A systematic review of FDG-PET in breast cancer.
OBJECTIVE
To assess the safety and efficacy of FDG-PET in breast cancer in the diagnostic of primary tumours, lymph node staging, the detection of recurrent disease/metastases, and the assessment of chemotherapy treatment.


METHODS
A systematic review was undertaken. A search was made for primary studies, other systematic reviews, and health technology assessment reports in different databases.


RESULTS
A total of 73 reports were included. FDG-PET does not appear to be sufficiently accurate to be used in isolation for ruling out the presence of a primary tumour. In lymph gland staging, FDG-PET does not appear to be accurate enough to detect occult axillary metastases or micrometastases (sensitivity 20 and 50%, respectively); sentinel node biopsy is required for confirmation. In the detection of bone metastases, FDG-PET should be complemented with other tests such as bone gammagraphy or SPECT. The assessment of response to chemotherapy, there seems to be no uniform criterion for establishing a standardized uptake value (SUV) for FDG that would allow responders and non-responders to be distinguished.


CONCLUSIONS
FDG-PET is insufficiently sensitive to rule out small primary tumours. Due to the high number of false positives returned, it cannot replace axillary dissection in axillary lymph gland staging. A complete biochemical response identified by FDG-PET should not be relied upon to mean an absence of disease since the technique cannot detect residual microscopic elements.
Escalona
S
S
Health Technology Assessment Unit, Unidad de Evaluación de Tecnologías Sanitarias (UETS), Agencia Laín Entralgo, Gran Vía 27, Madrid, Spain. sofia.escalona@salud.madrid.org
Blasco
J A
JA
Reza
M M
MM
Andradas
E
E
Gómez
N
N
D001943:Breast Neoplasms / Q000175:diagnosis*; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18