Sheikhbahaei Sara, Trahan Tyler J, Xiao Jennifer, Taghipour Mehdi, Mena Esther, Connolly Roisin M, Subramaniam Rathan M
Russell H. Morgan Department of Radiology and Radiological Sciences Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Oncologist. 2016 Aug;21(8):931-9. doi: 10.1634/theoncologist.2015-0353. Epub 2016 Jul 8.
This study compared the diagnostic test accuracy of magnetic resonance imaging (MRI) with that of (18)F-fluoro-2-glucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer.
A systematic search was performed in PubMed and EMBASE (last updated in June 2015). Studies investigating the performance of MRI and FDG-PET or FDG-PET/CT imaging during or after completion of NAC in patients with histologically proven breast cancer were eligible for inclusion. We considered only studies reporting a direct comparison between these imaging modalities to establish precise summary estimates in the same setting of patients. Pathologic response was considered as the reference standard. Two authors independently screened and selected studies that met the inclusion criteria and extracted the data.
A total of 10 studies were included. The pooled estimates of sensitivity and specificity across all included studies were 0.71 and 0.77 for FDG-PET/CT (n = 535) and 0.88 and 0.55 for MRI (n = 492), respectively. Studies were subgrouped according to the time of therapy assessment. In the intra-NAC setting, FDG-PET/CT imaging outperformed MRI with fairly similar pooled sensitivity (0.91 vs. 0.89) and higher specificity (0.69 vs. 0.42). However, MRI appeared to have higher diagnostic accuracy than FDG-PET/CT imaging when performed after the completion of NAC, with significantly higher sensitivity (0.88 vs. 0.57).
Analysis of the available studies of patients with breast cancer indicates that the timing of imaging for NAC-response assessment exerts a major influence on the estimates of diagnostic accuracy. FDG-PET/CT imaging outperformed MRI in intra-NAC assessment, whereas the overall performance of MRI was higher after completion of NAC, before surgery.
The timing of therapy assessment imaging exerts a major influence on overall estimates of diagnostic accuracy. (18)F-fluoro-2-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) imaging outperformed magnetic resonance imaging (MRI) in intra-neoadjuvant chemotherapy assessment with fairly similar pooled sensitivity and higher specificity. However, MRI appeared to be more accurate than FDG-PET/CT in predicting pathologic response when used in the post-therapy setting.
本研究比较了磁共振成像（MRI）与（18）F - 氟 - 2 - 葡萄糖 - 正电子发射断层扫描/计算机断层扫描（FDG - PET/CT）成像在评估乳腺癌新辅助化疗（NAC）疗效方面的诊断测试准确性。
在PubMed和EMBASE（最后更新于2015年6月）中进行了系统检索。纳入标准为研究组织学确诊的乳腺癌患者在NAC期间或完成后MRI和FDG - PET或FDG - PET/CT成像的表现。我们仅考虑报告这些成像方式之间直接比较的研究，以便在相同患者群体中建立精确的汇总估计。病理反应被视为参考标准。两位作者独立筛选并选择符合纳入标准的研究并提取数据。
共纳入10项研究。所有纳入研究中，FDG - PET/CT（n = 535）的敏感性和特异性汇总估计分别为0.71和0.77，MRI（n = 492）的敏感性和特异性汇总估计分别为0.88和0.55。研究根据治疗评估时间进行亚组分析。在NAC期间，FDG - PET/CT成像的表现优于MRI，两者汇总敏感性相当（0.91对0.89），但FDG - PET/CT特异性更高（0.69对0.42）。然而，在NAC完成后进行检查时，MRI的诊断准确性似乎高于FDG - PET/CT成像，其敏感性显著更高（0.88对0.57）。
对乳腺癌患者现有研究的分析表明，用于评估NAC疗效的成像时间对诊断准确性估计有重大影响。在NAC期间评估中，FDG - PET/CT成像优于MRI；而在NAC完成后、手术前，MRI的整体表现更高。
治疗评估成像的时间对诊断准确性的总体估计有重大影响。在新辅助化疗评估中，（18）F - 氟 - 2 - 葡萄糖 - 正电子发射断层扫描（FDG - PET）/计算机断层扫描（CT）成像优于磁共振成像（MRI），两者汇总敏感性相当且FDG - PET/CT特异性更高。然而，在治疗后使用时，MRI在预测病理反应方面似乎比FDG - PET/CT更准确。
