, bone scintigraphy and ultrasound of the abdomen”. Nuklearmedizin, 2008, 47, 97.

[16] Aukema T.S., Rutgers E.J., Vogel W.V., Teertstra H.J., Oldenburg H.S., Vrancken Peeters M.T., et al.: “The role of FDG PET/CT in patients with locoregional breast cancer recurrence: a comparison to conventional imaging techniques”. Eur. J. Surg. Oncol., 2010, 36, 387.

[17] Niikura N., Costelloe C.M., Madewell J.E., Hayashi N., Yu T.K., Liu J., et al.: “FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer”. Oncologist, 2011, 16, 1111.

[18] Koolen B.B., Vrancken Peeters M.J., Aukema T.S., Vogel W.V., Oldenburg H.S., van der Hage J.A., et al.: “18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques”. Breast Cancer Res. Treat., 2012, 131, 117.

[19] Glas A.S., Lijmer J.G., Prins M.H., Bonsel G.J., Bossuyt P.M.: ‘The diagnostic odds ratio: a single indicator of test performance”. J. Clin. Epidemiol., 2003, 56, 1129.

[20] Deeks J.J.: “Systematic reviews of evaluations of diagnostic and screening tests”. In: Egger M., Smith G.D., Altman D.G., (eds). Systematic reviews in health care: meta-analysis in context. London, UK: BMJ Publishing Group, 2001, 248.

[21] Jaeschke R., Guyatt G., Lijmer J.: “Diagnostic tests”. In: Guyatt G., Rennie D., (eds). Users’ guides to the medical literature: a manual for evidence-based clinical practice. Chicago, IL: AMA Press, 2002, 121.

[22] Walker R.E., Eustace S.J.: “Whole-body magnetic resonance imaging: techniques, clinical indications, and future applications”. Semin. Musculoskelet. Radiol., 2001, 5, 5.

[23] Barkhausen J., Quick H.H., Lauenstein T., Goyen M., Ruehm S.G., Laub G., et al.: “Whole-body MR imaging in 30 seconds with realtime true FISP and a continuously rolling table platform: feasibility study”. Radiology, 2001, 220, 252.

[24] Schmidt G.P., Baur-Melnyk A., Haug A., Heinemann V., Bauerfeind I., Reiser M.F., Schoenberg S.O.: “Comprehensive imaging of tumor recurrence in breast cancer patients using whole-body MRI at 1.5 and 3 T compared to FDG-PET-CT”. Eur. J. Radiol., 2008, 65, 47.