Meta-Analysis: 18F-FDG PET or PET/CT for the Evaluation of Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer

摘要

Purpose: To evaluate the accuracy and the predictive value of 18F-FDG PET or PET/CT in the assessment of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer by meta-analysis. Materials and Methods: Relevant studies were identified by systematic searches of PUBMED and COCHRANE databases, published in English. To ensure homogeneity of all included studies, selection criteria were established and all the studies were scored according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Meta-analysis was done on the diagnostic performance data from eligible studies. Draw funnel plots to explore the publication bias. Draw forest plots to exclude abnormal data(s). Use Spearman correlation coefficients p, likelihood ratio x2 test and I2 index in order to indicate heterogeneity. Estimate and compare the weighted summary sensitivities (SEs), specificities (SPs), diagnostic odds ratios (DORs), and summary receiver operating characteristic (SROC) curves of PET and other examinations (measuring the size of tumor). Subgroup analyses were performed to identify heterogeneity potential sources. Do Z test to find significant difference between each results. Results: 27 groups of data in 19 eligible studies were included with a total of 1164 subjects evaluated by 18F-FDG PET or PET/CT and 291 ones evaluated by other examinations. Funnel plots showed the existence of publication bias. Spearman correlation coefficients p, likelihood ratio x2 test and I2 index explored the heterogeneity. The Results of the Weighted Summary: SEPET was significantly higher than SED [83.7% (329/393) vs. 59.0% (98/166), p SPPET was significantly higher than SPD [66.8% (512/766) vs. 40.8% (51/125), p DORPET was significantly higher than DORD (14.02 vs. 1.29, p AUCPET and Q*PET were both significantly higher than AUCD and Q*D (AUCs 0.8838 vs. 0.6046; Q*s 0.8143 vs. 0.5788, p st or 2nd cycle of NAC was a litter better than later with higher SE (p = 0.083). Standardized uptake value (SUV) reduction rate between 40% and 45% as FDG-PET response threshold value was used for its highest SP (p = 0.01), while no significant difference was found comparing SEs and DORs (p > 0.05). Trend of higher SE and lower SP were found at ER negative breast cancers than ER positive ones (SEs 93.94% vs. 83.33%; SPs 35.76% vs. 62.24%), though Z test did not find significant difference (p > 0.05). Conclusion: This meta-analysis showed that FDG-PET or PET/CT does have a higher global accuracy in assessing the response for NAC in breast cancer. Comparing with clinical response, metabolic response plays a potential role in directing therapy for breast cancer. Factors which affected the accuracy of FDG-PET assessment included PET timing point, SUV reduction rate as threshold value and ER expression.