The accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis and systematic review

Abstract

Objectives: The aim of this meta-analysis was to evaluate the accuracy of ¹⁸F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients.

Methods: PubMed, Embase, the Cochrane Library (Central), and the Web of Science (SCI-Expanded) were systematically searched to identify pertinent studies. The methodologic quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. The Spearman correlation coefficient was used to explore the existence of a threshold effect. Heterogeneity was assessed by the likelihood ratio I ² index.

Results: The pooled values calculated with a mixed-effects model for the sensitivity, specificity and diagnostic odds ratio with 95% confidence intervals were 81.9% (76.0-86.6%), 79.3% (72.1-85.1%) and 17.35 (10.98-27.42), respectively.

Conclusions: ¹⁸F-FDG PET/CT has a moderate accuracy in predicting the pathological response during the early process of NAC in breast cancer patients. To increase the role of ¹⁸F-FDG PET/CT in monitoring the therapy response, future prospective studies are needed to explore how chemotherapy regimens and different subtypes affect the levels of glucose metabolism.

Key points: • This meta-analysis assesses the role of PET/CT in breast cancer during NAC. • Pathological responses were based on both primary tumour and lymph node. • ¹⁸ F-FDG PET/CT has a moderate accuracy in predicting the pathological response.

Keywords: Breast neoplasms; Meta-analysis; Neoadjuvant therapy; Pathological response; Positron-emission tomography.