The Diagnostic Value Of18F-FDG PET And99Tcm-MDP Bone Scintigraphy For Bone Metastases Of Breast Cancer:a Meta Analysis

Objective To perform a meta-analysis to evaluate the diagnostic accuracy of18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and technetium-99m methylene diphosphonate (MDP) bone scintigraphy (BS) in osseous metastases detection in patients with breast cancer.Methods Studies were systematically searched in the PubMed(1966-2011.5),EMBASE (1974-2011.5),the Cochrane library(1993-2011.5),CBM(1978-2011.5),CNKI(1994-2011.5), VIP(1989-2011.5)and WanFang databases(1982-2011.5).Additional studies were manually searched using the references of the retrieved articles. Studies were eligible for inclusion based on inclusion and exclusion criteria, the qualities of the studies were reviewed based on QUADAS criteria and data extracted from the studies include year of publication,authors, research design, sample size, imaging technique and technical characteristics, reference standard, method of image interpretation, and totals of true positives, false positives, true negatives, and false negatives. Patient-based and Lesion-based pooled sensitivity and specificity and area under summary receiver operating characteristic (ROC) curves were calculated respectively using Meta-disc1.4and RevMan5.0software.Results A total of six studies (222patients/13491esions) were included. Meta analysis showed: compared with surgical and pathological findings,①The pooled patient-based sensitivity, specificity and the area under the curve (AUC) for18F FDG-PET were84.6%(95%CI:75.5%-91.3%),93.9%(95%CI:88.3%-97.3%) and0.9651,respectively. The pooled sensitivity, specificity and the AUC of bone scan were80.2%(95%CI:70.6%-87.8%),85.5%(95%CI:78.3%-91.0%) and0.8878, respectively.②The pooled lesion-based sensitivity, specificity and the AUC for18F FDG-PET were53.7%(95%CI:48.8%-58.5%),99.2%(95%CI:98.5%-99.7%)and0.9571,respectively. The pooled sensitivity, specificity and the AUC for bone scan were87.9%(95%CI:84.4%-90.8%),96.0%(95%CI:94.5%-97.2%) and0.9449, respectively.Conclusions Current evidence suggests that99Tcm-MDP bone scan is the preferred method in screening breast cancer patients with bone metastases. PET imaging can be used when physicians failed to confirm the diagnosis or met atypical lesions confirmed by MDP bone imaging and clinical suspicion of bone metastases.