Diagnostic accuracy and safety of 16α-[18F]fluoro-17β-oestradiol PET-CT for the assessment of oestrogen receptor status in recurrent or metastatic lesions in patients with breast cancer: a prospective cohort study

Chae, Su Young; Ahn, Sei Hyun; Kim, Sung‐Bae; Han, Sangwon; Lee, Suk Hyun; Oh, Seung Jun; Lee, Sang Ju; Kim, Hee Jeong; Ko, Beom Seok; Lee, Jong Won; Son, Byung Ho; Kim, Jisun; Ahn, Jin‐Hee; Jung, Kyung Hae; Kim, Jeong Eun; Kim, Seog-Young; Choi, Woo Jung; Shin, Hee Jung; Gong, Gyungyub; Lee, Hyo Sang; Lee, Jung Bok; Moon, Dae Hyuk

doi:10.1016/s1470-2045(18)30936-7

Cited by 89 publications

(76 citation statements)

References 32 publications

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“…Other scholars and our previous studies have confirmed that 18 F-FES PET can noninvasively and systematically assess ER status in patients with recurrent or metastatic breast cancer, and as an imaging biomarker for predicting response to endocrine therapy ( 13 , 17 , 20 , 21 ). Nevertheless, 18 F-FES PET is challenging to monitor nonfunctional ER lesions, which might potentially lead to losing sight of ER-negative lesions.…”

Section: Discussionsupporting

confidence: 52%

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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Section: Discussionsupporting

confidence: 52%

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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“…]FDHT) PET/CT have been developed to non-invasively visualise, respectively, the ER and AR status in the tumour lesions within a patient. Previously, it has been shown that [ 18 F]FES and [ 18 F]FDHT uptake correlate well with ER and AR expression levels in representative breast cancer biopsies [8][9][10]. As a diagnostic tool, [ 18 F]FES PET leads to better diagnostic understanding in 88% and to a change of therapy in 48% of the patients presenting with a clinical dilemma [11].…”

Section: Introductionmentioning

confidence: 99%

Visual and quantitative evaluation of [18F]FES and [18F]FDHT PET in patients with metastatic breast cancer: an interobserver variability study

et al. 2020

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Purpose: Correct identification of tumour receptor status is important for treatment decisions in breast cancer. [ 18 F]FES PET and [ 18 F]FDHT PET allow non-invasive assessment of the oestrogen (ER) and androgen receptor (AR) status of individual lesions within a patient. Despite standardised analysis techniques, interobserver variability can significantly affect the interpretation of PET results and thus clinical applicability. The purpose of this study was to determine visual and quantitative interobserver variability of [ 18 F]FES PET and [ 18 F]FDHT PET interpretation in patients with metastatic breast cancer. Methods: In this prospective, two-centre study, patients with ER-positive metastatic breast cancer underwent both [ 18 F]FES and [ 18 F]FDHT PET/CT. In total, 120 lesions were identified in 10 patients with either conventional imaging (bone scan or lesions > 1 cm on high-resolution CT, n = 69) or only with [ 18 F]FES and [ 18 F]FDHT PET (n = 51). All lesions were scored visually and quantitatively by two independent observers. A visually PET-positive lesion was defined as uptake above background. For quantification, we used standardised uptake values (SUV): SUV max , SUV peak and SUV mean. Results: Visual analysis showed an absolute positive and negative interobserver agreement for [ 18 F]FES PET of 84% and 83%, respectively (kappa = 0.67, 95% CI 0.48-0.87), and 49% and 74% for [ 18 F]FDHT PET, respectively (kappa = 0.23, 95% CI − 0.04-0.49). Intraclass correlation coefficients (ICC) for quantification of SUV max , SUV peak and SUV mean were 0.98 (95% CI 0.96-0.98), 0.97 (95% CI 0.96-0.98) and 0.89 (95% CI 0.83-0.92) for [ 18 F]FES, and 0.78 (95% CI 0.66-0.85), 0.76 (95% CI 0.63-0.84) and 0.75 (95% CI 0.62-0.84) for [ 18 F]FDHT, respectively.

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“…On the other hand, fasting (at least 4 h before imaging) has also been suggested to reduce bowel accumulation due to reduced elimination of [ 18 F]-FES from the gall bladder [ 11 ]. Nowadays, different patient preparation instructions are used for [ 18 F]-FES-PET imaging, such as fasting, oral hydration with water, and non-fasting [ 11 , 12 , 13 ]. The first recommendation paper about [ 18 F]-FES-PET concluded that no specific patient preparation instructions are necessary, except when the PET scan is acquired in combination with a diagnostic (contrast-enhanced) computed tomography (CT)-scan [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

et al. 2020

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Background: High physiological 16α-[18F]-fluoro-17β-estradiol ([18F]-FES) uptake in the abdomen is a limitation of this positron emission tomography (PET) tracer. Therefore, we investigated the effect of food intake prior to PET acquisition on abdominal background activity in [18F]-FES-PET scans. Methods: Breast cancer patients referred for [18F]-FES-PET were included. Three groups were designed: (1) patients who consumed a chocolate bar (fatty meal) between tracer injection and imaging (n = 20), (2) patients who fasted before imaging (n = 20), and (3) patients without diet restrictions (control group, n = 20). We compared the physiological [18F]-FES uptake, expressed as mean standardized uptake value (SUVmean), in the abdomen between groups. Results: A significant difference in [18F]-FES uptake in the gall bladder and stomach lumen was observed between groups, with the lowest values for the chocolate group and highest for the fasting group (p = 0.015 and p = 0.011, respectively). Post hoc analysis showed significant differences in the SUVmean of these organs between the chocolate and fasting groups, but not between the chocolate and control groups. Conclusion: This exploratory study showed that, compared to fasting, eating chocolate decreases physiological gall bladder and stomach [18F]-FES uptake; further reduction through a normal diet was not seen. A prospective study is warranted to confirm this finding.

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Diagnostic accuracy and safety of 16α-[18F]fluoro-17β-oestradiol PET-CT for the assessment of oestrogen receptor status in recurrent or metastatic lesions in patients with breast cancer: a prospective cohort study

Cited by 89 publications

References 32 publications

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

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

Visual and quantitative evaluation of [18F]FES and [18F]FDHT PET in patients with metastatic breast cancer: an interobserver variability study

Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

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