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.	戴文静, 张伟. Pet/Ct在乳腺病变诊断中的应用价值. 肿瘤影像学, 2013, 22(2):125-128.
3.	李光. 乳腺癌腋窝淋巴结转移患者中应用PET-CT、临床触诊与B超诊断方法的意义与影响分析. 中国医药导刊. 2013, 15(3):451-452.
4.	毛俊峰, 施民新, 施冬辉. PET-CT在确定乳腺癌腋窝淋巴结转移的价值. 中外医学研究, 2012, 10(36):53-54.
5.	李静. 纳入研究的偏倚评价. 见:刘鸣, 主编. 系统评价、Meta-分析设计与实施方法(第1版). 北京:人民卫生出版社, 2011:72-74.
6.	张天嵩, 钟文昭. Meta-DiSc软件在诊断试验Meta分析中的应用. 循证医学, 2008, 8(2):97-108.
7.	唐立岷, 马超. ¹⁸F-FDG PET/CT在诊断浸润性乳腺癌和淋巴结转移中的价值. 上海交通大学学报(医学版), 2012, (6):761-765.
8.	赵继红, 丁军, 徐松柏, 等. ¹⁸F-FDG PET/CT与MRI对乳腺癌诊断价值的比较. 吉林大学学报(医学版), 2011, 37(4):746-749.
9.	杨传盛, 黄湛, 张诠, 等. PET/CT对cT-(1-2)N-0M-0期乳腺癌腋窝淋巴结转移的诊断价值. 实用癌症杂志, 2011, 26(5):467-469.
10.	郭佳, 陈跃. ¹⁸F-FDG PET/CT显像在诊断乳腺癌中的价值. 四川医学, 2011, 32(2):258-260.
11.	宗祥云, 俞洋, 杨红健. PET-CT在乳腺癌术前诊断与分期的临床应用分析. 肿瘤学杂志, 2008, 14(7):578-580.
12.	魏伟宏, 蒋军, 冯彦林. PET-CT诊断乳腺癌及其腋窝淋巴结转移的价值. 肿瘤研究与临床, 2008, 20(9):604-606,609.
13.	蒋军. PET-CT、临床触诊与B超诊断乳腺癌腋窝淋巴结转移的作用评价. 现代医院, 2008, 8(4):67-70.
14.	邹海东, 马榕, 余之刚, 等. PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价. 外科理论与实践, 2006, 11(2):108-111.
15.	孙宪昶, 刘庆伟, 赵素红, 等. 多层螺旋CT和正电子发射计算机体层成像-CT评价乳腺癌腋窝淋巴结状态的对照研究. 中华放射学杂志, 2008, 42(1):68-72.
16.	祖德贵, 刘庆伟, 李昕, 等. PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究. 中华核医学杂志, 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, 李亚明, 等. ¹⁸F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值. 中华核医学杂志, 2008, 28(4):247-249.
31.	朱湘, 徐文贵, 马文超, 等. (18)F-FDG PET-CT CT在诊断乳腺癌腋窝淋巴结转移状态的对比研究. 中国肿瘤临床, 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. 戴文静, 张伟. Pet/Ct在乳腺病变诊断中的应用价值. 肿瘤影像学, 2013, 22(2):125-128.
3. 李光. 乳腺癌腋窝淋巴结转移患者中应用PET-CT、临床触诊与B超诊断方法的意义与影响分析. 中国医药导刊. 2013, 15(3):451-452.
4. 毛俊峰, 施民新, 施冬辉. PET-CT在确定乳腺癌腋窝淋巴结转移的价值. 中外医学研究, 2012, 10(36):53-54.
5. 李静. 纳入研究的偏倚评价. 见:刘鸣, 主编. 系统评价、Meta-分析设计与实施方法(第1版). 北京:人民卫生出版社, 2011:72-74.
6. 张天嵩, 钟文昭. Meta-DiSc软件在诊断试验Meta分析中的应用. 循证医学, 2008, 8(2):97-108.
7. 唐立岷, 马超. ¹⁸F-FDG PET/CT在诊断浸润性乳腺癌和淋巴结转移中的价值. 上海交通大学学报(医学版), 2012, (6):761-765.
8. 赵继红, 丁军, 徐松柏, 等. ¹⁸F-FDG PET/CT与MRI对乳腺癌诊断价值的比较. 吉林大学学报(医学版), 2011, 37(4):746-749.
9. 杨传盛, 黄湛, 张诠, 等. PET/CT对cT-(1-2)N-0M-0期乳腺癌腋窝淋巴结转移的诊断价值. 实用癌症杂志, 2011, 26(5):467-469.
10. 郭佳, 陈跃. ¹⁸F-FDG PET/CT显像在诊断乳腺癌中的价值. 四川医学, 2011, 32(2):258-260.
11. 宗祥云, 俞洋, 杨红健. PET-CT在乳腺癌术前诊断与分期的临床应用分析. 肿瘤学杂志, 2008, 14(7):578-580.
12. 魏伟宏, 蒋军, 冯彦林. PET-CT诊断乳腺癌及其腋窝淋巴结转移的价值. 肿瘤研究与临床, 2008, 20(9):604-606,609.
13. 蒋军. PET-CT、临床触诊与B超诊断乳腺癌腋窝淋巴结转移的作用评价. 现代医院, 2008, 8(4):67-70.
14. 邹海东, 马榕, 余之刚, 等. PET/CT诊断乳腺癌及腋窝淋巴结状态的作用评价. 外科理论与实践, 2006, 11(2):108-111.
15. 孙宪昶, 刘庆伟, 赵素红, 等. 多层螺旋CT和正电子发射计算机体层成像-CT评价乳腺癌腋窝淋巴结状态的对照研究. 中华放射学杂志, 2008, 42(1):68-72.
16. 祖德贵, 刘庆伟, 李昕, 等. PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究. 中华核医学杂志, 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, 李亚明, 等. ¹⁸F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值. 中华核医学杂志, 2008, 28(4):247-249.
31. 朱湘, 徐文贵, 马文超, 等. (18)F-FDG PET-CT CT在诊断乳腺癌腋窝淋巴结转移状态的对比研究. 中国肿瘤临床, 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