Abstract
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Aim: To assess available literature on FDG-PET/CT and contrast-enhanced CT in response evaluation in metastatic breast cancer (MBC) by PET Response Criteria in Solid Tumours (PERCIST) and Response Evaluation Criteria in Solid Tumours (RECIST), respectively.
Methods: A systematic search in Embase, PubMed/Medline, and Cochrane Libraries was conducted. A modified PICO-model was utilised, to structure our literature search. PICO is a widely used framework to develop literature search strategies and an acronym for Population (e.g. Metastatic breast cancer patients), Intervention (e.g. 18F-FDG-PET/CT), Comparison (e.g. CE-CT), and Outcome (e.g. Relapse). Our population category consisted of MBC patients and the intervention category of PERCIST or RECIST. We used relevant Medical subject headings (MeSH) and Emtree Thesaurus in PubMed/Medline and Embase, respectively. Quality assessment was performed using QUADAS-2 checklist.
Results: A total of 1971 articles were found including 26 additional records identified through other sources. The 1971 articles were screened by title/abstract by the two authors, and 74 were selected for further analysis. Two duplicates and 33 conference abstracts were excluded. One out of 39 eligible articles met our inclusion and exclusion criteria and was considered main article, while the other 38 supplied with additional information concerning metrics, thresholds, and response evaluation in MBC in general. A flow diagram of the study selection can be seen in Figure 1. The main article was a retrospective study of 65 patients with MBC showing one-year progression free survival (PFS) for responders versus non-responders by RECIST to be 59% vs 27% (p = 0.2) compared to 64% vs 0% (p = 0.0001) by PERCIST, where PERCIST had a higher concordance index for PFS than RECIST (0.70 vs 0.60). The study also found four-year disease specific survival (DSS) of responders versus non-responders by RECIST to be 50% and 38% respectively (p = 0.003) compared to 58% versus 18% by PERCIST (p = 0.0001), where PERCIST again had a higher concordance index (0.55 vs 0.65). Hence response classification by PERCIST had a stronger correlation with PFS and DSS than RECIST.
Conclusions: This systematic review identified a lack of studies analysing FDG-PET/CT and PERCIST in response evaluation and prediction of prognosis in MBC patients. The limited available literature indicates that that PERCIST might be more appropriate for prediction of prognosis than RECIST in patients with MBC. Prospective studies addressing response evaluation and disease prediction with PERCIST and RECIST are greatly needed.
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