Diagnostic role of 18F-FDG PET/MRI in the TNM staging of breast cancer: a systematic review and meta-analysis

BACKGROUND To investigate the value of 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) in diagnosing local tumor invasion (T stage), evaluating regional lymph node involvement (N stage), and detecting distant metastasis (M stage) in breast cancer patients. METHODS A comprehensive computer search and manual search were performed to select any potentially eligible studies that evaluated the diagnostic efficacy of 18F-FDG PET/MRI in the tumor-node-metastasis (TNM) staging of breast cancer. Data from the included studies were extracted to calculate the pooled sensitivity, specificity, and area under the curve (AUC) to evaluate the value of 18F-FDG PET/MRI in TNM staging. Quality and publication bias were also assessed in this meta-analysis. RESULTS Based on seven studies, the pooled sensitivity, specificity and AUC for the diagnosis of T stage were 91% (95% CI: 84-96%), 91% (95% CI: 81-96%), and 0.96 (95% CI: 0.94-0.98), respectively. For N stage evaluation, four studies were included, with values of 94% (95% CI: 83-98%), 90% (95% CI: 81-95%), and 0.96 (95% CI: 0.94-0.97). For M stage detection, five studies were evaluated, with values of 98% (95% CI: 96-99%), 96% (95% CI: 83-99%), and 0.99 (95% CI: 0.98-1.00). CONCLUSIONS 18F-FDG PET/MRI demonstrates higher diagnostic value in the TNM staging of breast cancer and can serve as an effective and promising imaging biomarker for future evaluation of TNM stage in breast cancer patients.