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Diagnostic effectiveness of [18F]Fluoroestradiol PET/CT in oestrogen receptor-positive breast cancer: the key role of histopathology. Evidence from an international multicentre prospective study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Introduction

[18F]Fluoroestradiol ([18F]FES) PET/CT has been proposed as a tool for detecting the oestrogen receptor density in patients with metastatic breast cancer (BC) non-invasively across all disease localizations. However, its diagnostic potential in terms of the detection rate (DR) of metastases is unclear. In this study, we pitted this method against [18F]FDG PET/CT and tried to identify predictors of the diagnostic superiority of the [18F] FES-based method.

Materials and methods

From a multicentre database, we enrolled all patients with metastatic BC who had undergone both [18F]FES PET/CT and [18F]FDG PET/CT. Two readers assessed both images independently and used a patient-based (PBA) and lesion-based analysis (LBA) to calculate the DR. Pathology-related and clinical factors were tested as predictors of [18F]FES PET/CT superiority using a multivariate model.

Results

92 patients, bearing a total of 2678 metastases, were enrolled. On PBA, the DR of [18F]FDG and [18F]FES PET/CT was 97% and 86%, respectively (p = 0.018). On LBA, the [18F]FES method proved more sensitive than [18F]FDG PET/CT in lymph nodes, bone, lung and soft tissue (p < 0.01). This greater sensitivity was associated with lobular histology, both on PBA (Odds Ratio (OR) 3.4, 95%CI 1.0–12.3) and on LBA (OR 4.4, 95%CI 1.2–16.1 for lymph node metastases and OR 3.29, 95%CI 1.1–10.2 for bone localizations).

Conclusions

The overall DR of [18F]FES PET/CT appears to be lower than that of [18F]FDG PET/CT on PBA. However, the [18F]FES method, if positive, can identify more lesions than [18F]FDG at most sites. The higher sensitivity of [18F]FES PET/CT was associated with lobular histology.

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Data availability

The datasets analysed during the current study are available from the corresponding author upon reasonable request.

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Funding

This research received grants from “Associazione Italiana per la Ricerca sul Cancro” (AIRC 2013) and ERA-Net TRANSCAN JTC 2011 Italian Ministry of Health.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, E.O. “Ospedali Galliera”, Mura delle Cappuccine 14, 16128, Italy

    Gianluca Bottoni, Francesco Fiz & Arnoldo Piccardo

  2. Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy

    Matteo Puntoni

  3. Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST)- Dino Amadori, Meldola, Italy

    Federica Matteucci

  4. Biostatistics and Clinical Trials Unit, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST)- Dino Amadori_, Meldola, Italy

    Manuela Monti

  5. Department of Medicine and Oncology, E.O. “Ospedali Galliera”, Genoa, Italy

    Andrea DeCensi

  6. Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo studio e la cura dei tumori, IRST, Meldola, Italy

    Oriana Nanni

  7. Department of Clinical Research & Medical Oncology, Institut Curie (Hôpital René Huguenin), St Cloud, France

    Etienne Brain

  8. Nuclear Medicine Department Centre Georges-Francois Leclerc, 1 rue du Pr Marion, 21079, Dijon Cedex, France

    Jean Louis Alberini

  9. Nuclear Medicine Unit, AOU Maggiore della Carità, Novara, Italy

    Bassam Dib & Gianmauro Sacchetti

  10. Clinic of Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Pierpaolo Trimboli

  11. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland

    Pierpaolo Trimboli & Giorgio Treglia

  12. Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland

    Giorgio Treglia

  13. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, 1015, Lausanne, Switzerland

    Giorgio Treglia

  14. Breast Centre, Department of Obstetrics and Gynaecology, LMU University Hospital, Munich, Germany

    Nadia Harbeck

  15. Pathology Unit, E.O. “Ospedali Galliera”, Genoa, Italy

    Simona Sola

  16. Department of Translational Oncology, University of Eastern Piedmont, Novara, Italy

    Alessandra Gennari

Authors
  1. Gianluca Bottoni
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  2. Francesco Fiz
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  4. Federica Matteucci
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  5. Manuela Monti
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  6. Andrea DeCensi
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  8. Etienne Brain
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  9. Jean Louis Alberini
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  13. Giorgio Treglia
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  16. Alessandra Gennari
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  17. Arnoldo Piccardo
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Gianluca Bottoni, Francesco Fiz and Arnoldo Piccardo. The first draft of the manuscript was written by Arnoldo Piccardo and Andrea DeCensi; all authors commented on previous versions of the manuscript.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Francesco Fiz.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was approved by the local ethics committees and the public medical agencies of all the centres involved in this clinical trial.

Informed consent

Written informed consent was obtained from all patients.

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Alessandra Gennari and Arnoldo Piccardo share senior co-authorship.

This article is part of the Topical Collection on Oncology - General

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Bottoni, G., Fiz, F., Puntoni, M. et al. Diagnostic effectiveness of [18F]Fluoroestradiol PET/CT in oestrogen receptor-positive breast cancer: the key role of histopathology. Evidence from an international multicentre prospective study. Eur J Nucl Med Mol Imaging 50, 2477–2485 (2023). https://doi.org/10.1007/s00259-023-06173-9

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