Breast Cancer Research and Treatment

, Volume 90, Issue 2, pp 105–112 | Cite as

A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases

  • Carmen R. IsasiEmail author
  • Renee M. Moadel
  • M. Donald Blaufox


Objective. To evaluate the diagnostic performance of 18F-2-deoxy-2-fluoro-d-glucose-positron emission tomography (FDG-PET) in the evaluation of breast cancer recurrence and metastases.

Data Sources. Articles published in medical journals during January 1995–June 2004 were identified by a systematic Medline search, supplemented by a manual search of the references listed in original and review articles.

Study Selection. Studies that evaluated FDG-PET with a dedicated camera for the diagnosis of breast cancer recurrence or metastases, and reporting sufficient data to permit calculation of sensitivity and specificity, were included in the analysis.

Data Extraction. Two reviewers independently reviewed the eligibility and abstracted data regarding the sample population, technical imaging characteristics of FDG-PET, and the number of true positives, true negatives, false positives and false negatives. Differences between readers were resolved by consensus.

Data Synthesis. We used meta-analytic methods to estimate the pooled sensitivity, false positive rate, and the maximum joint sensitivity and specificity. Eighteen studies met the inclusion criteria. Sixteen studies included patient-based data, comprising a sample size of 808 subjects, and eight studies included lesion-based data, totaling 1013 lesions. Among the studies with patient-based data, the median sensitivity was 92.7%, and the median specificity was 81.6%. The pooled sensitivity was 90% [95% confidence interval (86.8–93.2)], and the pooled false positive rate was 11% [95% confidence interval (7.8–14.6)], after the exclusion of outliers. The maximum joint sensitivity and specificity, was 88% [95% confidence interval (86.0–90.6)].

Conclusion. These results indicate that FDG-PET is a valuable tool for detecting breast cancer recurrence and metastases.


False Negative False Positive Rate True Positive Diagnostic Performance Median Specificity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Cancer Society: Breast Cancer Facts and Figures. American Cancer Society, Atlanta, GA, 2002, pp. 9–10.Google Scholar
  2. 2.
    Ries LAG, Eisner MP, Kosary CL, et al. (eds): SEER Cancer Statistics Review, 1975–2001 National Cancer Institute, Bethesda, MD,, 2004Google Scholar
  3. 3.
    Warburg, O eds. 1930The metabolism of tumorsArnold ConstableLondon75327Google Scholar
  4. 4.
    Di Chiro, G, DeLaPaz, RL, Brooks, RA,  et al. 1982Glucose utilization of cerebral gliomas measured by [18F] fluorodeoxyglucose and positron emission tomographyNeurology3213231329PubMedGoogle Scholar
  5. 5.
    Hustinx, R, Benard, F, Alavi, A 2002Whole-body FDG-PET imaging in the management of patients with cancerSemin Nucl Med323546PubMedGoogle Scholar
  6. 6.
    Gambhir, SS, Czermin, J, Schwimmer, J,  et al. 2001A tabulated summary of the FDG PET literature.J Nucl Med421S93SPubMedGoogle Scholar
  7. 7.
    Czermin, J, Phelps, M 2002Positron emission tomography scanning: current and future applicationsAnnu Rev Med5389112Google Scholar
  8. 8.
    Bender, H, Kirst, J, Palmedo, H,  et al. 1997Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinomaAnticancer Research1716871692PubMedGoogle Scholar
  9. 9.
    Eubank, WB, Mankoff, DA, Tagasugi, J,  et al. 2001 18Fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancerJ Clin Oncol1935163523PubMedGoogle Scholar
  10. 10.
    Smith, IC, Ogston, KN, Whitford, P,  et al. 1998Staging the axilla in breast cancer. accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-d-glucose. Annals of Surgery228220227PubMedGoogle Scholar
  11. 11.
    Ohta, M, Tokuda, Y, Suzuki, Y,  et al. 2001Whole body PET for the evaluation of bony metastases in patients with breast cancer: comparison with 99Tcm-MDP bone scintigraphyNuclear Medicine Communications22875879PubMedGoogle Scholar
  12. 12.
    Dose, J, Bleckman, C, Bachman, S,  et al. 2002Comparison of flurodeoxyglucose positron emission tomography and conventional diagnostic procedures for the detection of distant metastases in breast cancer patientsNuclear Medicine Communications23857864PubMedGoogle Scholar
  13. 13.
    Zhou, XH, McClish, DK, Obuchowski, NA 2002Statistical Methods in Diagnostic MedicineWiley InterscienceNew York222240Google Scholar
  14. 14.
    Irwig, L, Tosteson, A, Gatsonis, C,  et al. 1994Guidelines for meta-analyses evaluating diagnostic testsAnn Int Med120667676PubMedGoogle Scholar
  15. 15.
    Gould, MK, Kuschner, WG, Rydzak, CE,  et al. 2003Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small cell lung cancer. A meta-analysis. Ann Intern Med29879892Google Scholar
  16. 16.
    Schelbert, HR, Hoh, CK, Royal, HD,  et al. 1998Procedure guideline for tumor imaging using fluorine-18-FDG. Society of Nuclear Medicine. J Nucl Med3913021305PubMedGoogle Scholar
  17. 17.
    Moses, LE, Shapiro, D, Littenberg, B 1993Combining independent studies of a diagnostic test into a summary ROC curve: data analytic approaches and some additional considerations.Stat Med1212931316PubMedGoogle Scholar
  18. 18.
    StataCorp Stata statistical software: release 7.0. Stata Corporation, College Station, TX 2001.Google Scholar
  19. 19.
    Siggelkow, W, Zimmy, M, Faridi, A,  et al. 2003The value of positron emission tomography in the follow-up for breast cancerAnticancer Res2318591868PubMedGoogle Scholar
  20. 20.
    Eubank, WB, Mankoff, DA, Takasugi, J,  et al. 2001 18Fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancerJ Clin Oncol1935163523PubMedGoogle Scholar
  21. 21.
    Cook, GJ, Houston, S, Rubens, R 1998Detection of bone metastases in breast cancer by 18FDG-PET: different metabolic activity in osteoblastic and osteolytic lesionsJ Clin Oncol1633753379PubMedGoogle Scholar
  22. 22.
    Schirrmeister, H, Guhlman, A, Kotzerke, J,  et al. 1999Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluorine ion and positron emission tomographyJ Clin Oncol1723812389PubMedGoogle Scholar
  23. 23.
    Petrén-Mallmin, M, Andréasson, I, Ljunggren, O,  et al. 1998Skeletal metastases from breast cancer: Uptake of 18F-fluoride measured with positron emission tomography in correlation with CTSkeletal Radiol277276CrossRefPubMedGoogle Scholar
  24. 24.
    Pecking, AP, Mechelany-Corone, C, Bertrand-Kermorgant, F,  et al. 2001Detection of occult disease in breast cancer using fluorodeoxyglucose camera-based positron emission tomographyClin Breast Cancer2229234CrossRefPubMedGoogle Scholar
  25. 25.
    Grahek, D, Montravers, F, Kerrou, K,  et al. 2004[18F] FDG in recurrent breast cancer: diagnostic performance, clinical impact and relevance of induced changes in managementEur J Nucl Med Mol Imaging31179188PubMedGoogle Scholar
  26. 26.
    Hoeven, J, Krak, NC, Hoekstra, OS,  et al. 2004 18F-2-Fluoro-2-deoxy-D-glucose positron emission tomography in staging of locally advanced breast cancerJ Clin Oncol31179188Google Scholar
  27. 27.
    Liu, CS, Shen, YY, Lin, CC,  et al. 2002Clinical impact of [(18)F]FDG-PET in patients with suspected recurrent breast cancer based on asymptomatically elevated tumor marker serum levels: a preliminary reportJpn J Clin Oncol32244247PubMedGoogle Scholar
  28. 28.
    Lonneux, M, Borbath, I, Berliere, M,  et al. 2000The place of whole body PET FDG for the diagnosis of distant recurrence of breast cancerClin Positron Imaging34549PubMedGoogle Scholar
  29. 29.
    Gallowitsch, KG, Igerc, I, Mikosch, P,  et al. 2003F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imagingInvest Radiol38250256CrossRefPubMedGoogle Scholar
  30. 30.
    Goerres, GW, Michel, SC, Fehr, MK,  et al. 2003Follow-up of women with breast cancer: comparison between MRI and FDG PETEur Radiol1316351644CrossRefPubMedGoogle Scholar
  31. 31.
    Hubner, KF, Smith, GT, Thie, JA,  et al. 2000The potential of F-18-FDG PET in breast cancer: detection of primary lesions, axillary lymph node metastases or distant metastasesClin Positron Imaging3197205PubMedGoogle Scholar
  32. 32.
    Samson, D, Flamm, CR, Pisano, ED,  et al. 2002Should FDG PET be used to decide whether a patient with an abnormal mammogram or breast finding at physical examination should undergo biopsyAcad Radiol9773783PubMedGoogle Scholar
  33. 33.
    Irwig, L, Macaskill, P, Glasziou, P,  et al. 1995Meta-analytic methods for diagnostic test accuracyJ Clin Epidemiol48119130PubMedGoogle Scholar
  34. 34.
    Lijmer, J, Bossuyt, PM, Heisterkamp, SH 2002Exploring sources of heterogeneity in systematic reviews of diagnostic testsStatist Med2115251537Google Scholar
  35. 35.
    Thompson, SG 1994Systematic review: why sources of heterogeneity in meta-analysis should be investigatedBMJ30913511355PubMedGoogle Scholar
  36. 36.
    Gould, MK, Maclean, CC, Kuschner, WG,  et al. 2001Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysisJAMA285914924CrossRefPubMedGoogle Scholar
  37. 37.
    Dwamena, BA, Sonnad, SS, Angobaldo, JO,  et al. 1999Metastases from non-small cell lung cancer: mediastinal staging in the 1990s–meta-analytic comparison of PET and CTRadiology213530536PubMedGoogle Scholar
  38. 38.
    Huebner, RH, Park, KC, Sheperd, JE,  et al. 2000A meta-analysis of the literature for whole body FDG PET detection of recurrent colorectal cancerJ Nucl Med4111771189PubMedGoogle Scholar
  39. 39.
    Kinkel, K, Lu, Y, Both, M,  et al. 2002Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR Imaging, PET): a meta-analysisRadiology224748756PubMedGoogle Scholar
  40. 40.
    Moon, H, Maddahi, J, Silverman, D, Glaspy, JA,  et al. 1998Accuracy of whole body fluorine-18-FDG PET for the detection of recurrent or metastatic breast carcinomaJ Nucl Med39431435PubMedGoogle Scholar
  41. 41.
    Hathaway, PB, Mankoff, DA, Maravilla, KR,  et al. 1999Value of combined FDG PET and MR imaging in the evaluation of suspected recurrent local-regional breast cancer: preliminary experienceRadiology210807814PubMedGoogle Scholar
  42. 42.
    Rostom, AY, Powe, J, Kandil, A,  et al. 1999Positron emissi1999; on tomography in breast cancer: a clinicopathological correlation of resultsBr J Radiol7210641068PubMedGoogle Scholar
  43. 43.
    Kim, TS, Moon, WK, Lee, DS,  et al. 2001Fluorodeoxyglucose positron emission tomography for detection of recurrent metastatic breast cancerWorld Surg257829834Google Scholar
  44. 44.
    Suarez, M, Perez-Castejon, MJ, Jimenez, A,  et al. 2002Early diagnosis of recurrent breast cancer with FDG-PET in patients with progressive elevation of serum tumor markersQ J Nucl Med46113121PubMedGoogle Scholar
  45. 45.
    Kamel, EM, Wyss, MT, Fehr, MK,  et al. 2003[18F]-fluorodeoxyglucose positron emission tomography in patients with suspected recurrence of breast cancerJ Clin Oncol129147153Google Scholar
  46. 46.
    Lin, WY, Tsai, Sc, Cheng, KY,  et al. 2002Fluorine-18 FDG-PET in detecting local recurrence and distant metastases in breast cancer–Taiwanese experiencesCancer Invest20725729PubMedGoogle Scholar
  47. 47.
    Yang, SN, Liang, JA, Lin, FJ,  et al. 2002Comparing whole body 18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphonate bone scan to detect bone metastases in patients with breast cancerJ Cancer Res Clin Oncol128325328PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Carmen R. Isasi
    • 1
    • 2
    Email author
  • Renee M. Moadel
    • 1
  • M. Donald Blaufox
    • 1
  1. 1.Department of Nuclear Medicine, Montefiore Medical CenterAlbert Einstein College of Medicine of Yeshiva UniversityNYUSA
  2. 2.Department of Epidemiology and Population HealthAlbert Einstein College of Medicine of Yeshiva University, Montefiore Medical ParkBronxUSA

Personalised recommendations