Molecular imaging approaches in the diagnosis of breast cancer: A systematic review and meta-analysis

The accuracy of positron emission tomography with computed tomography (PET/CT), positron emission mammography (PEM), and breast specific-gamma imaging (BSGI) in diagnosing breast cancer has never been systematically assessed, the present systematic review was aimed to address this issue. 

PubMed, Scopus and EMBASE were searched for studies dealt with the detection of breast cancer by PET/CT, PEM or BSGI. Histopathologic examination and/or at least six months imaging follow-up were used as a golden reference. To calculate diagnostic test parameters: sensitivity, specificity, summary receiver operating characteristic curves (SROC) and to test for heterogeneity, true positive (TP), true negative (TN), false positive (FP) and false negative (FN) were extracted.

Thirty one studies were included in the analysis. On per-patient basis, the pooled sensitivities after corrected for threshold effect for 18F-FDG PET/CT, PEM, and 99mTc-MIBI BSGI were 0.89 (95% CI: 0.78- 0.95), 0.73 (95% CI: 0.41 - 0.92), and 0.80 (95% CI: 0.72 - 0.86) respectively. The pooled specificities for detection of breast cancer using FDG PET/CT, PEM, and 99mTc-MIBI BSGI were 0.93 (95 % CI, 0.86 - 0.96), 0.91 (95 % CI, 0.77- 96), and 0.78 (95 % CI, 0.64 - 0.88), respectively. AUC of FDG PET/CT, PEM, and BSGI were 0.9549, 0.8852 and 0.8573, respectively.

This meta-analysis indicated that PET/CT showed better diagnostic accuracy than PEM, and BSGI on per-patient basis. On per-lesion analysis, PEM with the highest AUC, DOR and Q* was better than PET/CT, and BSGI for detecting breast cancer.