Open AccessCan 18F-Fluoroestradiol positron emission tomography become a new imaging standard in the estrogen receptor-positive breast cancer patient: A prospective comparative study with 18F-Fluorodeoxyglucose positron emission tomography?
Author(s) -
Manoj Gupta,
Anupama Datta,
Partha S Choudhury,
Maria D’Souza,
Ullas Batra,
Anil K. Mishra
Publication year - 2017
Publication title -
world journal of nuclear medicine
Language(s) - English
Resource type - Journals
eISSN - 1607-3312
pISSN - 1450-1147
DOI - 10.4103/1450-1147.203071
Subject(s) - medicine , positron emission tomography , breast cancer , standardized uptake value , nuclear medicine , mcnemar's test , estrogen receptor , fluorodeoxyglucose , prospective cohort study , positron emission , radiology , cancer , pathology , statistics , mathematics
Correct staging is the most crucial for the treatment outcome in cancer management. Molecular imaging with 18 F-fluoroestradiol (FES) positron emission tomography-computed tomography (PET-CT) targets estrogen receptor (ER) and may have a higher incremental value in diagnosis by aiding specificity. We enrolled 12 female breast cancer patients prospectively and did 18 F-FES PET-CT and 18 F-fluorodeoxyglucose (FDG) PET-CT within 1 week interval time. Lesion detection sensitivity was compared for a total number of lesions and for nonhepatic lesions only by McNemar test. 18 F-FES PET-CT was taken as reference in case of indeterminate lesions. The incremental value reported by identifying 18 F-FES exclusive lesions and by characterization of 18 F-FDG indeterminate lesions. Spearman rank test was used to correlate ER expression and maximum standardized uptake value (SUVmax). Two ER-negative patients with no 18 F-FES uptake were excluded. Ten ER-positive patients with 154 disease lesions were finally analyzed. 18 F-FDG picked-up 142 lesions (sensitivity 92.21%), whereas 18 F-FES picked-up 116 lesions (sensitivity 75.32%) and this difference was statistically significant. For nonhepatic lesions ( n = 136) detectability, 18 F-FDG picked-up 124 (sensitivity 91.18%), whereas 18 F-FES picked-up 116 (sensitivity 85.29%) lesions and this difference was not statistically significant. Beside 12 exclusive lesions, 18 F-FES characterized 41 (27.5%) 18 F-FDG indeterminate lesions. Overall 18 F-FES impacted 20% patient management. The positive trend was also seen with 18 F-FES SUVmax with ER expression and negative with 18 F-FDG SUVmax. We conclude, 18 F-FDG has overall better sensitivity than 18 F-FES PET-CT, however for nonhepatic metastasis difference was not significant. 18 F-FES PET-CT better-characterized lesions and impacted 20% patient management. Therefore, 18 F-FES PET-CT should be used with 18 F-FDG PET-CT in strongly ER expressing patients for better specificity.