Han Sangwon, Choi Joon Young
From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Clin Nucl Med. 2021 Apr 1;46(4):271-282. doi: 10.1097/RLU.0000000000003502.
We performed a systematic review and meta-analysis to evaluate the impact of 18F-FDG PET, PET/CT, and PET/MRI on staging and management during the initial staging of breast cancer.
We searched the PubMed, Embase, Cochrane Library, and KoreaMed databases until March 2020 to identify studies that reported the proportion of breast cancer patients whose clinical stage or management were changed after PET scans. The proportion of changes was pooled using a random-effects model. Subgroup and metaregression analyses were performed to explore heterogeneity.
We included 29 studies (4276 patients). The pooled proportions of changes in stage and management were 25% (95% confidence interval [CI], 21%-30%) and 18% (95% CI, 14%-23%), respectively. When stage changes were stratified according to initial stage, the pooled proportions were 11% (95% CI, 3%-22%) in stage I, 20% (95% CI, 16%-24%) in stage II, and 34% (95% CI, 27%-42%) in stage III. The relative proportions of intermodality and intention-to-treat changes were 74% and 70%, respectively. Using metaregression analyses, the mean age and the proportion of initial stage III to IV and histologic grade II to III were significant factors affecting the heterogeneity in changes in stage or management.
Currently available literature suggests that the use of 18F-FDG PET, PET/CT, or PET/MRI leads to significant modification of staging and treatment in newly diagnosed breast cancer patients. Therefore, there may be a role for routine clinical use of PET imaging for the initial staging of breast cancer.
我们进行了一项系统评价和荟萃分析，以评估18F-FDG PET、PET/CT和PET/MRI在乳腺癌初始分期期间对分期和治疗管理的影响。
我们检索了截至2020年3月的PubMed、Embase、Cochrane图书馆和KoreaMed数据库，以确定报告PET扫描后临床分期或治疗管理发生改变的乳腺癌患者比例的研究。使用随机效应模型汇总改变的比例。进行亚组分析和Meta回归分析以探讨异质性。
我们纳入了29项研究（4276例患者）。分期和治疗管理改变的汇总比例分别为25%（95%置信区间[CI]，21%-30%）和18%（95%CI，14%-23%）。根据初始分期对分期改变进行分层时，I期的汇总比例为11%（95%CI，3%-22%），II期为20%（95%CI，16%-24%），III期为34%（95%CI，27%-42%）。不同模态间和意向性治疗改变的相对比例分别为74%和70%。通过Meta回归分析，平均年龄以及初始III至IV期和组织学II至III级的比例是影响分期或治疗管理改变异质性的显著因素。
现有文献表明，使用18F-FDG PET、PET/CT或PET/MRI会显著改变新诊断乳腺癌患者的分期和治疗。因此，PET成像在乳腺癌初始分期的常规临床应用中可能具有作用。
