Impact of (18)F-FDG PET, PET/CT, and PET/MRI on Staging and Management as an Initial Staging Modality in Breast Cancer: A Systematic Review and Meta-analysis

OBJECTIVES: We performed a systematic review and meta-analysis to evaluate the impact of (18)F-FDG PET, PET/CT, and PET/MRI on staging and management during the initial staging of breast cancer. METHODS: We searched the PubMed, Embase, Cochrane Library, and KoreaMed databases until March 2020 to identify studies that reported the proportion of breast cancer patients whose clinical stage or management were changed after PET scans. The proportion of changes was pooled using a random-effects model. Subgroup and metaregression analyses were performed to explore heterogeneity. RESULTS: We included 29 studies (4276 patients). The pooled proportions of changes in stage and management were 25% (95% confidence interval [CI], 21%–30%) and 18% (95% CI, 14%–23%), respectively. When stage changes were stratified according to initial stage, the pooled proportions were 11% (95% CI, 3%–22%) in stage I, 20% (95% CI, 16%–24%) in stage II, and 34% (95% CI, 27%–42%) in stage III. The relative proportions of intermodality and intention-to-treat changes were 74% and 70%, respectively. Using metaregression analyses, the mean age and the proportion of initial stage III to IV and histologic grade II to III were significant factors affecting the heterogeneity in changes in stage or management. CONCLUSIONS: Currently available literature suggests that the use of (18)F-FDG PET, PET/CT, or PET/MRI leads to significant modification of staging and treatment in newly diagnosed breast cancer patients. Therefore, there may be a role for routine clinical use of PET imaging for the initial staging of breast cancer.