Abstract
Purpose of ReviewMolecular imaging with positron emission tomography (PET) is a powerful tool to visualize breast cancer characteristics. Nonetheless, implementation of PET imaging into cancer care is challenging, and essential steps have been outlined in the international “imaging biomarker roadmap.” In this review, we identify hurdles and provide recommendations for implementation of PET biomarkers in breast cancer care, focusing on the PET tracers 2-[18F]-fluoro-2-deoxyglucose ([18F]-FDG), sodium [18F]-fluoride ([18F]-NaF), 16α-[18F]-fluoroestradiol ([18F]-FES), and [89Zr]-trastuzumab.Recent FindingsTechnical validity of [18F]-FDG, [18F]-NaF, and [18F]-FES is established and supported by international guidelines. However, support for clinical validity and utility is still pending for these PET tracers in breast cancer, due to variable endpoints and procedures in clinical studies.SummaryAssessment of clinical validity and utility is essential towards implementation; however, these steps are still lacking for PET biomarkers in breast cancer. This could be solved by adding PET biomarkers to randomized trials, development of imaging data warehouses, and harmonization of endpoints and procedures.
Highlights
Over the last decade, there has been an increasing interest in molecular imaging with positron emission tomography (PET), in particular in the field of oncology
The IMPACT breast trial (NCT01957332), in which baseline [18F]-FDG-PET/CT was performed in 200 metastatic BC (MBC) patients of all subtypes, including biopsy of a metastasis and conventional imaging, is likely to provide these data in the near future
Within two prospective cohort trials, the multicenter IMPACT breast trial and the ECOG-ACRIN trial (NCT02398773; 99 newly diagnosed MBC patients), the analysis of baseline [18F]-FES uptake related to treatment response or progression-free survival (PFS) is ongoing
Summary
There has been an increasing interest in molecular imaging with positron emission tomography (PET), in particular in the field of oncology. Clinical utility, i.e., whether the test improves patient outcome and is cost-effective, is determined by health-related measurements. Successful progress through these tracks is essential for a test to pass from analytical to clinical research stage, and subsequently to routine clinical practice [1]. Reproducibility, inter- and intra-observer, diagnosis, prognosis, response to treatment, survival, metastases, technical and clinical validity/ utility, cost-effectiveness, BC, PET, and meta-analysis. One meta-analysis of 5 studies, including 102 cancer patients of which 6 had metastatic BC (MBC), assessed the repeatability of [18F]-FDG-PET(/ CT) by measuring the standardized uptake value (SUV)max/ mean in the same patient on two separate occasions with an interval of 1–4 days [5].
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