Diagnositc Value of <sup>18</sup>F-FDG PET/CT for Breast Cancer and Axillary Lymph Node Metastases: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YANGPin ^1,2 , YANKun ^1,2 , LIJin-kui ¹ , YANRui-feng ^1,2 , LIFei-long ¹ , JIANGChang-qin ¹ ,  LEIJun-qiang ^1,2

1. First Clinical Medical School of Lanzhou University, First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China;
2. Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China;

Corresponding?author：

LEIJun-qiang, Email: leijq1990@163.com

Keywords：

Breast cancer; Positron emission computed tomography; Tomography; Metastases; Staging; Systematic review; Meta-analysis; Diagnostic test

DOI：

10.7507/1672-2531.20150052

Video：

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Objective To evaluate diagnostic value of ¹⁸F-FDG PET/CT for breast cancer and axillary lymph node metastases. Methods Literature search was conducted in PubMed (1966 to 2013.10, EMbase (1974 to 2013.10), The Cochrane Library (Issue 8, 2013), Web of Science (1950 to 2013.10), CBM (1978 to 2013.10), WanFang Data (1990 to 2013.10) and CNKI (1994 to 2013.10) to retrieve the diagnostic studies about PET/CT in the diagnosis of breast cancer and axillary lymph node metastasis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using Meta-DiSc 1.4 software. Results A total of 25 studies involving 2 089 patients met the eligible criteria. With the comparison of pathological results used as the gold standard, pooled sensitivity (Sen) and specificity (Spe), pooled positive likelihood ratio (+LR), pooled negative likelihood ratio (-LR), pooled diagnostic odds ratio (DOR) and the area under (AUC) of the summary receiver-operating characteristic curve (SROC) were:a) for diagnosing breast cancer, 0.69 (95%CI 0.60 to 0.76), 0.98 (95%CI 0.94 to 1.00), 10.75 (95%CI 4.10 to 28.16), 0.16 (95%CI 0.02 to 1.13), 56.76 (95%CI 17.50 to 184.14), 0.962 6; and b) axillary lymph node metastases, 0.63 (95%CI 0.59 to 0.66), 0.92 (95%CI 0.91 to 0.94), 6.01 (95%CI 4.07 to 8.89), 0.39 (95%CI 0.30 to 0.50), 17.35 (95%CI 10.58 to 28.46), 0.866 4. Conclusion ¹⁸F-FDG PET/CT has a middle-degree sensitivity and relatively good specificity in diagnosing breast cancer and axillary lymph node metastases which can be regarded as an effective and feasible method for preoperative staging of breast cancer.

Citation： YANGPin, YANKun, LIJin-kui, YANRui-feng, LIFei-long, JIANGChang-qin, LEIJun-qiang. Diagnositc Value of ¹⁸F-FDG PET/CT for Breast Cancer and Axillary Lymph Node Metastases: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(3): 305-311. doi: 10.7507/1672-2531.20150052 Copy

1.	Breast cancer:prevention and control. World Health Organization 2006.[cited 2013 Nov 7]. Available at:http://www.who.int/cancer/detection/breastcancer/en/index.html.
2.	戴文靜, 張偉. Pet/Ct在乳腺病變診斷中的應用價值. 腫瘤影像學, 2013, 22(2):125-128.
3.	李光. 乳腺癌腋窩淋巴結轉移患者中應用PET-CT、臨床觸診與B超診斷方法的意義與影響分析. 中國醫藥導刊. 2013, 15(3):451-452.
4.	毛俊峰, 施民新, 施冬輝. PET-CT在確定乳腺癌腋窩淋巴結轉移的價值. 中外醫學研究, 2012, 10(36):53-54.
5.	李靜. 納入研究的偏倚評價. 見:劉鳴, 主編. 系統評價、Meta-分析設計與實施方法(第1版). 北京:人民衛生出版社, 2011:72-74.
6.	張天嵩, 鐘文昭. Meta-DiSc軟件在診斷試驗Meta分析中的應用. 循證醫學, 2008, 8(2):97-108.
7.	唐立岷, 馬超. ¹⁸F-FDG PET/CT在診斷浸潤性乳腺癌和淋巴結轉移中的價值. 上海交通大學學報(醫學版), 2012, (6):761-765.
8.	趙繼紅, 丁軍, 徐松柏, 等. ¹⁸F-FDG PET/CT與MRI對乳腺癌診斷價值的比較. 吉林大學學報(醫學版), 2011, 37(4):746-749.
9.	楊傳盛, 黃湛, 張詮, 等. PET/CT對cT-(1-2)N-0M-0期乳腺癌腋窩淋巴結轉移的診斷價值. 實用癌癥雜志, 2011, 26(5):467-469.
10.	郭佳, 陳躍. ¹⁸F-FDG PET/CT顯像在診斷乳腺癌中的價值. 四川醫學, 2011, 32(2):258-260.
11.	宗祥云, 俞洋, 楊紅健. PET-CT在乳腺癌術前診斷與分期的臨床應用分析. 腫瘤學雜志, 2008, 14(7):578-580.
12.	魏偉宏, 蔣軍, 馮彥林. PET-CT診斷乳腺癌及其腋窩淋巴結轉移的價值. 腫瘤研究與臨床, 2008, 20(9):604-606,609.
13.	蔣軍. PET-CT、臨床觸診與B超診斷乳腺癌腋窩淋巴結轉移的作用評價. 現代醫院, 2008, 8(4):67-70.
14.	鄒海東, 馬榕, 余之剛, 等. PET/CT診斷乳腺癌及腋窩淋巴結狀態的作用評價. 外科理論與實踐, 2006, 11(2):108-111.
15.	孫憲昶, 劉慶偉, 趙素紅, 等. 多層螺旋CT和正電子發射計算機體層成像-CT評價乳腺癌腋窩淋巴結狀態的對照研究. 中華放射學雜志, 2008, 42(1):68-72.
16.	祖德貴, 劉慶偉, 李昕, 等. PET/CT與增強CT檢測乳腺癌及其腋淋巴結轉移的對照研究. 中華核醫學雜志, 2005, 25(4):200-202, 257.
17.	Riegger C, Koeninger A, Hartung V, et al. Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol, 2012, 53(10):1092-1098.
18.	Machida Y, Kubota K, Katayama T, et al. Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography combined with ultrasonography-guided fine needle aspiration cytology for identifying axillary lymph node status in patients with breast cancer. EJSO, 2013, 39(1):26-30.
19.	Hahn S, Hecktor J, Grabellus F, et al. Diagnostic accuracy of dual-time-point ¹⁸F-FDG PET/CT for the detection of axillary lymph node metastases in breast cancer patients. Acta Radiol, 2012, 53(5):518-523.
20.	Choi YJ, Shin YD, Kang YH, et al. The effects of preoperative ¹⁸F-FDG PET/CT in breast cancer patients in comparison to the conventional imaging study. J Breast Cancer, 2012, 15(4):441-448.
21.	Garami Z, Hascsi Z, Varga J, 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. EJSO, 2012, 38(1):31-37.
22.	Bernsdorf M, Berthelsen AK, Wielenga VT, et al. Preoperative PET/CT in early-stage breast cancer. Ann Oncol, 2012, 23(9):2277-2282.
23.	Choi WH, Yoo IR, Kim SH, et al. The value of dual-time-point ¹⁸F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients. Br J Radiol, 2011, 84(1003):593-599.
24.	Kong EJ, Chun KA, Cho IH, et al. ¹⁸F-FDG PET/CT with contrast enhancement for evaluation of axillary lymph node involvement in T1 breast cancer. Eur J Nucl Med Mol I, 2010, 44(3):170-176.
25.	Kim J, Lee J, Chang E, et al. Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients:Single Institutional Experience. World J Surg, 2009, 33(5):943-949.
26.	Monzawa S, Adachi S, Suzuki K, et al. Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography of breast cancer in detecting axillary lymph node metastasis:comparison with ultrasonography and contrast-enhanced CT. Ann Nucl Med, 2009, 23(10):855-861.
27.	Chae BJ, Bae JS, Kang BJ, et al. Positron Emission Tomography-Computed Tomography in the Detection of Axillary Lymph Node Metastasis in Patients with Early Stage Breast Cancer. J Clin Oncol, 2009, 39(5):284-289.
28.	Ueda S, Tsuda H, Asakawa H, et al. Utility of ¹⁸F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (¹⁸F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer. BMC Cancer, 2008, 8(14):165.
29.	Fuster D, Duch J, Paredes P, 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(29):4746-4751.
30.	李雪娜, 尹雅芙, 李亞明, 等. ¹⁸F-FDG PET/CT不同診斷方法對乳腺癌及其淋巴結轉移的應用價值. 中華核醫學雜志, 2008, 28(4):247-249.
31.	朱湘, 徐文貴, 馬文超, 等. (18)F-FDG PET-CT CT在診斷乳腺癌腋窩淋巴結轉移狀態的對比研究. 中國腫瘤臨床, 2010, 37(7):388-391.

1. Breast cancer:prevention and control. World Health Organization 2006.[cited 2013 Nov 7]. Available at:http://www.who.int/cancer/detection/breastcancer/en/index.html.
2. 戴文靜, 張偉. Pet/Ct在乳腺病變診斷中的應用價值. 腫瘤影像學, 2013, 22(2):125-128.
3. 李光. 乳腺癌腋窩淋巴結轉移患者中應用PET-CT、臨床觸診與B超診斷方法的意義與影響分析. 中國醫藥導刊. 2013, 15(3):451-452.
4. 毛俊峰, 施民新, 施冬輝. PET-CT在確定乳腺癌腋窩淋巴結轉移的價值. 中外醫學研究, 2012, 10(36):53-54.
5. 李靜. 納入研究的偏倚評價. 見:劉鳴, 主編. 系統評價、Meta-分析設計與實施方法(第1版). 北京:人民衛生出版社, 2011:72-74.
6. 張天嵩, 鐘文昭. Meta-DiSc軟件在診斷試驗Meta分析中的應用. 循證醫學, 2008, 8(2):97-108.
7. 唐立岷, 馬超. ¹⁸F-FDG PET/CT在診斷浸潤性乳腺癌和淋巴結轉移中的價值. 上海交通大學學報(醫學版), 2012, (6):761-765.
8. 趙繼紅, 丁軍, 徐松柏, 等. ¹⁸F-FDG PET/CT與MRI對乳腺癌診斷價值的比較. 吉林大學學報(醫學版), 2011, 37(4):746-749.
9. 楊傳盛, 黃湛, 張詮, 等. PET/CT對cT-(1-2)N-0M-0期乳腺癌腋窩淋巴結轉移的診斷價值. 實用癌癥雜志, 2011, 26(5):467-469.
10. 郭佳, 陳躍. ¹⁸F-FDG PET/CT顯像在診斷乳腺癌中的價值. 四川醫學, 2011, 32(2):258-260.
11. 宗祥云, 俞洋, 楊紅健. PET-CT在乳腺癌術前診斷與分期的臨床應用分析. 腫瘤學雜志, 2008, 14(7):578-580.
12. 魏偉宏, 蔣軍, 馮彥林. PET-CT診斷乳腺癌及其腋窩淋巴結轉移的價值. 腫瘤研究與臨床, 2008, 20(9):604-606,609.
13. 蔣軍. PET-CT、臨床觸診與B超診斷乳腺癌腋窩淋巴結轉移的作用評價. 現代醫院, 2008, 8(4):67-70.
14. 鄒海東, 馬榕, 余之剛, 等. PET/CT診斷乳腺癌及腋窩淋巴結狀態的作用評價. 外科理論與實踐, 2006, 11(2):108-111.
15. 孫憲昶, 劉慶偉, 趙素紅, 等. 多層螺旋CT和正電子發射計算機體層成像-CT評價乳腺癌腋窩淋巴結狀態的對照研究. 中華放射學雜志, 2008, 42(1):68-72.
16. 祖德貴, 劉慶偉, 李昕, 等. PET/CT與增強CT檢測乳腺癌及其腋淋巴結轉移的對照研究. 中華核醫學雜志, 2005, 25(4):200-202, 257.
17. Riegger C, Koeninger A, Hartung V, et al. Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol, 2012, 53(10):1092-1098.
18. Machida Y, Kubota K, Katayama T, et al. Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography combined with ultrasonography-guided fine needle aspiration cytology for identifying axillary lymph node status in patients with breast cancer. EJSO, 2013, 39(1):26-30.
19. Hahn S, Hecktor J, Grabellus F, et al. Diagnostic accuracy of dual-time-point ¹⁸F-FDG PET/CT for the detection of axillary lymph node metastases in breast cancer patients. Acta Radiol, 2012, 53(5):518-523.
20. Choi YJ, Shin YD, Kang YH, et al. The effects of preoperative ¹⁸F-FDG PET/CT in breast cancer patients in comparison to the conventional imaging study. J Breast Cancer, 2012, 15(4):441-448.
21. Garami Z, Hascsi Z, Varga J, 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. EJSO, 2012, 38(1):31-37.
22. Bernsdorf M, Berthelsen AK, Wielenga VT, et al. Preoperative PET/CT in early-stage breast cancer. Ann Oncol, 2012, 23(9):2277-2282.
23. Choi WH, Yoo IR, Kim SH, et al. The value of dual-time-point ¹⁸F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients. Br J Radiol, 2011, 84(1003):593-599.
24. Kong EJ, Chun KA, Cho IH, et al. ¹⁸F-FDG PET/CT with contrast enhancement for evaluation of axillary lymph node involvement in T1 breast cancer. Eur J Nucl Med Mol I, 2010, 44(3):170-176.
25. Kim J, Lee J, Chang E, et al. Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients:Single Institutional Experience. World J Surg, 2009, 33(5):943-949.
26. Monzawa S, Adachi S, Suzuki K, et al. Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography of breast cancer in detecting axillary lymph node metastasis:comparison with ultrasonography and contrast-enhanced CT. Ann Nucl Med, 2009, 23(10):855-861.
27. Chae BJ, Bae JS, Kang BJ, et al. Positron Emission Tomography-Computed Tomography in the Detection of Axillary Lymph Node Metastasis in Patients with Early Stage Breast Cancer. J Clin Oncol, 2009, 39(5):284-289.
28. Ueda S, Tsuda H, Asakawa H, et al. Utility of ¹⁸F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (¹⁸F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer. BMC Cancer, 2008, 8(14):165.
29. Fuster D, Duch J, Paredes P, 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(29):4746-4751.
30. 李雪娜, 尹雅芙, 李亞明, 等. ¹⁸F-FDG PET/CT不同診斷方法對乳腺癌及其淋巴結轉移的應用價值. 中華核醫學雜志, 2008, 28(4):247-249.
31. 朱湘, 徐文貴, 馬文超, 等. (18)F-FDG PET-CT CT在診斷乳腺癌腋窩淋巴結轉移狀態的對比研究. 中國腫瘤臨床, 2010, 37(7):388-391.

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Diagnositc Value of ¹⁸F-FDG PET/CT for Breast Cancer and Axillary Lymph Node Metastases: A Meta-analysis

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Diagnositc Value of 18F-FDG PET/CT for Breast Cancer and Axillary Lymph Node Metastases: A Meta-analysis

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Diagnositc Value of ¹⁸F-FDG PET/CT for Breast Cancer and Axillary Lymph Node Metastases: A Meta-analysis