Early detection of breast cancer (BC) recurrence is a fundamental issue during follow-up. Although the utilization of new therapeutic protocols aimed at reducing the recurrence risk is defined, the diagnostic approach for early detection remains to be clarified. We aim to provide a critical overview of recently published reports and perform a meta-analysis on the use of tumor markers in BC patients as a guide for fluorodeoxyglucose positron emission tomography (PET) imaging.
Medline and Google Scholar were used for searching English and non-English articles that evaluate the role of PET in BC recurrence when an increase in tumor markers is found. All complete studies were reviewed; thus, quantitative and qualitative analyses were performed.
From 2001 to May 2011, we found 19 complete articles that critically evaluated the role of PET in BC recurrence detection in the presence of elevated tumor markers. The meta-analysis of the 13 studies provided the following results: pooled sensitivity 0.878 (95% CI: 0.838–0.909), pooled specificity 0.693 (95% CI: 0.553–0.805), and pooled accuracy 0.828 (95% CI: 0.762–0.878).
The current experience confirms the potential of fluorodeoxyglucose PET, and in particular of PET/CT, in detecting occult soft tissue and bone metastases in the presence of a progressive increase of serum tumor markers in BC patients, but this should be better defined in the current practical recommendations.
From the *Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto (IOV–IRCCS), Padova, Italy; †Second Medical Oncology Unit, Istituto Oncologico Veneto (IOV–IRCCS), Padova, Italy; ‡Department of Nuclear Medicine, Hammersmith Hospital, London, United Kingdom; §Department of Nuclear Medicine, Radiology, Medical Physics, Santa Maria della Misericordia Hospital, Rovigo, Italy; and ¶Department of Radiology Oncology, Istituto Oncologico Veneto (IOV–IRCCS), Padova, Italy.
Received for publication July 11, 2011; revision accepted December 21, 2011.
Conflicts of interest and sources of funding: none declared.
Reprints: Domenico Rubello, MD, Department of Nuclear Medicine, Radiology, Medical Physics, Head of Service of Nuclear Medicine, PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 45100 Rovigo, Italy. E-mail: firstname.lastname@example.org.