The diagnostic performance of 18F-FDG PET/CT versus 18F-NaF PET/CT in breast cancer with bone metastases: an indirect comparative meta-analysis

Abstract

Abstract Purpose: This study aimed to evaluate the comparison of the diagnostic performance of 18F-FDG PET/CT and 18F-NaF PET/CT in breast cancer patients with bone metastases. Materials and Methods: The databases PubMed and Embase were used to search the English literature on the diagnostic performance of 18F-FDG PET/CT and 18F-NaF PET/CT for breast cancer bone metastases. Two authors independently extracted data. Studies were selected for analysis if the data presented in the study reports could be used to construct a 2×2 contingency table. The methodology quality of the enrolled studies was assessed by QUADAS-2, and forest plots were generated based on the sensitivity and specificity of 18F-FDG PET/CT versus 18F-NaF PET/CT in the diagnosis of breast cancer bone metastases. Stata Software Version 14.0 (Stata Corporation, College Station, TX, USA) was used for statistical processing. Results: A total of 14 articles were identified, eight of which were about the analysis of 18F-FDG PET/CT in the diagnosis of breast cancer bone metastases, five of which were about 18F-NaF PET/CT, and one article was an analysis of the diagnostic performance of both them. The studies of 18F-FDG PET/CT and 18F-NaF PET/CT included 530 and 389 patients, respectively. The pooled sensitivities were 0.88 (95% CI: 0.80-0.99) for 18F-FDG PET/CT and 0.98 (95% CI: 0.92-1.00) for 18F-NaF PET/CT, respectively, and the pooled specificities were 0.99 (95% CI: 0.98-1.00) and 0.91 (95% CI: 0.76-0.97), respectively. The area under the SROC curve of both 18F-FDG PET/CT and 18F-NaF PET/CT were 0.99 (95%CI: 0.98-1.00),, of which 18F-FDG PET/CT 1038 lesions were included and a sensitivity of 0.84 (95% CI: 0.67-1.00) and specificity of 1.00 (95% CI: 0.98-1.00) were reported for lesion-based 18F-FDG PET/CT for BM. Compared with 18F-FDG PET/CT, 18F-NaF PET/CT showed higher sensitivity (98% vs 88%, p= 0.09), but lower specificity (91% vs 99%, p=0.13), both of which were not statistically significant. Conclusions: The results showed that 18F-NaF PET/CT and 18F-FDG PET/CT are accurate methods for detecting bone metastases in breast cancer patients. The diagnostic accuracy of both is the same.