Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, 227 South Chongqing Rd., Shanghai, People's Republic of China.
Breast Cancer Res Treat. 2012 Jan;131(2):357-69. doi: 10.1007/s10549-011-1780-z. Epub 2011 Sep 30.
Clinical evidence regarding the value of (18)F-FDG PET for therapy responses assessment in breast cancer is increasing. The objective of this study is to evaluate the accuracy of (18)F-FDG PET in predicting responses to neoadjuvant therapies with meta-analysis and explore its optimal regimen for clinical use. Articles in English language relating to the accuracy of (18)F-FDG PET for this utility were retrieved. Methodological quality was assessed by QUADAS tool. Pooled estimation and subgroup analysis data were obtained by statistical analysis. Nineteen studies met the inclusion criteria and involved 920 pathologically confirmed patients in total (mean age 49.8 years, all female). Methodological quality was relatively high. To predict histopathological response in primary breast lesions by PET, the pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio were 84% (95% CI, 78-88%), 66% (95% CI, 62-70%), 50% (95% CI, 44-55%), 91% (95% CI, 87-94%), and 11.90 (95% CI, 6.33-22.36), respectively. In regional lymph nodes, sensitivity and NPV of PET were 92% (95% CI, 83-97%) and 88% (95% CI, 76-95%), respectively. Subgroup analysis showed that performing a post-therapy (18)F-FDG PET early (after the 1st or 2nd cycle of chemotherapy) was significantly better than later (accuracy 76% vs. 65%, P = 0.001). Furthermore, the best correlation with pathology was yielded by employing a reduction rate (RR) cutoff value of standardized uptake value between 55 and 65%. (18)F-FDG PET is useful to predict neoadjuvant therapy response in breast cancer. However, the relatively low specificity and PPV still call for caution. It is suggested to perform PET in an earlier course of therapy and use RR cutoff value between 55 and 65%, which might potentially identify non-responders early. However, further prospective studies are warranted to assess this regimen and adequately position PET in treatment management.
越来越多的临床证据表明 18F-FDG PET 对乳腺癌治疗反应评估具有价值。本研究旨在通过荟萃分析评估 18F-FDG PET 预测新辅助治疗反应的准确性，并探索其在临床应用中的最佳方案。检索到与 18F-FDG PET 在此应用中的准确性相关的英文文献。采用 QUADAS 工具评估方法学质量。通过统计分析获得汇总估计和亚组分析数据。19 项研究符合纳入标准，共纳入 920 例经病理证实的患者（平均年龄 49.8 岁，均为女性）。方法学质量相对较高。通过 PET 预测原发性乳腺病变的组织病理学反应，PET 预测的汇总敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断比值比分别为 84%（95%CI，78-88%）、66%（95%CI，62-70%）、50%（95%CI，44-55%）、91%（95%CI，87-94%）和 11.90（95%CI，6.33-22.36）。在区域淋巴结中，PET 的敏感性和 NPV 分别为 92%（95%CI，83-97%）和 88%（95%CI，76-95%）。亚组分析显示，在化疗第 1 或第 2 周期后进行（18）F-FDG PET 检查明显优于稍后进行（准确性分别为 76%和 65%，P=0.001）。此外，采用标准化摄取值（SUV）降低率（RR）截断值为 55-65%时，与病理相关性最佳。（18）F-FDG PET 有助于预测乳腺癌新辅助治疗反应。然而，相对较低的特异性和 PPV 仍需谨慎。建议在治疗早期进行 PET 检查，并采用 SUV 降低率（RR）截断值为 55-65%，这可能有助于早期识别无反应者。然而，仍需要进一步的前瞻性研究来评估该方案，并充分确定 PET 在治疗管理中的地位。
