Background: Estrogen receptor (ER) – targeting therapeutics play a large role in the treatment of breast cancer as 75% of breast cancers are ER positive. Molecular-based imaging strategies targeting ER are evolving to become integral to the management of breast cancer. 18F fluoroestradiol (18F -FES), an FDA-approved PET agent allowing non-invasive imaging of ER status for recurrent or metastatic breast cancer, is increasingly integrated into breast oncology practice, particularly following its recent inclusion in the NCCN guideline. The purpose of this educational exhibit is to provide a timely resource for the clinical applications and imaging interpretation of 18F FES PET for breast cancer patients.
Learning Objectives: This case-based educational exhibit is designed to allow participants to 1) Understand the radiopharmaceutical and biology of 18F FES for imaging estrogen receptor-positive breast cancer. 2) Review the imaging protocol, normal distribution, and interpretation criteria of 18F FES PET/CT 3) Appreciate the current clinical applications and appropriateness guidelines of 18F FES PET/CT.
Abstract Content/Results: Illustrative 18F FES PET/CT images demonstrating various use cases in breast cancer management acquired at a tertiary care academic institution were selected to highlight the teaching points for this exhibit, including:
1. The radiopharmaceuticals, mechanism of uptake and biodistribution of 18F FES 2. The patient preparation, imaging protocol, interpretation and pitfalls of 18F FES PET/CT 3. A case-based approach to review: A. staging for newly diagnosed locally advanced ER+ breast cancer B. assessing tumor burden of de novo metastatic ER+ breast cancer C. evaluation of clinically suspected recurrent ER+ breast cancer D. determination of ER status in recurrent ER+ breast cancer E. evaluation of ER+, non-FDG-avid invasive lobular cancer 4. A summary table and take-home points will be provided to facilitate transfer of knowledge.
Conclusion: 18F-FES PET allows for noninvasive molecular imaging of ER status in breast cancer patients. This educational exhibit provides radiologists and clinicians with essential knowledge about the biology, application, and interpretation of 18F-FES PET, enabling them to effectively utilize this precision imaging agent.
