| Summary: | Due to the importance of correct and timely diagnosis of bone metastases in advanced breast cancer (BrC), we performed a meta-analysis evaluating the diagnostic accuracy of [<sup>18</sup>F]FDG, or Na[<sup>18</sup>F]F PET, PET(/CT), and (/MRI) versus [<sup>99m</sup>Tc]Tc-diphosphonates bone scintigraphy (BS). The PubMed, Embase, Scopus, and Scholar electronic databases were searched. The results of the selected studies were analyzed using pooled sensitivity and specificity, diagnostic odds ratio (DOR), positive–negative likelihood ratio (LR<sup>+</sup>–LR<sup>−</sup>), and summary receiver–operating characteristic (SROC) curves. Eleven studies including 753 BrC patients were included in the meta-analysis. The patient-based pooled values of sensitivity, specificity, and area under the SROC curve (AUC) for BS (with 95% confidence interval values) were 90% (86–93), 91% (87–94), and 0.93, respectively. These indices for [<sup>18</sup>F]FDG PET(/CT) were 92% (88–95), 99% (96–100), and 0.99, respectively, and for Na[<sup>18</sup>F]F PET(/CT) were 96% (90–99), 81% (72–88), and 0.99, respectively. BS has good diagnostic performance in detecting BrC bone metastases. However, due to the higher and balanced sensitivity and specificity of [<sup>18</sup>F]FDG PET(/CT) compared to BS and Na[<sup>18</sup>F]F PET(/CT), and its advantage in evaluating extra-skeletal lesions, [<sup>18</sup>F]FDG PET(/CT) should be the preferred multimodal imaging method for evaluating bone metastases of BrC, if available.
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