Introduction. This study compared the diagnostic test accuracy of magnetic resonance imaging (MRI) with that of 18 F-fluoro-2-glucose-positron emission tomography/ computed tomography (FDG-PET/CT) imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer. Methods. A systematic search was performed in PubMed and EMBASE (last updated in June 2015). Studies investigating the performance of MRI and FDG-PET or FDG-PET/CT imaging during or after completion of NAC in patients with histologically proven breast cancer were eligible for inclusion. We considered only studies reporting a direct comparison between these imaging modalities to establish precise summary estimates in the same setting of patients. Pathologic response was considered as the reference standard. Two authors independently screened and selected studies that met the inclusion criteria and extracted the data.
Fourth and subsequent follow-up PET/CT scans affect the treatment and management of patients with NHL and add value to clinical assessment and management, especially in patients with a previous clinical suspicion of recurrence.
Objective
To evaluate the accuracy and value of the fourth and subsequent post-therapy follow-up fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) scans in the clinical assessment of breast cancer patients.
Materials and methods
Ninety-two female patients, with a total of 426 fourth and subsequent follow-up PET/CT scans, were retrospectively included. Patients were followed for a median of 23.7 months (range, 0.7–124.4) from the fourth follow-up PET/CT. The diagnostic accuracy of PET/CT, its impact on clinical assessment, patients’ management, and survival outcome were established.
Result
Of the 426 follow-up PET/CT scans, 264 (62%) were interpreted as positive and 162 (38%) were interpreted as negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the fourth and subsequent follow-up PET/CT scans were 97.7, 98.1, 98.8, 96.3, and 97.9%, respectively. Fourth and subsequent follow-up PET/CT were useful in excluding a tumor in 13.4% (39/292) of patients with a clinical suspicion of recurrence and identifying suspected recurrence in 10.5% (14/134) of patients without previous clinical suspicion. A change in management was noted in 6.7% (9/134) of scan times when the scans were performed without previous clinical suspicion of recurrence or therapy response and was 27.7% (81/292) when the scans were performed with clinical suspicion. Overall survival differed significantly between patients with all negative follow-up scans (n = 23) and those who had at least one positive follow-up scan (n = 69) (hazard ratio of 4.65, P < 0.001).
Conclusion
The fourth and subsequent PET/CT scans performed after the completion of primary treatment led to a change in management in 27.7% of patients when the scans were performed with clinical suspicion and only in 6.7% of patients when performed without clinical suspicion or context.
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