Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique

Estrogen receptor (ER) expression in breast cancer is routinely studied on immunohistochemistry (IHC) of tissue obtained from core biopsy or surgical specimen. Sampling error and heterogeneity of tumor may incorrectly label a breast tumor as ER negative, thus denying patient hormonal treatment. Mole...

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Main Authors: Vuthaluru Seenu, Ankit Sharma, Rakesh Kumar, Suhani Suhani, Arun Prashanth, Sandeep Mathur, Rajinder Parshad
Format: Article
Language:English
Published: Thieme Medical and Scientific Publishers Pvt. Ltd. 2020-07-01
Series:World Journal of Nuclear Medicine
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Online Access:http://www.thieme-connect.de/DOI/DOI?10.4103/wjnm.WJNM_71_19
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author Vuthaluru Seenu
Ankit Sharma
Rakesh Kumar
Suhani Suhani
Arun Prashanth
Sandeep Mathur
Rajinder Parshad
author_facet Vuthaluru Seenu
Ankit Sharma
Rakesh Kumar
Suhani Suhani
Arun Prashanth
Sandeep Mathur
Rajinder Parshad
author_sort Vuthaluru Seenu
collection DOAJ
description Estrogen receptor (ER) expression in breast cancer is routinely studied on immunohistochemistry (IHC) of tissue obtained from core biopsy or surgical specimen. Sampling error and heterogeneity of tumor may incorrectly label a breast tumor as ER negative, thus denying patient hormonal treatment. Molecular functional ER imaging can assess the in-vivo ER expression of primary tumor and metastases at sites inaccessible for biopsy and also track changes in expression over time. The aim was to study ER expression using 16α-18F-fluoro-17β-estradiol or 18F-fluoroestradiol (18F FES) positron emission tomography (PET) computed tomography (CT). Twenty-four biopsy-proven breast cancer patients consenting to participate in the study underwent FES PET CT. Standard uptake value (SUVmean) of maximum of 7 lesions/patient was analyzed, and tumor-to-background ratio was calculated for each lesion. Visual interpretation score was calculated for lesion on FES PET and correlated with the Allred score on IHC of tumor tissue samples for ER expression. The diagnostic indices of FES PET CT were assessed taking IHC as “gold standard.” On FES PET CT, the mean SUV for ER+ tumors was 4.75, whereas the mean SUV for ER − tumors was 1.41. Using receiver operating characteristic curve, tumors with an SUV of ≥ 1.8 on FES PET could be considered as ER+. The overall accuracy of FES PET CT to detect ER expression was 91.66%, with two false negatives noted in this study. 18F-FES PET CT appears promising in evaluating ER expression in breast cancer. It is noninvasive and has potential to assess the in-vivo ER expression of the entire primary tumor and metastasis not amenable for biopsy.
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spelling doaj-art-8b77484801374aaeb5f0bc68c36b88132025-08-20T01:58:22ZengThieme Medical and Scientific Publishers Pvt. Ltd.World Journal of Nuclear Medicine1450-11471607-33122020-07-01190323323910.4103/wjnm.WJNM_71_19Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel techniqueVuthaluru Seenu0Ankit Sharma1Rakesh Kumar2Suhani Suhani3Arun Prashanth4Sandeep Mathur5Rajinder Parshad6Department of Surgical Disciplines, All India Institute of Medical Sciences, New DelhiDepartment of Surgical Disciplines, All India Institute of Medical Sciences, New DelhiDepartment of Nuclear Medicine, All India Institute of Medical Sciences, New DelhiDepartment of Surgical Disciplines, All India Institute of Medical Sciences, New DelhiDepartment of Surgical Disciplines, All India Institute of Medical Sciences, New DelhiDepartment of Pathology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Surgical Disciplines, All India Institute of Medical Sciences, New DelhiEstrogen receptor (ER) expression in breast cancer is routinely studied on immunohistochemistry (IHC) of tissue obtained from core biopsy or surgical specimen. Sampling error and heterogeneity of tumor may incorrectly label a breast tumor as ER negative, thus denying patient hormonal treatment. Molecular functional ER imaging can assess the in-vivo ER expression of primary tumor and metastases at sites inaccessible for biopsy and also track changes in expression over time. The aim was to study ER expression using 16α-18F-fluoro-17β-estradiol or 18F-fluoroestradiol (18F FES) positron emission tomography (PET) computed tomography (CT). Twenty-four biopsy-proven breast cancer patients consenting to participate in the study underwent FES PET CT. Standard uptake value (SUVmean) of maximum of 7 lesions/patient was analyzed, and tumor-to-background ratio was calculated for each lesion. Visual interpretation score was calculated for lesion on FES PET and correlated with the Allred score on IHC of tumor tissue samples for ER expression. The diagnostic indices of FES PET CT were assessed taking IHC as “gold standard.” On FES PET CT, the mean SUV for ER+ tumors was 4.75, whereas the mean SUV for ER − tumors was 1.41. Using receiver operating characteristic curve, tumors with an SUV of ≥ 1.8 on FES PET could be considered as ER+. The overall accuracy of FES PET CT to detect ER expression was 91.66%, with two false negatives noted in this study. 18F-FES PET CT appears promising in evaluating ER expression in breast cancer. It is noninvasive and has potential to assess the in-vivo ER expression of the entire primary tumor and metastasis not amenable for biopsy.http://www.thieme-connect.de/DOI/DOI?10.4103/wjnm.WJNM_71_19breast cancerestrogen receptorfluoroestradiol positron emission tomographypositron emission tomography
spellingShingle Vuthaluru Seenu
Ankit Sharma
Rakesh Kumar
Suhani Suhani
Arun Prashanth
Sandeep Mathur
Rajinder Parshad
Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique
World Journal of Nuclear Medicine
breast cancer
estrogen receptor
fluoroestradiol positron emission tomography
positron emission tomography
title Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique
title_full Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique
title_fullStr Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique
title_full_unstemmed Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique
title_short Evaluation of estrogen expression of breast cancer using 18F-FES PET CT-A novel technique
title_sort evaluation of estrogen expression of breast cancer using 18f fes pet ct a novel technique
topic breast cancer
estrogen receptor
fluoroestradiol positron emission tomography
positron emission tomography
url http://www.thieme-connect.de/DOI/DOI?10.4103/wjnm.WJNM_71_19
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AT suhanisuhani evaluationofestrogenexpressionofbreastcancerusing18ffespetctanoveltechnique
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