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van Geel JJL, de Vries EFJ, van Kruchten M, Hospers GAP, Glaudemans AWJM, Schröder CP. Molecular imaging as biomarker for treatment response and outcome in breast cancer. Ther Adv Med Oncol 2023; 15:17588359231170738. [PMID: 37223262 PMCID: PMC10201167 DOI: 10.1177/17588359231170738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/28/2023] [Indexed: 05/25/2023] Open
Abstract
Molecular imaging, such as positron emission tomography (PET), is increasingly used as biomarker to predict and assess treatment response in breast cancer. The number of biomarkers is expanding with specific tracers for tumour characteristics throughout the body and this information can be used to aid the decision-making process. These measurements include metabolic activity using [18F]fluorodeoxyglucose PET ([18F]FDG-PET), oestrogen receptor (ER) expression using 16α-[18F]Fluoro-17β-oestradiol ([18F]FES)-PET and human epidermal growth factor receptor 2 (HER2) expression using PET with radiolabelled trastuzumab (HER2-PET). In early breast cancer, baseline [18F]FDG-PET is frequently used for staging, but limited subtype-specific data reduce its usefulness as biomarker for treatment response or outcome. Early metabolic change on serial [18F]FDG-PET is increasingly used in the neo-adjuvant setting as dynamic biomarker to predict pathological complete response to systemic therapy, potentially allowing de-intensification or step-up intensification of treatment. In the metastatic setting, baseline [18F]FDG-PET and [18F]FES-PET can be used as biomarker to predict treatment response, in triple-negative and ER-positive breast cancer, respectively. Metabolic progression on repeated [18F]FDG-PET appears to precede progressive disease on standard evaluation imaging; however, subtype-specific studies are limited and more prospective data are needed before implementation in clinical practice. Even though (repeated) [18F]FDG-PET, [18F]FES-PET and HER2-PEt all show promising results as biomarkers to predict therapy response and outcome, for eventual integration into clinical practice, future studies will have to clarify at what timepoint this integration has to optimally take place.
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Affiliation(s)
- Jasper J. L. van Geel
- Department of Medical Oncology, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
| | - Erik F. J. de Vries
- Department of Nuclear Medicine and Molecular
Imaging, University Medical Center Groningen, University of Groningen,
Groningen, The Netherlands
| | - Michel van Kruchten
- Department of Medical Oncology, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
| | - Geke A. P. Hospers
- Department of Medical Oncology, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
| | - Andor W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular
Imaging, University Medical Center Groningen, University of Groningen,
Groningen, The Netherlands
| | - Carolina P. Schröder
- Department of Medical Oncology, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
- Department of Medical Oncology, Netherlands
Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands
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Hadebe B, Harry L, Ebrahim T, Pillay V, Vorster M. The Role of PET/CT in Breast Cancer. Diagnostics (Basel) 2023; 13:diagnostics13040597. [PMID: 36832085 PMCID: PMC9955497 DOI: 10.3390/diagnostics13040597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer worldwide, with an estimated 2.3 million new cases (11.7%), followed by lung cancer (11.4%) The current literature and the National Comprehensive Cancer Network (NCCN) guidelines state that 18F-FDG PET/CT is not routine for early diagnosis of breast cancer, and rather PET/CT scanning should be performed for patients with stage III disease or when conventional staging studies yield non-diagnostic or suspicious results because this modality has been shown to upstage patients compared to conventional imaging and thus has an impact on disease management and prognosis. Furthermore, with the growing interest in precision therapy in breast cancer, numerous novel radiopharmaceuticals have been developed that target tumor biology and have the potential to non-invasively guide the most appropriate targeted therapy. This review discusses the role of 18F-FDG PET and other PET tracers beyond FDG in breast cancer imaging.
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Affiliation(s)
- Bawinile Hadebe
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu Natal, Private Bag X54001, Durban 4001, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa
- Correspondence:
| | - Lerwine Harry
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu Natal, Private Bag X54001, Durban 4001, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa
| | - Tasmeera Ebrahim
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu Natal, Private Bag X54001, Durban 4001, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa
| | - Venesen Pillay
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu Natal, Private Bag X54001, Durban 4001, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu Natal, Private Bag X54001, Durban 4001, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa
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Heterogeneity of bone metastases as an important prognostic factor in patients affected by oestrogen receptor-positive breast cancer. The role of combined [18F]Fluoroestradiol PET/CT and [18F]Fluorodeoxyglucose PET/CT. Eur J Radiol 2021; 141:109821. [PMID: 34139575 DOI: 10.1016/j.ejrad.2021.109821] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the prognostic role of different inter and intralesional expression (heterogeneity) of oestrogen receptor (ER) in bone metastases, as identified by the combined use of [18F]FES PET/CT and [18F]FDG PET/CT in patients with oestrogen receptor-positive (ER+) metastatic breast cancer (BC). METHODS We analysed patients with a new diagnosis of bone metastases who were candidates for first-line systemic endocrine therapy. Before starting therapy, patients underwent baseline [18F]FES PET/CT and [18]FDG PET/CT. Semi-quantitative evaluation of whole-body bone metabolic burden (WB-B-MB) was performed on [18F]FES and [18F]FDG PET/CT in order to evaluate disease extent, tumour metabolism and ER heterogeneity. We used time-to-event analyses (Kaplan-Meier and Cox proportional-hazards methods) to estimate progression-free (PFS) and overall survival (OS), in order to assess the independent prognostic value of [18F]FES PET/CT and [18F]FDG PET/CT, alone and in combination. RESULTS According to our criteria, we enrolled 49 patients. Over a median follow-up of 44.7 months, 35 patients suffered disease progression (71.4 %) and 15 died of disease (30.6 %). When the risk of disease progression was calculated by means of the Cox model, only [18F]FDG WB-B-MB was independently and directly associated to PFS (p = 0.02). On analysing the association between all prognostic parameters and survival, the Cox model showed that the only parameter associated with OS was the WB-B-MB FES/FDG ratio (p = 0.01). CONCLUSION The combined use of [18F]FES-PET/CT and [18F]FDG-PET/CT can identify ER heterogeneity in BC bone metastases. This heterogeneity is significantly associated with survival. Moreover, the extension of the FDG-avid component correlates with the risk of disease progression.
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Taralli S, Caldarella C, Lorusso M, Scolozzi V, Altini C, Rubini G, Calcagni ML. Comparison between 18F-FDG and 18F-NaF PET imaging for assessing bone metastases in breast cancer patients: a literature review. Clin Transl Imaging 2020. [DOI: 10.1007/s40336-020-00363-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Raynor WY, Al-Zaghal A, Zadeh MZ, Seraj SM, Alavi A. Metastatic Seeding Attacks Bone Marrow, Not Bone: Rectifying Ongoing Misconceptions. PET Clin 2019; 14:135-144. [PMID: 30420215 DOI: 10.1016/j.cpet.2018.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Conventional modalities, such as bone scintigraphy, are commonly used to assess osseous abnormalities in skeletal metastasis. Fluorine-18 (18F)-sodium fluoride (NaF) PET similarly portrays osteoblastic activity but with improved spatial and contrast resolution and more accurate anatomic localization. However, these modalities rely on indirect evidence for tumor activity. PET imaging with 18F-fluorodeoxyglucose (FDG) and tumor-specific tracers may have an increased role by directly portraying the metabolic activity of cancer cells, which are often seeded in bone marrow and cause osseous disease after initial latency. This article describes the utility and limitations of these modalities in assessing skeletal metastases.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Radiology, Drexel University College of Medicine, 230 N Broad Street, Philadelphia, PA 19102, USA
| | - Abdullah Al-Zaghal
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mahdi Zirakchian Zadeh
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Siavash Mehdizadeh Seraj
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Pujara AC, Kim E, Axelrod D, Melsaether AN. PET/MRI in Breast Cancer. J Magn Reson Imaging 2018; 49:328-342. [DOI: 10.1002/jmri.26298] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Akshat C. Pujara
- Department of Radiology, Division of Breast Imaging; University of Michigan Health System; Ann Arbor Michigan USA
| | - Eric Kim
- Department of Radiology; NYU School of Medicine; New York New York USA
| | - Deborah Axelrod
- Department of Surgery; Perlmutter Cancer Center, NYU School of Medicine; New York New York USA
| | - Amy N. Melsaether
- Department of Radiology; NYU School of Medicine; New York New York USA
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Accuracy of 18F-NaF PET/CT in bone metastasis detection and its effect on patient management in patients with breast carcinoma. Nucl Med Commun 2018; 39:325-333. [DOI: 10.1097/mnm.0000000000000807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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8
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18F-Fluoride PET/CT tumor burden quantification predicts survival in breast cancer. Oncotarget 2018; 8:36001-36011. [PMID: 28415595 PMCID: PMC5482633 DOI: 10.18632/oncotarget.16418] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/14/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose In bone-metastatic breast cancer patients, there are no current imaging biomarkers to identify which patients have worst prognosis. The purpose of our study was to investigate if skeletal tumor burden determined by 18F-Fluoride PET/CT correlates with clinical outcomes and may help define prognosis throughout the course of the disease. Results Bone metastases were present in 49 patients. On multivariable analysis, skeletal tumor burden was significantly and independently associated with overall survival (p < 0.0001) and progression free-survival (p < 0.0001). The simple presence of bone metastases was associated with time to bone event (p = 0.0448). Materials and Methods We quantified the skeletal tumor burden on 18F-Fluoride PET/CT images of 107 female breast cancer patients (40 for primary staging and the remainder for restaging after therapy). Clinical parameters, primary tumor characteristics and skeletal tumor burden were correlated to overall survival, progression free-survival and time to bone event. The median follow-up time was 19.5 months. Conclusions 18F-Fluoride PET/CT skeletal tumor burden is a strong independent prognostic imaging biomarker in breast cancer patients.
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Etchebehere E, Brito AE, Rezaee A, Langsteger W, Beheshti M. Therapy assessment of bone metastatic disease in the era of 223radium. Eur J Nucl Med Mol Imaging 2017; 44:84-96. [DOI: 10.1007/s00259-017-3734-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 02/05/2023]
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Lapa P, Marques M, Costa G, Lima J. The value of quantitative analysis in 18F-NaF PET/CT. Rev Esp Med Nucl Imagen Mol 2017; 36:78-84. [DOI: 10.1016/j.remn.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 11/26/2022]
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The value of quantitative analysis in 18 F-NaF PET/CT. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Breast and whole-body PET/MR imaging is being used to detect local and metastatic disease and is being investigated for potential imaging biomarkers, which may eventually help personalize treatments and prognoses. This article provides an overview of breast and whole-body PET/MR exam techniques, summarizes PET and MR breast imaging for lesion detection, outlines investigations into multi-parametric breast PET/MR, looks at breast PET/MR in the setting of neo-adjuvant chemotherapy, and reviews the pros and cons of whole-body PET/MR in the setting of metastatic or suspected metastatic breast cancer.
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Affiliation(s)
- Amy Melsaether
- Department of Radiology, New York University School of Medicine, 160 East 34th Street, 3rd Floor, New York, NY 10016, USA.
| | - Linda Moy
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI(2)R), New York University School of Medicine, 160 East 34th Street, 3rd Floor, New York, NY 10016, USA
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Mahajan A, Azad GK, Cook GJ. PET Imaging of Skeletal Metastases and Its Role in Personalizing Further Management. PET Clin 2016; 11:305-18. [PMID: 27321034 DOI: 10.1016/j.cpet.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In oncology, the skeleton is one of the most frequently encountered sites for metastatic disease and thus early detection not only has an impact on an individual patient's management but also on the overall outcome. Multiparametric and multimodal hybrid PET/computed tomography and PET/MR imaging have revolutionized imaging for bone metastases, but irrespective of tumor biology or morphology of the bone lesion it remains unclear which imaging modality is the most clinically relevant to guide individualized cancer care. In this review, we highlight the current clinical challenges of PET imaging in evaluation and quantification of skeletal tumor burden and its impact on personalized cancer management.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, India
| | - Gurdip Kaur Azad
- Division of Imaging Sciences and Biomedical Engineering, Cancer Imaging Department, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Gary J Cook
- Division of Imaging Sciences and Biomedical Engineering, Cancer Imaging Department, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Clinical PET Centre, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
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Caglar M, Kupik O, Karabulut E, Høilund-Carlsen P. Detection of bone metastases in breast cancer patients in the PET/CT era: Do we still need the bone scan? Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Caglar M, Kupik O, Karabulut E, Høilund-Carlsen PF. Detection of bone metastases in breast cancer patients in the PET/CT era: Do we still need the bone scan? Rev Esp Med Nucl Imagen Mol 2015; 35:3-11. [PMID: 26514321 DOI: 10.1016/j.remn.2015.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/17/2015] [Accepted: 08/30/2015] [Indexed: 11/18/2022]
Abstract
AIM To examine the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of bone metastasis in breast cancer patients and assess whether whole body bone scan (BS) with (99m)Tc-methylene diphosphonate provides any additional information. MATERIAL AND METHODS Study group comprised 150 patients, mean age 52 years (range 27-85) with breast cancer, suspected of having bone metastases. All patients had undergone both FDG-PET/CT and BS with or without single photon emission tomography/computed tomography (SPECT/CT) within a period of 6 weeks. The final diagnosis of bone metastasis was established by histopathological findings, additional imaging, or clinical follow-up longer than 10 months. Cancer antigen 15-3 (CA15-3) and carcinoembryogenic antigen (CEA) were measured in all patients. RESULTS Histologically 83%, 7% and 10% had infiltrating ductal, lobular and mixed carcinoma respectively. Confirmed bone metastases were present in 86 patients (57.3%) and absent in 64 (42.7%). Mean CA15-3 and CEA values in patients with bone metastases were 74.6ng/mL and 60.4U/mL respectively, compared to 21.3ng/mL and 3.2U/mL without metastases (p<0.001). The sensitivity of FDG-PET/CT for the detection of bone metastases was 97.6% compared to 89.5% with SPECT/CT. In 57 patients, FDG-PET/CT correctly identified additional pulmonary, hepatic, nodal and other soft tissue metastases, not detected by BS. CONCLUSION Our findings suggest that FDG-PET/CT is superior to BS with or without SPECT/CT.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Bone Neoplasms/blood
- Bone Neoplasms/diagnostic imaging
- Bone Neoplasms/secondary
- Breast Neoplasms/pathology
- Carcinoembryonic Antigen/blood
- Carcinoma, Ductal, Breast/blood
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/blood
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/secondary
- Female
- Fluorine Radioisotopes/analysis
- Fluorodeoxyglucose F18/analysis
- Humans
- Middle Aged
- Mucin-1/blood
- Positron Emission Tomography Computed Tomography
- Positron-Emission Tomography
- Radiopharmaceuticals/analysis
- Retrospective Studies
- Single Photon Emission Computed Tomography Computed Tomography
- Technetium Tc 99m Medronate/analysis
- Whole Body Imaging
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Affiliation(s)
- M Caglar
- Hacettepe University Medical Faculty, Department of Nuclear Medicine, Sihhiye, Ankara 06100, Turkey.
| | - O Kupik
- Hacettepe University Medical Faculty, Department of Nuclear Medicine, Sihhiye, Ankara 06100, Turkey
| | - E Karabulut
- Hacettepe University Medical Faculty, Department of Biostatistics, Sihhiye, Ankara 06100, Turkey
| | - P F Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense C, Denmark
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