Cheng Xu, Li Yongjun, Liu Biao, Xu Zhaoqiang, Bao Lihua, Wang Jie
Department of Nuclear Medcine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Acta Radiol. 2012 Jul;53(6):615-27. doi: 10.1258/ar.2012.110603. Epub 2012 Jun 25.
Neoadjuvant chemotherapy is increasingly the treatment for patients with inoperable breast cancer. Considering the side-effects of chemotherapy, there is a need for early evaluating response to neoadjuvant chemotherapy.
To determinate the diagnostic performance of 18F-fluorodeoxyglucose position emission tomography/computed tomography (FDG PET/CT) and FDG PET for evaluating response to neoadjuvant chemotherapy in patients with breast cancer.
"PubMed" (MEDLINE included) database, EMBASE, and Cochrane Database of Systematic Reviews were searched for relevant articles. We assessed the methodological quality of included study with Quality Assessment of Diagnosis Accuracy Studies (QUADAS) score tool, and used "Meta-DiSc" statistic software to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve.
Seventeen studies (a total of 781 subjects) met the inclusion criteria. The pooled sensitivity was 0.840 (95% confidence interval [CI] 0.796-0.878). The pooled specificity was 0.713 (95% CI 0.667-0.756). For FDG PET/CT (10 studies included), the pooled sensitivity was 0.847 (95% CI 0.793-0.892), the pooled specificity was 0.661 (95% CI 0.598-0.720). The pooled likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were 2.835 (95% CI 1.640-4.900), 0.221 (95% CI 0.160-0.305), and 17.628 (95% CI 7.431-41.818). The area under the SROC curve (AUC) was 0.8934. For FDG PET (7 studies included), the pooled sensitivity and specificity were 0.826 (95% CI 0.741-0.892) and 0.789 (95% CI 0.719-0.849). The pooled LR + , LR-, and DOR were 3.601 (95% CI 2.601-4.986), 0.242 (95% CI 0.157-0.374), and 13.641 (95% CI 7.433-25.030). The AUC was 0.8764.
Our results indicate that FDG PET/CT and PET have reasonable sensitivity in evaluating response to neoadjuvant chemotherapy in breast cancer; however, the specificity is relative low. The combination of other imaging methods with FDG PET/CT or PET is recommended.
新辅助化疗越来越多地用于无法手术的乳腺癌患者的治疗。考虑到化疗的副作用，有必要尽早评估对新辅助化疗的反应。
确定18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）和FDG PET在评估乳腺癌患者新辅助化疗反应方面的诊断性能。
检索“PubMed”（包括MEDLINE）数据库、EMBASE和Cochrane系统评价数据库中的相关文章。我们使用诊断准确性研究质量评估（QUADAS）评分工具评估纳入研究的方法学质量，并使用“Meta-DiSc”统计软件获得敏感性、特异性、诊断比值比（DOR）和总结性受试者操作特征（SROC）曲线的合并估计值。
17项研究（共781名受试者）符合纳入标准。合并敏感性为0.840（95%置信区间[CI]0.796-0.878）。合并特异性为0.713（95%CI 0.667-0.756）。对于FDG PET/CT（纳入10项研究），合并敏感性为0.847（95%CI 0.793-0.892），合并特异性为0.661（95%CI 0.598-0.720）。合并似然比（LR+）、阴性似然比（LR-）和诊断比值比（DOR）分别为2.835（95%CI 1.640-4.900）、0.221（95%CI 0.160-0.305）和17.628（95%CI 7.431-41.818）。SROC曲线下面积（AUC）为0.8934。对于FDG PET（纳入7项研究），合并敏感性和特异性分别为0.826（95%CI 0.741-0.892）和0.789（95%CI 0.719-0.849）。合并LR+、LR-和DOR分别为3.601（95%CI 2.601-4.986）、0.242（95%CI 0.157-0.374）和13.641（95%CI 7.433-25.030）。AUC为0.8764。
我们的结果表明，FDG PET/CT和PET在评估乳腺癌新辅助化疗反应方面具有合理的敏感性；然而，特异性相对较低。建议将其他成像方法与FDG PET/CT或PET联合使用。
