18F-FES PET/CT Influences the Staging and Management of Patients with Newly Diagnosed Estrogen Receptor-Positive Breast Cancer: A Retrospective Comparative Study with 18F-FDG PET/CT

Liu, Cheng; Gong, Chengcheng; Liu, Shuai; Zhang, Yingjian; Zhang, Yongping; Xu, Xiaoping; Yuan, Huiyu; Wang, Biyun; Yang, Zhongyi

doi:10.1634/theoncologist.2019-0096

Cited by 31 publications

(100 citation statements)

References 31 publications

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“…Positron emission tomography (PET) with 16α‐18F‐fluoro‐17β‐estradiol ( 18 F‐FES) assesses ER functioning in a manner analogous to in vitro ligand‐binding assays . 18 F‐FES PET has been shown by several groups to be an excellent noninvasive method for determining ER status in multiple lesions throughout the body (with the exception of the liver, whence it is cleared) . ER positivity by 18 F‐FES PET has been shown to predict, beyond clinical and pathological predictors, longer progression‐free survival (PFS) on endocrine monotherapy , potentially impacting therapy choices in patients with a clinical dilemma .…”

Section: Introductionmentioning

confidence: 99%

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Kurland

Wiggins²,

Coche³

et al. 2020

The Oncologist

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Estrogen receptor (ER) status by immunohistochemistry (IHC) of cancer tissue is currently used to direct endocrine therapy in breast cancer. Positron emission tomography (PET) with 16α-18F-fluoro-17β-estradiol (18 F-FES) noninvasively characterizes ER ligand-binding function of breast cancer lesions. Concordance of imaging and tissue assays should be established for 18 F-FES PET to be an alternative or complement to tissue biopsy for metastatic lesions. We conducted a metaanalysis of published results comparing 18 F-FES PET and tissue assays of ER status in patients with breast cancer. PubMed and EMBASE were searched for English-language manuscripts with at least 10 patients and low overall risk of bias. Thresholds for imaging and tissue classification could differ between studies but had to be clearly stated. We used hierarchical summary receiver-operating characteristic curve models for the meta-analysis. The primary analysis included 113 nonbreast lesions from 4 studies; an expanded analysis included 327 total lesions from 11 studies. Treating IHC results as the reference standard, sensitivity was 0.78 (95% confidence region 0.65-0.88) and specificity 0.98 (0.65-1.00) for the primary analysis of nonbreast lesions. In the expanded analysis including non-IHC tissue assays and all lesion sites, sensitivity was 0.81 (0.73-0.87) and specificity 0.86 (0.68-0.94). These results suggest that 18 F-FES PET is useful for characterization of ER status of metastatic breast cancer lesions. We also review current best practices for conducting 18 F-FES PET scans. This imaging assay has potential to improve clinically relevant outcomes for patients with (historically) ER-positive metastatic breast cancer, including those with brain metastases and/or lobular histology.

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Section: Introductionmentioning

confidence: 99%

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Kurland

Wiggins²,

Coche³

et al. 2020

The Oncologist

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“…Yet for locoregional extraaxillary nodes including internal mammary, infraclavicular, and supraclavicular nodes, 18 F-FDG PET-CT has obvious advantages in the detection of these lymph node metastases ( 17 – 19 ), as our finding shows. Similarly, for distant metastases such as brain, lung, liver, and bone, 18 F-FDG PET-CT examination has obvious advantages over other examination methods and contributes to improving staging and treatment ( 20 ). And the NCCN guideline of breast cancer also expressed similar views ( 17 , 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, for distant metastases such as brain, lung, liver, and bone, 18 F-FDG PET-CT examination has obvious advantages over other examination methods and contributes to improving staging and treatment ( 20 ). And the NCCN guideline of breast cancer also expressed similar views ( 17 , 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Is 18F-FDG PET/CT Beneficial for Newly Diagnosed Breast Cancer Patients With Low Proportion of ER Expression?

et al. 2021

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ObjectiveIt is unclear whether the receptor status of breast malignancy or the proportion of receptors expression is useful in the interpretation of 18F-FDG PET/CT. This study’s purpose was to analyze whether 18F-FDG PET/CT was valuable for helping newly diagnosed breast cancer patients find suspected or unsuspected metastasis lesions based on the proportion of receptors expression.Materials and MethodsEighty newly diagnosed breast cancer patients were divided into six groups, containing N0 (no extraaxillary lymph node metastasis), N1 (extraaxillary lymph node metastasis), M0 (no distant metastasis), and M1 (distant metastasis) groups, C0 (no unsuspected metastasis), and C1 (unsuspected metastasis and treatment plan changed) detected by PET/CT. The main data, including the proportion of receptors ER (estrogen receptor), PR (progesterone receptor), and Her-2 (human epidermal growth factor receptor 2) status, were extracted. Simple correlation and logistic regression were preformed to analyze the association between them.ResultsPatients in N1 group had lower proportion of ER (%) and PR (%) than that in N0 group (ER: 2 [0–80] vs. 80 [15–95]; PR: 1 [0–10] vs. 20 [0–45], p<0.001). Moreover, the proportions of ER and PR were negatively correlated with N1 (ER: [r= −0.339, p= 0.002], PR: [r= −0.247, p= 0.011]) by simple correlation. Also, patients in C1 group had lower proportion of ER (%) and PR (%) than those in C0 group (ER: 10 [0–85] vs. 80 [15–90], p=0.026; PR: 1 [0–10] vs. 20 [0–70], p=0.041), while the distribution of ER and PR between M1 and M0 group had no significant difference. After the adjustment of traditional factors, the negative correlation between the proportion of ER (OR=0.986, 95% CI of OR [0.972–0.999], p=0.016) and C1 was found by logistic regression, cutoff value was 25% (ER) calculated by ROC (Receiver Operating Characteristic) curve (AUC [Area Under Curve]= 0.647, p=0.024).ConclusionThe proportion of ER in newly diagnosed breast cancer was negatively correlated with unsuspected metastasis detected by 18F-FDG PET/CT. 18F-FDG PET/CT might be recommended for newly diagnosed breast cancer patients with single lesions when the ER expression proportion is less than 25% to find unsuspected metastasis lesions and to modify treatment plan contrasted with conventional imaging and clinical examination.

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“…The synthesis and quality control of 18 F-FDG and 18 F-FES were performed as reported in our previous study ( 15 ).…”

Section: Methodsmentioning

confidence: 99%

Dual Tracers of 16α-[18F]fluoro-17β-Estradiol and [18F]fluorodeoxyglucose for Prediction of Progression-Free Survival After Fulvestrant Therapy in Patients With HR+/HER2- Metastatic Breast Cancer

Liu

Yuan

et al. 2020

Front. Oncol.

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Objective The purpose of this study was to employ dual tracers 16α-[18F]fluoro-17β-estradiol ( 18 F-FES) and [18F]fluorodeoxyglucose ( 18 F-FDG) as imaging biomarkers in predicting progression-free survival (PFS) in ER-positive metastatic breast cancer (MBC) patients receiving fulvestrant therapy. Methods We retrospectively analyzed 35 HR+HER2- MBC patients who underwent 18 F-FES and 18 F-FDG PET/CT scans prior to fulvestrant therapy in our center. The SUVmax across all metastatic lesions on the PET/CT were assessed. The heterogeneity of ER expression was assigned by the presence of any 18 F-FES negative lesions for patients with entirely 18 F-FES positive lesions categorized into two groups by the median ratio of FES/FDG SUVmax, low FES/FDG, and high FES/FDG. PFS were estimated by the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazard model. Results In total, 12 patients had both 18 F-FES negative and positive lesions, indicating the heterogeneity of ER expression in metastatic lesions. These patients had a low median PFS of 5.5 months (95% CI 2.3–8.7). Of patients with entirely 18 F-FES positive lesions, 11 had a low FES/FDG, and 12 had a high FES/FDG. These groups had a median PFS of 29.4 months (95% CI 2.3–56.5) and 14.7 months (95% CI 10.9–18.5), respectively. The patients were stratified in three categories based on incorporating both 18 F-FES and 18 F-FDG imaging results that were significantly correlated with PFS by univariate analysis ( P < 0.001) and multivariate analysis ( P = 0.006). Conclusion 18 F-FES and 18 F-FDG PET could serve as prognostic imaging biomarkers for ER-positive MBC patients treated with fulvestrant therapy.

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18F-FES PET/CT Influences the Staging and Management of Patients with Newly Diagnosed Estrogen Receptor-Positive Breast Cancer: A Retrospective Comparative Study with 18F-FDG PET/CT

Cited by 31 publications

References 31 publications

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Whole-Body Characterization of Estrogen Receptor Status in Metastatic Breast Cancer with 16α-18F-Fluoro-17β-Estradiol Positron Emission Tomography: Meta-Analysis and Recommendations for Integration into Clinical Applications

Is 18F-FDG PET/CT Beneficial for Newly Diagnosed Breast Cancer Patients With Low Proportion of ER Expression?

Dual Tracers of 16α-[18F]fluoro-17β-Estradiol and [18F]fluorodeoxyglucose for Prediction of Progression-Free Survival After Fulvestrant Therapy in Patients With HR+/HER2- Metastatic Breast Cancer

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