A meta-analysis of 18F-FDG PET or PET/CT for the evaluation of neoadjuvant chemotherapy in locally advanced breast cancer

Objective To evaluate the accuracy and predictive value of 18F-FDG PET or PET/CT in the assessment of neoadjuvant chemotherapy in locally advanced breast cancer by meta-analysis.Methods Relevant studies were retrieved from PubMed,Embase,Cochrane and Wanfang,in English or Chinese.To ensure the homogeneity of all included studies,selection criteria were established and all the studies were scored according to a quality assessment of diagnostic accuracy studies (QUADAS) table.The combined Se,Sp,LR,diagnostic odds ratio (DOR),and AUC of PET and other conventional imaging techniques were compared.The assessment standard of neoadjuvant chemotherapy by conventional imaging techniques is tumor size change.Funnel plot and analysis with meta-regression were performed to explore the source of heterogeneity.Results Sixteen eligible studies were included with a total of 662 subjects.The combined results were:(1) PET:SePET 86.1％(247/287),SpET 69.6％(261/375),LR + PET 3.18,LR - PET 0.23,DORPET 17.26; (2) Other imaging techniques:Sed 57.2％(91/159),Spd 48.5％(50/103),LR+d 1.07,LR-d 0.87,DORd 1.30.ROC analysis showed that Q* values of PET ( QPET* ) and other imaging techniques ( Qd* ) were 0.8058 and 0.5328,respectively.Funnel plot showed that publication bias was not the main source of heterogeneity.Meta-regression results suggested that the year of publication might be one of the sources of heterogeneity (P=0.05).Conclusion This meta-analysis suggests that,in the assessment of treatment rosponse of neoadjuvant chemotherapy for breast cancer,FDG PET or PET/CT in monitoring the changes in glucose metabolism is more accurate than conventional imaging techniques in monitoring tumor size. Key words: Breast neoplasms; Drug therapy; Tomography,emission-computed; Tomography,X-ray computed; Meta-analysis; Deoxyglucose