Is Tc-99m sestamibi scintimammography useful in the prediction of neoadjuvant chemotherapy responses in breast cancer? A systematic review and meta-analysis.

To evaluate the accuracy of Tc-99m sestamibi (MIBI) scintimammography in the prediction of neoadjuvant chemotherapy response in breast cancer. 'PubMed' (MEDLINE included) and Embase database were searched for relevant publications in English. Methodological quality of the included studies was assessed with Quality Assessment of Diagnosis Accuracy Studies (QUADAS), and 'Meta-Disc' and 'Stata' software were used to determine pooled sensitivity, specificity, and diagnostic odds ratio (DOR), and construct a summary receiver-operating characteristic curve. Fourteen studies (a total of 503 individuals) fulfilled the inclusion criteria. The pooled sensitivity was 0.86 [95% confidence interval (CI): 0.78-0.92] and the pooled specificity was 0.69 (95% CI: 0.64-0.74). Pooled likelihood ratio (LRp), negative likelihood ratio (LR-), and DOR were 2.64 (95% CI: 1.81-3.85), 0.26 (95% CI: 0.15-0.46), and 12.06 (95% CI: 6.94-20.96), respectively. The area under the summary receiver-operating characteristic curve was 0.86. For the prediction of pathological complete response (10 studies included), the pooled sensitivity and specificity and DOR were 0.86 (95% CI: 0.77-0.93), 0.67 (95% CI: 0.62-0.72), and 11.43 (95% CI: 5.95-21.97). Our results indicated that Tc-99m MIBI scintimammography had acceptable sensitivity in the prediction of neoadjuvant chemotherapy response in breast cancer; however, its relatively low specificity showed that a combination of other imaging modalities would still be needed. Subgroup analysis indicated that performing early mid-treatment Tc-99m MIBI scintimammography (using the reduction rate of one or two cycles or within the first half-courses of chemotherapy compared with the baseline) was better than carrying out later (after three or more courses) or post-treatment scintimammography in the prediction of neoadjuvant chemotherapy response.