TY - JOUR
T1 - Analyzing the Estrogen Receptor Status of Liver Metastases with [F-18]-FES-PET in Patients with Breast Cancer
AU - Boers, Jorianne
AU - Loudini, Naila
AU - de Haas, Robbert J
AU - Willemsen, Antoon T M
AU - van der Vegt, Bert
AU - de Vries, Elisabeth G E
AU - Hospers, Geke A P
AU - Schröder, Carolina P
AU - Glaudemans, Andor W J M
AU - de Vries, Erik F J
PY - 2021/11
Y1 - 2021/11
N2 - BACKGROUND: Positron emission tomography (PET) with 16α-[18F]-fluoro-17β-estradiol ([18F]-FES) can visualize estrogen receptor (ER) expression, but it is challenging to determine the ER status of liver metastases, due to high physiological [18F]-FES uptake. We evaluated whether [18F]-FES-PET can be used to determine the ER status of liver metastases, using corresponding liver biopsies as the gold standard.METHODS: Patients with metastatic breast cancer (n = 23) were included if they had undergone a [18F]-FES-PET, liver metastasis biopsy, CT-scan, and [18F]-FDG-PET. [18F]-FES-PET scans were assessed by visual and quantitative analysis, tracer uptake was correlated with ER expression measured by immunohistochemical staining and the effects of region-of-interest size and background correction were determined.RESULTS: Visual analysis allowed ER assessment of liver metastases with 100% specificity and 18% sensitivity. Quantitative analysis improved the sensitivity. Reduction of the region-of-interest size did not further improve the results, but background correction improved ER assessment, resulting in 83% specificity and 77% sensitivity. Using separate thresholds for ER+ and ER- metastases, positive and negative predictive values of 100% and 75%, respectively, could be obtained, although 30% of metastases remained inconclusive.CONCLUSION: In the majority of liver metastases, ER status can be determined with [18F]-FES-PET if background correction and separate thresholds are applied.
AB - BACKGROUND: Positron emission tomography (PET) with 16α-[18F]-fluoro-17β-estradiol ([18F]-FES) can visualize estrogen receptor (ER) expression, but it is challenging to determine the ER status of liver metastases, due to high physiological [18F]-FES uptake. We evaluated whether [18F]-FES-PET can be used to determine the ER status of liver metastases, using corresponding liver biopsies as the gold standard.METHODS: Patients with metastatic breast cancer (n = 23) were included if they had undergone a [18F]-FES-PET, liver metastasis biopsy, CT-scan, and [18F]-FDG-PET. [18F]-FES-PET scans were assessed by visual and quantitative analysis, tracer uptake was correlated with ER expression measured by immunohistochemical staining and the effects of region-of-interest size and background correction were determined.RESULTS: Visual analysis allowed ER assessment of liver metastases with 100% specificity and 18% sensitivity. Quantitative analysis improved the sensitivity. Reduction of the region-of-interest size did not further improve the results, but background correction improved ER assessment, resulting in 83% specificity and 77% sensitivity. Using separate thresholds for ER+ and ER- metastases, positive and negative predictive values of 100% and 75%, respectively, could be obtained, although 30% of metastases remained inconclusive.CONCLUSION: In the majority of liver metastases, ER status can be determined with [18F]-FES-PET if background correction and separate thresholds are applied.
KW - <p>FES-PET/CT</p>
KW - CT
KW - breast cancer
KW - liver metastases
KW - estrogen receptor
KW - quantification
KW - PET
KW - F-18-FLUOROESTRADIOL
KW - IMAGE
KW - SITE
U2 - 10.3390/diagnostics11112019
DO - 10.3390/diagnostics11112019
M3 - Article
C2 - 34829366
SN - 2075-4418
VL - 11
JO - Diagnostics
JF - Diagnostics
IS - 11
M1 - 2019
ER -