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

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.