Impact of 18 F-FES PET/CT on Clinical Decisions in the Management of Recurrent or Metastatic Breast Cancer

• Published in: Journal of Nuclear Medicine Vol. 65; no. 11; pp. 1689 - 1694
• Main Authors: Ryu, Jeongryul, Hyung, Jaewon, Han, Sangwon, Jeong, Jae Ho, Lee, Sae Byul, Yoo, Tae-Kyung Robyn, Kim, Jisun, Kim, Hee Jeong, Chung, Il Yong, Ko, Beom Seok, Lee, Jong Won, Son, Byung Ho, Jeong, Hyehyun, Ahn, Jin-Hee, Jung, Kyung Hae, Kim, Sung-Bae, Moon, Dae Hyuk
• Format: Journal Article
• Language: English
• Published: United States 01.11.2024
• Subjects: Adult; Aged; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Clinical Decision-Making; Estradiol - analogs & derivatives; Female; Humans; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local - diagnostic imaging; Positron Emission Tomography Computed Tomography; Recurrence; Retrospective Studies; breast cancer; 18F-FES PET; estrogen receptor; standard imaging; impact
• ISSN: 0161-5505; 2159-662X; 1535-5667
• DOI: 10.2967/jnumed.124.267913

The clinical impact of 16α- F-fluoro-17β-estradiol ( F-FES) PET/CT on patient management has not been well investigated. The aim of this study was to assess the clinical impact of F-FES PET/CT on the management of patients with recurrent or metastatic breast cancer. Study subjects were identified retrospectively from a database of a prospective trial for postmarketing surveillance of F-FES between 2021 and 2023. Patients who were suspected or known to have recurrent or metastatic estrogen receptor-positive breast cancer based on a routine standard workup were included. Planned management before and actual management after F-FES PET/CT were assessed by 2 experienced medical oncologists via medical chart review. A 5-point questionnaire was provided to evaluate the value of F-FES PET/CT for management planning. The rate of intention-to-treat and interdisciplinary changes, and the impact of F-FES PET/CT according to PET/CT result or clinical indication, were examined. Of the 344 included patients, 120 (35%) experienced a change in management after F-FES PET/CT. In 139 (40%) patients, F-FES PET/CT supported the existing management decision without a change in management. Intention-to-treat and interdisciplinary changes accounted for 64% (77/120) and 68% (82/120) of all changes, respectively. A higher rate of change was observed when lesions were F-FES-negative (44% [36/81]) than F-FES-positive (30% [51/172]) or mixed F-FES-positive/negative (36% [33/91]). Regarding clinical indications, the highest rate of change was shown when evaluating the origins of metastasis of double primary cancers (64% [9/14]). F-FES PET/CT modified the management of recurrent or metastatic breast cancer, serving as an impactful imaging modality in clinical practice.