The preliminary study of 16α-[18F]fluoroestradiol PET/CT in assisting the individualized treatment decisions of breast cancer patients.

Yifei Sun,Beiling Zhu,Zhongyi Yang,Jing Xue,Wei Shi,Herong Pan,Mingwei Wang,Zhifeng Yao,Silong Hu,Yingjian Zhang,Yongping Zhang,Juri G Gelovani

doi:10.1371/journal.pone.0116341

Yifei Sun, Beiling Zhu + Show 10 more

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https://doi.org/10.1371/journal.pone.0116341

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ObjectiveTo evaluate the clinical value of 16α-[18F]fluoroestradiol (18F-FES) PET/CT in assisting the individualized treatment decisions of breast cancer patients.MethodsThirty-three breast cancer patients, who underwent both 18F-FES and 18F-FDG PET/CT from July 2010 to March 2013 in our center, were enrolled in this preliminary study. All the patients used 18F-FES PET/CT as a diagnostic tool with a clinical dilemma. We used the maximum Standardized Uptake Value (SUVmax) to quantify ER expression and a cutoff value of 1.5 to dichotomize results into ER positive and negative lesions. All patients were clinically followed up at least 6 months.ResultsIn evaluating equivocal lesions on conventional work-up group (n = 4), three lung lesions and another iliac lesion were enrolled. As for three lung lesions, 18F-FES PET/CT showed one lesion with high uptake, which suggested it was an ER positive metastasis. The other two lesions were 18F-FES negative, which meant an ER negative metastasis or secondary primary tumor. Additionally, one iliac lesion was detected by MRI. 18F-FDG uptake was high at the suspected lesion, whereas 18F-FES uptake was absent; In predicting origin of metastasis group (n = 2), two breast cancer patients had secondary primary tumors were collected. They were 18F-FES negative, which showed low possibility of metastasis from breast cancer and they were all confirmed by biopsy. In detecting ER status in metastasis group (n = 27), 18F-FES PET/CT showed increased 18F-FES uptake in all metastatic lesions in 11 patients; absent in all lesions in 13 patients; and the remaining 3 patients had both 18F-FES positive and negative lesions. Totally, on the basis of the 18F-FES PET/CT results, we found changes in the treatment plans in 16 patients (48.5%, 16/33).Conclusions18F-FES PET/CT could assess the entire tumor volume receptor status; therefore, it may be used to assist the individualized treatment decisions of breast cancer patients.

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Breast cancer is the most common nondermatologic cancer and the second leading cause of cancer death in women [1]
One iliac lesion was detected by MRI. 18F-FDG uptake was high at the suspected lesion, whereas 18F-FES uptake was absent; In predicting origin of metastasis group (n = 2), two breast cancer patients had secondary primary tumors were collected
The patients were enrolled through the following protocols: using 18F-FES Positron emission tomography (PET)-CT as a diagnostic tool for the patients presenting with clinical dilemmas

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Introduction

Breast cancer is the most common nondermatologic cancer and the second leading cause of cancer death in women [1]. Over 70% of breast cancers are ER positive, and ER-directed adjuvant therapy is regarded as a crucial factor in decreasing the death rate of breast cancer [2]. The objective response rate to second-line endocrine therapy is less than 20% [3]. One factor hypothesized to underlie the acquired resistance to endocrine therapy is discordancy of ER expression. 18%–55% of the patients present with discordant ER expression between primary tumor and metastasis [4, 5]. ER expression may change over time in the same patient, caused either by genetic or epigenetic loss of the receptor, such as ER promoter B associated factor 1 [7]

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