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

Tian, Fei; Shen, Guohua; Deng, Yunfu; Diao, Wei; Jia, Zhiyun

doi:10.1007/s00330-017-4831-y

Cited by 60 publications

(61 citation statements)

References 56 publications

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“…To date, three main methods were reported for early response assessment in neoadjuvant treatment of breast cancer: 18 F-FDG PET/CT, dynamic contrast enhanced MRI (DCE-MRI), and ultrasound 9 , 15 , 16 . Meta-analysis showed that 18 F-FDG PET/CT had a moderate accuracy for the early prediction for pCR (sensitivity 85%, specificity 79% and diagnostic odds ratio 21.8), especially in HER2 positive and triple negative breast cancer 16 , 17 . DCE-MRI was also an effective method for early monitoring the efficacy during NAT (sensitivity 87%, specificity 82% and diagnostic odds ratio 30.3) 18 .…”

Section: Discussionmentioning

confidence: 99%

Early response and pathological complete remission in Breast Cancer with different molecular subtypes: a retrospective single center analysis

Jiang¹,

Wu²,

Huang³

et al. 2020

J. Cancer

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Purpose: To evaluate the association of clinical early response and pathological complete remission (pCR) in breast cancer patients with different molecular subtypes. Materials and methods: Breast cancer patients who received neoadjuvant treatment (NAT) with clinical early response assessment from October 2008 to October 2018 were retrospectively analyzed. Clinical early response was defined as tumor size decreasing ≥30% evaluated by ultrasound after two cycles of NAT. Chi-square test was used to compare the pCR rates between the responder and non-responder groups with different molecular subtypes. Multivariate logistic regression was used to identify independent factors associated with the pCR. Results: A total of 328 patients were included: 100 responders and 228 non-responders. The progesterone receptor (PR) expression was an independent factor associated with clinical early response (OR=2.39, 95%CI=1.41-4.05, P =0.001). The pCR rate of breast was 50.0% for responders and 18.0% for non-responders ( P <0.001). Regarding different molecular subtypes, responders had higher pCR rates than non-responders for patients with HER2 overexpression (OR=10.66, 95%CI=2.18-52.15, P =0.001), triple negative (OR=3.29, 95%CI=1.23-8.84, P =0.016) and Luminal (HER2-) subtypes (OR=8.58, 95%CI=3.05-24.10, P <0.001) respectively. Moreover, pCR rate can be achieved as high as 88.2% in HER2 overexpression patients with early clinical response, which was significantly higher than patients without early response (41.3%, P =0.001). Multivariate analysis showed that clinical early response was an independent factor associated with the pCR rate (OR=4.87, 95%CI=2.72-8.72, P <0.001). Conclusions: Early response was significantly associated with a higher pCR rate in breast cancer patients receiving NAT, especially for patients with HER2 overexpression subtype, which warrants further clinical evaluation.

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Section: Discussionmentioning

confidence: 99%

Early response and pathological complete remission in Breast Cancer with different molecular subtypes: a retrospective single center analysis

Jiang¹,

Wu²,

Huang³

et al. 2020

J. Cancer

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“…In a systematic analysis, the sensitivity of MRI was shown to be superior to that of other diagnostic modalities, with the exception of PET–CT. On the other hand, meta‐analytical data suggested that PET–CT yields moderate accuracy in the identification of patients who will have a pCR. However, recent results suggested that PET–CT and integrated metabolic radiomics may have prognostic value for Ki‐67 expression, response to NAT, as well as local recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Breast MRI is commonly used to assess the disease response to NAT but is known to overestimate residual disease 29 , especially when a pCR has been achieved 30 , and could potentially result in higher rates of mastectomy, as in the setting of upfront surgery 31 . In a systematic analysis 32 , the sensitivity of MRI was shown to be superior to that of other diagnostic modalities, with the exception of PET-CT. On the other hand, meta-analytical data suggested that PET-CT yields moderate accuracy in the identification of patients who will have a pCR 33 . However, recent results 34 suggested that PET-CT and integrated metabolic radiomics may have prognostic value for Ki-67 expression, response to NAT, as well as local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer

Karakatsanis

Tasoulis

Wärnberg

et al. 2018

British Journal of Surgery

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“…Decreased glucose metabolism within breast cancer tissue on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) is a useful indicator to assess the effectiveness of NAC [ 6 ]. Several meta-analyses have reported that 18 F-FDG PET/CT scans performed during or after NAC could predict the final pathological response after completion of NAC [ 7 – 10 ]. A meta-analysis directly comparing PET/CT and breast MRI reported that PET/CT has a higher sensitivity and specificity for assessment of pathological response than conventional MRI when performed before 3 cycles of NAC [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

Han

Choi

2020

Breast Cancer Res

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Background We performed a systematic review and meta-analysis to evaluate the prognostic significance of 18F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of 18F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model. Results Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14–0.32) for interim PET scans and 0.31 (95% CI, 0.21–0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09–0.44) and 0.26 (95% CI, 0.14–0.51), respectively. Conclusions The currently available literature suggests that the use of 18F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.

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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: • 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. • F-FDG PET/CT has a moderate accuracy in predicting the pathological response.

Cited by 60 publications

References 56 publications

Early response and pathological complete remission in Breast Cancer with different molecular subtypes: a retrospective single center analysis

Early response and pathological complete remission in Breast Cancer with different molecular subtypes: a retrospective single center analysis

Meta-analysis of neoadjuvant therapy and its impact in facilitating breast conservation in operable breast cancer

Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

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