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Tumor Marker–Guided PET in Breast Cancer Patients—A Recipe for a Perfect Wedding: A Systematic Literature Review and Meta-Analysis

Evangelista, Laura MD*; Cervino, Anna Rita MD*; Ghiotto, Cristina MD; Al-Nahhas, Adil MD; Rubello, Domenico MD§; Muzzio, Pier Carlo MD

doi: 10.1097/RLU.0b013e31824850b0
Original Articles

Introduction: 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.

Methods: 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.

Results: 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).

Conclusions: 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:

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