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A meta-analysis of 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer

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Abstract

Objective

To perform a meta-analysis comparing the diagnostic value of 18FDG-PET, MRI, and bone scintigraphy (BS) in detecting bone metastases in patients with breast cancer.

Materials and Methods

MEDLINE, EMBASE, Scopus, ScienceDirect, SpringerLink, Web of Knowledge, EBSCO, and the Cochrane Database of Systematic Review databases were searched for relevant original articles published from January 1995 to January 2010. Inclusion criteria was as follows: 18FDG-PET, MRI or 99mTc-MDP BS was performed to detect bone metastases (the number of published CT studies was inadequate for meta-analysis and therefore could not be included in this study); sufficient data were presented to construct a 2 × 2 contingency table; histopathological analysis and/or close clinical and imaging follow-up for at least 6 months were used as the reference standard. Two reviewers independently assessed potentially eligible studies and extracted relevant data. A software program called “META-DiSc” was used to obtain the pooled estimates for sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves, and the *Q index for each modality.

Results

Thirteen articles consisting of 23 studies fulfilled all inclusion criteria. On a per-patient basis, the pooled sensitivity estimates for MRI (97.1%) were significantly higher than those for PET (83.3%) and BS (87.0%; P <0.05). There was no significant difference between PET and BS (P <0.05). The pooled specificity estimates for PET (94.5%) and MRI (97.0%) were both significantly higher than those for BS (88.1%; P <0.05). There was no significant difference between PET and MRI (P >0.05). The pooled DOR estimates for MRI (298.5) were significantly higher than those for PET (82.1%) and BS (49.3%; P <0.05). There was no significant difference between PET and BS (P >0.05). The SROC curve for MRI showed better diagnostic accuracy than those for PET and BS. The SROC curve for PET was better than that for BS. The*Q index for MRI (0.935), PET (0.922), and BS (0.872) showed no significant difference (P ≥0.05). On a per-lesion basis, the pooled sensitivity estimates for BS (87.8%) were significantly higher than those for PET (52.7%; P <0.05). The pooled specificity estimates for PET (99.6%) were significantly higher than those for BS (96.1%; P <0.05).The pooled DOR estimates for PET (283.3) were significantly higher than those for BS (66.8%; P <0.05). The SROC curve for PET showed better diagnostic accuracy than that for BS. The*Q index for PET (0.941) was significantly higher than that for BS (0.893; P <0.05).

Conclusion

Magnetic resonance imaging was found to be better than 18FDG-PET and BS for diagnosis of bone metastases in patients with breast cancer on a per-patient basis. On a per-lesion basis, 18FDG-PET had lower sensitivity, higher specificity, a higher DOR, and a higher *Q index than BS.

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Acknowledgements

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to subject matter of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, No188, Shizi Street, Suzhou, 215006, People’s Republic of China

    Tao Liu & Hui-Lin Yang

  2. Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China

    Tao Cheng

  3. Department of Epidemiology and Biostatistics, Public Health School of Soochow University, Suzhou, People’s Republic of China

    Wen Xu

  4. Departments of Nuclear Medicine, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China

    Wei-Li Yan

  5. Departments of Radiology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China

    Jia Liu

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  1. Tao Liu
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Correspondence to Hui-Lin Yang.

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Tao Liu and Tao Cheng contributed equally to this work as the first authors

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Liu, T., Cheng, T., Xu, W. et al. A meta-analysis of 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer. Skeletal Radiol 40, 523–531 (2011). https://doi.org/10.1007/s00256-010-0963-8

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  • DOI: https://doi.org/10.1007/s00256-010-0963-8

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