PET imaging of oestrogen receptors in patients with breast cancer

• Published in: The lancet oncology Vol. 14; no. 11; pp. e465 - e475
• Main Authors: van Kruchten, Michel, MD, de Vries, Elisabeth G E, Prof, Brown, Myles, Prof, de Vries, Erik F J, PhD, Glaudemans, Andor W J M, MD, Dierckx, Rudi A J O, Prof, Schröder, Carolien P, MD, Hospers, Geke A P, Prof
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2013; Elsevier Limited
• Subjects: Animals; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - metabolism; Female; Hematology, Oncology and Palliative Medicine; Humans; Positron-Emission Tomography; Receptors, Estrogen - metabolism
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(13)70292-4

Summary Oestrogen receptors are overexpressed in around 70% of all breast cancers, and are a target for endocrine therapy. These receptors can be visualised on PET with use of 16α-[18 F]-fluoro-17β-oestradiol (18 F-FES) as a tracer. Compared with biopsy, which enables assessment of individual sites, whole-body18 F-FES-PET enables quantification of oestrogen-receptor expression in all metastases. In several studies, measurement of tumour protein expression in oestrogen receptors by18 F-FES-PET, concurrent with biopsy, detected oestrogen-receptor-positive tumour lesions with a sensitivity of 84% and specificity of 98%. Roughly 45% of patients with metastatic breast cancer have discordant oestrogen-receptor expression across lesions (ie,18 F-FES-positive and18 F-FES-negative metastases). Low tumour18 F-FES uptake in metastases can predict failure of hormonal therapy in patients with oestrogen-receptor-positive primary tumours. Finally,18 F-FES-PET has shown that oestrogen-receptor binding capacity changes after intervention with hormonal drugs, but findings need to be confirmed. Factors other than oestrogen-receptor expression, including menopausal status and concomitant therapies, that can affect tumour18 F-FES uptake must be taken into account.