Impact of 18F-FDG PET on the management of recurrent breast cancer: a meta-analysis

Purpose The incidence of breast cancer has increased steadily. We performed a meta-analysis to assess the impact of F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the management of breast cancer with respect to the detection of recurrence/metastasis after curative surgery. Methods We performed systematic searches of the MEDLINE and EMBASE databases for English language publications. All published studies regarding the impact of PET on the management of patients with breast cancer with respect to the detection of recurrence/metastasis after curative surgery, such as mastectomy or lumpectomy, were searched. The proportion of management change (%), defined as the percentage of patients for whom management was changed after FDG PET among patients who underwent FDG PET, was calculated. Results Thirteen studies, which included 982 patients, were included in this study. The impact of PET was evaluated based on the proportion of management change, and a pooled effect of 44.4% was noted. In the subgroup analyses for (1) equivocal/suspicious recurrence/metastasis on conventional imaging, (2) abnormal symptoms or physical examination, and (3) elevated tumor markers (n = 834), the pooled rate of management change was 45.9%. In patients with elevated tumor markers (n = 350) and in those who underwent PET for routine surveillance, the pooled rates of management change were 52.3% and 12.4%, respectively. Conclusions F-18-FDG PET has a major impact on the management of patients with breast cancer after curative surgery. These findings suggest that F-18-FDG PET should be performed in patients with breast cancer in cases involving equivocal or suspicious recurrence/metastasis on conventional imaging or in cases involving elevated tumor markers during follow-up. However, this study does not support the routine use of F-18-FDG PET for surveillance in breast cancer.