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To evaluate the diagnostic properties of FDG-PET and bone scintigraphy in the detection of osseous metastases in patients with breast cancer.Studies evaluating the diagnostic accuracy of FDG-PET and bone scintigraphy in the diagnosis of osseous metastasis were systematically searched for in the MEDLINE, CINAHL, and EBM Review databases from January 1995 to November 2006. Two reviewers independently abstracted data including research design, sample size, imaging technique and technical characteristics, reference standard, method of image interpretation, and totals of true positives, false positives, true negatives, and false negatives. Per-patient and per-lesion pooled sensitivity and specificity, and area under summary receiver operating characteristic curves were calculated using Meta-Test software.The pooled patient-based sensitivity for FDG-PET was 81% (95% CI: 70%–89%), specificity was 93% (95% CI: 84%–97%), and the area under the curve (AUC) was 0.08. The pooled sensitivity of bone scan was 78% (95% CI: 67%–86%), specificity was 79% (95% CI: 40%–95%), and the AUC was 0.43. The pooled lesion-based sensitivity for FDG-PET was 69% (95% CI: 28%–93%), specificity was 98% (95% CI: 87%–100%), and the AUC was 0.09. The pooled sensitivity for bone scan was 88% (95% CI: 82%–92%), specificity was 87% (95% CI: 29%–99%), and the AUC was 0.81.It remains inconclusive whether FDG-PET or bone scintigraphy is superior in detecting osseous metastasis from breast cancer. However, FDG-PET does have a higher specificity and may better serve as a confirmatory test than bone scintigraphy and used to monitor response to therapy.