title: Tumor marker-guided PET in breast cancer patients-a recipe for a perfect wedding: a systematic literature review and meta-analysis.
abstract: BACKGROUND
  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.
authors.affiliation: Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Evangelista
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Cervino
authors.forename: Cristina
authors.initials: C
authors.lastname: Ghiotto
authors.forename: Adil
authors.initials: A
authors.lastname: Al-Nahhas
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Pier Carlo
authors.initials: PC
authors.lastname: Muzzio
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D006801:Humans; D049268:Positron-Emission Tomography
chemical_list: D014408:Biomarkers, Tumor