Comparing the diagnostic efficacy of [18F]FDG PET/CT and [18F]FDG PET/MRI for detecting bone metastases in breast cancer: a meta-analysis

Xia, Longjie; Lai, Jianqin; Huang, Di; Qiu, Shenghui; Hu, Huiqiong; Luo, Yunxiang; Cao, Jie

doi:10.2478/raon-2023-0037

Abstract

Background

This meta-analysis aimed to evaluate the comparative diagnostic efficacy of [¹⁸F]FDG PET/CT and [¹⁸F] FDG PET/MRI in detecting bone metastases in breast cancer patients.

Methods

An extensive search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify available publications up to February 2023. Studies were included if they evaluated the diagnostic efficacy of [¹⁸F]FDG PET/CT and [¹⁸F]FDG PET/MRI in patients with breast cancer bone metastases. Sensitivity and specificity were assessed using the DerSimonian and Laird method, followed by transformation via the Freeman-Tukey double inverse sine transformation.

Results

16 articles (including 4 head-to-head comparison articles) involving 1,261 patients were included in the meta-analysis. The overall sensitivity of [¹⁸F]FDG PET/CT in patient-based analysis, lesion-based analysis, and head-to-head comparison were 0.73, 0.89, and 0.87, respectively, while the overall sensitivity of [¹⁸F]FDG PET/MRI were 0.99, 0.99, and 0.99. The results indicated that [¹⁸F]FDG PET/MRI appears to a higher sensitivity in comparison to [¹⁸F]FDG PET/CT(all P < 0.05). In contrast, the overall specificity of [¹⁸F]FDG PET/CT in patient-based analysis, lesion-based analysis, and head-to-head comparison were 1.00, 0.99, and 1.00, respectively, while the overall specificity of [¹⁸F]FDG PET/MRI were 1.00, 0.99, and 0.98. These results suggested that [¹⁸F]FDG PET/CT has a similar level of specificity compared to [¹⁸F]FDG PET/MRI.

Conclusions

Our meta-analysis indicates that [¹⁸F]FDG PET/MRI demonstrates superior sensitivity and similar specificity to [¹⁸F]FDG PET/CT in detecting bone metastases in breast cancer patients. Further prospective research is required to confirm these findings and assess the clinical application of these techniques.

References

Torre LA, Islami F, Siegel RL, Ward EM, Jemal A. Global cancer in women: burden and trends. Cancer Epidemiol Biomarkers Prev 2017; 26: 444–57. doi: 10.1158/1055-9965.Epi-16-0858
Open DOI Search in Google Scholar Back to article
Ahmed A, Glynne-Jones R, Ell PJ. Skeletal scintigraphy in carcinoma of the breast – a ten year retrospective study of 389 patients. Nucl Med Commun 1990; 11: 421–6. doi: 10.1097/00006231-199006000-00004
Open DOI Search in Google Scholar Back to article
Hortobagyi GN, Theriault RL, Lipton A, Porter L, Blayney D, Sinoff C, et al. Long-term prevention of skeletal complications of metastatic breast cancer with pamidronate. Protocol 19 Aredia Breast Cancer Study Group. J Clin Oncol 1998; 16: 2038–44. doi: 10.1200/jco.1998.16.6.2038
Open DOI Search in Google Scholar Back to article
Roberts CC, Daffner RH, Weissman BN, Bancroft L, Bennett DL, Blebea JS, et al. ACR appropriateness criteria on metastatic bone disease. J Am Coll Radiol 2010; 7: 400–9. doi: 10.1016/j.jacr.2010.02.015
Open DOI Search in Google Scholar Back to article
Rong J, Wang S, Ding Q, Yun M, Zheng Z, Ye S. Comparison of 18 FDG PET-CT and bone scintigraphy for detection of bone metastases in breast cancer patients. A meta-analysis. Surg Oncol 2013; 22: 86–91. doi: 10.1016/j.suronc.2013.01.002
Open DOI Search in Google Scholar Back to article
Evangelista L, Cuppari L, Burei M, Zorz A, Caumo F. Head-to-head comparison between ¹⁸F-FDG PET/CT and PET/MRI in breast cancer. Clin Transl Imaging 2019; 7: 99–104. doi: 10.1007/s40336-019-00319-2
Open DOI Search in Google Scholar Back to article
Choi YJ, Shin YD, Kang YH, Lee MS, Lee MK, Cho BS, et al. The Effects of pre-operative (18)F-FDG PET/CT in breast cancer patients in comparison to the conventional imaging Study. J Breast Cancer 2012; 15: 441–8. doi: 10.4048/jbc.2012.15.4.441
Open DOI Search in Google Scholar Back to article
Evangelista L, Cervino AR, Ghiotto C, Al-Nahhas A, Rubello D, Muzzio PC. Tumor marker-guided PET in breast cancer patients-a recipe for a perfect wedding: a systematic literature review and meta-analysis. Clin Nucl Med 2012; 37: 467–74. doi: 10.1097/RLU.0b013e31824850b0
Open DOI Search in Google Scholar Back to article
Botsikas D, Bagetakos I, Picarra M, Da Cunha Afonso Barisits AC, Boudabbous S, Montet X, et al. What is the diagnostic performance of 18-FDG-PET/MR compared to PET/CT for the N- and M-staging of breast cancer? Eur Radiol 2018; 29: 1787–98. doi: 10.1007/s00330-018-5720-8
Open DOI Search in Google Scholar Back to article
Melsaether AN, Raad RA, Pujara AC, Ponzo FD, Pysarenko KM, Jhaveri K, et al. Comparison of whole-body (18)F FDG PET/MR imaging and whole-body (18)F FDG PET/CT in terms of lesion detection and radiation dose in patients with breast cancer. Radiology 2016; 281: 193–202. doi: 10.1148/radiol.2016151155
Open DOI Search in Google Scholar Back to article
Sawicki LM, Grueneisen J, Schaarschmidt BM, Buchbender C, Nagarajah J, Umutlu L, et al. Evaluation of ¹⁸F-FDG PET/MRI, ¹⁸F-FDG PET/CT, MRI, and CT in whole-body staging of recurrent breast cancer. Eur J Radiol 2016; 85: 459–65. doi: 10.1016/j.ejrad.2015.12.010
Open DOI Search in Google Scholar Back to article
McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, Clifford T, et al. Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. Jama 2018; 319: 388–96. doi: 10.1001/jama.2017.19163
Open DOI Search in Google Scholar Back to article
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529–36. doi: 10.7326/0003-4819-155-8-201110180-00009
Open DOI Search in Google Scholar Back to article
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–58. doi: 10.1002/sim.1186
Open DOI Search in Google Scholar Back to article
Catalano OA, Nicolai E, Rosen BR, Luongo A, Catalano M, Iannace C, et al. Comparison of CE-FDG-PET/CT with CE-FDG-PET/MR in the evaluation of osseous metastases in breast cancer patients. Br J Cancer 2015; 112: 1452–60. doi: 10.1038/bjc.2015.112
Open DOI Search in Google Scholar Back to article
Bruckmann NM, Kirchner J, Umutlu L, Fendler WP, Seifert R, Herrmann K, et al. Prospective comparison of the diagnostic accuracy of ¹⁸F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. Eur Radiol 2021; 31: 8714–24. doi: 10.1007/s00330-021-07956-0
Open DOI Search in Google Scholar Back to article
Balci TA, Koc ZP, Komek H. Bone scan or F-18-Fluorodeoxyglucose positron emission tomography/computed tomography; which modality better shows bone metastases of breast cancer? Breast Care 2012; 7: 389–93. doi: 10.1159/000341559
Open DOI Search in Google Scholar Back to article
Hahn S, Heusner T, Kümmel S, Köninger A, Nagarajah J, Müller S, et al. Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer. Acta Radiol 2011; 52: 1009–14. doi: 10.1258/ar.2011.100507
Open DOI Search in Google Scholar Back to article
Manohar K, Mittal BR, Senthil R, Kashyap R, Bhattacharya A, Singh G. Clinical utility of F-18 FDG PET/CT in recurrent breast carcinoma. Nucl Med Commun 2012; 33: 591–6. doi: 10.1097/MNM.0b013e3283516716
Open DOI Search in Google Scholar Back to article
Demir SS, Aktas GE, Yenici FU. A Lesion based and sub-regional comparison of FDG PET/CT and MDP bone scintigraphy in detection of bone metastasis in breast cancer. Curr Med Imaging 2017; 13: 422–30. doi: 10.2174/1573405613666170126121221
Open DOI Search in Google Scholar Back to article
Niikura N, Hashimoto J, Kazama T, Koizumi J, Ogiya R, Terao M, et al. Diagnostic performance of F-18-fluorodeoxyglucose PET/CT and bone scintigraphy in breast cancer patients with suspected bone metastasis. Breast Cancer 2016; 23: 662–7. doi: 10.1007/s12282-015-0621-z
Open DOI Search in Google Scholar Back to article
Riegger C, Herrmann J, Nagarajah J, Hecktor J, Kuemmel S, Otterbach F, et al. Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients. Eur J Nucl Med Mol Imaging 2012; 39: 852–63. doi: 10.1007/s00259-012-2077-0
Open DOI Search in Google Scholar Back to article
Rager O, Lee-Felker SA, Tabouret-Viaud C, Felker ER, Poncet A, Amzalag G, et al. Accuracy of whole-body HDP SPECT/CT, FDG PET/CT, and their combination for detecting bone metastases in breast cancer: an intra-personal comparison. Am J Nucl Med Mol Imaging 2018; 8: 159–68. PMID: 30042868
Search in Google Scholar Back to article
Hansen JA, Naghavi-Behzad M, Gerke O, Baun C, Falch K, Duvnjak S, et al. Diagnosis of bone metastases in breast cancer: lesion-based sensitivity of dual-timepoint FDG-PET/CT compared to low-dose CT and bone scintigraphy. PLoS ONE 2021; 16: e0260066. doi: 10.1371/journal.pone.0260066
Open DOI Search in Google Scholar Back to article
Niikura N, Costelloe CM, Madewell JE, Hayashi N, Yu TK, Liu J, et al. FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist 2011; 16: 1111–9. doi: 10.1634/theoncologist.2011-0089
Open DOI Search in Google Scholar Back to article
Shawky M, Ali ZAE, Hashem DH, Houseni M. Role of positron-emission tomography/computed tomography (PET/CT) in breast cancer. Egipt J Radiol Nucl Med 2020; 51: 125. doi: 10.1186/s43055-020-00244-9
Open DOI Search in Google Scholar Back to article
Teke F, Teke M, Inal A, Kaplan MA, Kucukoner M, Aksu R, et al. Significance of hormone receptor status in comparison of ¹⁸F-FDG-PET/CT and ⁹⁹mTc-MDP bone scintigraphy for evaluating bone metastases in patients with breast cancer: single center experience. Asian Pac J Cancer Prev 2015; 16: 387–91. doi: 10.7314/apjcp.2015.16.1.387
Open DOI Search in Google Scholar Back to article
Zhang C, Liang Z, Liu W, Zeng X, Mo Y. Comparison of whole-body ¹⁸F-FDG PET/CT and PET/MRI for distant metastases in patients with malignant tumors: a meta-analysis. BMC Cancer 2023; 23: 37. doi: 10.1186/s12885-022-10493-8
Open DOI Search in Google Scholar Back to article
Wu LM, Gu HY, Zheng J, Xu X, Lin LH, Deng X, et al. Diagnostic value of whole-body magnetic resonance imaging for bone metastases: a systematic review and meta-analysis. J Magn Reson Imaging 2011; 34: 128–35. doi: 10.1002/jmri.22608
Open DOI Search in Google Scholar Back to article
Bruckmann NM, Morawitz J, Fendler WP, Ruckhäberle E, Bittner AK, Giesel FL, et al. A role of PET/MR in breast cancer? Semin Nucl Med 2022; 52: 611–8. doi: 10.1053/j.semnuclmed.2022.01.003
Open DOI Search in Google Scholar Back to article
Tabouret-Viaud C, Botsikas D, Delattre BM, Mainta I, Amzalag G, Rager O, et al. PET/MR in breast cancer. Semin Nucl Med 2015; 45: 304–21. doi: 10.1053/j.semnuclmed.2015.03.003
Open DOI Search in Google Scholar Back to article
Pfannenberg C, Schwenzer N. Whole-body staging of malignant melanoma: advantages, limitations and current importance of PET-CT, whole-body MRI and PET-MRI. Radiologe 2015; 55: 120–6. doi: 10.1007/s00117-014-2762-z
Open DOI Search in Google Scholar Back to article
Tunariu N, Blackledge M, Messiou C, Petralia G, Padhani A, Curcean S, et al. What's new for clinical whole-body MRI (WB-MRI) in the 21st century. Br J Radiol 2020; 93: 20200562. doi: 10.1259/bjr.20200562
Open DOI Search in Google Scholar Back to article