Comparison of diagnostic sensitivity of [18F]fluoroestradiol and [18F]fluorodeoxyglucose positron emission tomography/computed tomography for breast cancer recurrence in patients with a history of estrogen receptor-positive primary breast cancer

Abstract

Background: To compare the diagnostic sensitivity of [ 18 F]fluoroestradiol ([ 18 F]FES) and [ 18 F]fluorodeoxyglucose ([ 18 F]FDG) positron emission tomography/computed tomography (PET/CT) for breast cancer recurrence in patients with estrogen receptor (ER)-positive primary breast cancer. Methods: Our database of consecutive patients enrolled in a previous prospective cohort study to assess [ 18 F]FES PET/CT was reviewed to identify eligible patients who had ER-positive primary breast cancer with suspected first recurrence at presentation and who underwent [ 18 F]FDG PET/CT. The sensitivity of qualitative [ 18 F]FES and [ 18 F]FDG PET/CT interpretations was assessed, comparing them with histological diagnoses. Results: Of the 46 enrolled patients, 45 were confirmed as having recurrent breast cancer, while one was diagnosed with chronic granulomatous inflammation. Forty (89%) patients were ER-positive, four (9%) were ER-negative, and one (2%) patient did not undergo an ER assay. The sensitivity of [ 18 F]FES PET/CT was 71.1% (32/45, 95% CI, 55.7-83.6), while that of [ 18 F]FDG PET/CT was 80.0% (36/45, 95% CI, 65.4-90.4) with a threshold of positive interpretation, and 93.3% (42/ 45, 95% CI, 81.7-98.6) when a threshold of equivocal was used. There was no significant difference in sensitivity between [ 18 F]FES and [ 18 F]FDG PET/CT (P = 0.48) with a threshold of positive [ 18 F]FDG uptake, but the sensitivity of [ 18 F]FDG was significantly higher than [ 18 F]FES (P = 0.013) with a threshold of equivocal [ 18 F]FDG uptake. One patient with a benign lesion showed negative [ 18 F]FES but positive [ 18 F]FDG uptake.

Head-to-Head Comparison between 18F-FES PET/CT and 18F-FDG PET/CT in Oestrogen Receptor-Positive Breast Cancer: A Systematic Review and Meta-Analysis

“…The injected radiotracer activity ranged from 185 to 370 MBq for 18 F-FDG PET/CT and from 111 to 222 for 18 F-FES PET/CT. The time interval between radiotracer injection and PET/CT image acquisition was similar across the studies, being 60 min for both tracers in the majority of cases but one [ 19 ] in which 18 F-FES PET/CT acquisition started 80–100 min after the tracer injection.…”

“…Out of the remaining 43 records, 36 were excluded because they did not meet the set inclusion criteria. Therefore, seven articles were finally selected [ 12 , 17 , 18 , 19 , 20 , 21 , 22 ], including 171 ER+ BC patients ( Figure 1 ).…”

“…When 18 F-FES PET/CT was considered, in three studies a SUV max cut-off was introduced to interpret as positive each focal tracer uptake [ 18 , 20 , 22 ]. On the other hand, a visual interpretation (i.e., uptake higher than surrounding background) was used in another study [ 12 ], and in a further three analyses, the criteria were not reported [ 17 , 19 , 21 ]. All technical aspects are summarized in Table 2 .…”

“…Overall, 18 F-FDG PET/CT and 18 F-FES PET/CT showed very high sensitivity in detecting sites of disease in ER+ BC patients. Indeed, in two studies, 18 F-FDG PET/CT identified more patients with BC lesions/metastases than 18 F-FES PET/CT [ 19 , 22 ]. Conversely, in one study, 18 F-FES PET/CT showed more BC lesions than 18 F-FDG PET/CT [ 21 ].…”

Utility of [18F]-fluoroestradiol (FES) PET/CT with dedicated brain acquisition in differentiating brain metastases from posttreatment change in estrogen receptor-positive breast cancer

“…The specificity of FES PET/CT is greater than 90%, 1 while the sensitivity ranges from 70% to 90%. 2 , 3 [18F]FES PET/CT has been utilized in various clinical scenarios, including as a problem-solving tool in patients with heterogeneous ER expression, 4 to select patients suitable for neoadjuvant endocrine therapy and evaluate treatment response, 5 , 6 to more accurately stage patients with ER-positive invasive lobular cancer which can be occult or underdiagnosed on FDG PET/CT, and extent of disease assessment and quantification of suspected metastatic disease burden. 7 At present, there are limited data available regarding the detection of brain metastases using [18F]-FES PET/CT.…”