Purpose: We compared the clinical value of 16a-18F-fluoro-17b-estradiol (18F-FES) positron emission tomography (PET)/computed tomography (CT) and 18F-fluoro-2-deoxy-D-glucose (18F-FDG) PET/CT and investigated whether and how 18F-FES PET/CT affects the implemented management of newly diagnosed estrogen receptor positive breast cancer patients.
Materials and methods: We retrospectively analyzed 19 female patients newly diagnosed with immunohistochemistry-confirmed estrogen receptor (ER)-positive breast cancer who underwent 18F-FES and 18F-FDG PET/CT within 1 week in our center. The sensitivity of 18F-FES and 18F-FDG in diagnosed lesions were compared. To investigate the definite clinical impact of 18F-FES on managing patients with newly diagnosed ER positive breast cancer, we designed two kinds of questionnaires. Referring physicians completed the first questionnaire based on the 18F-FDG report to propose the treatment regime, and the second was completed immediately after reviewing the imaging report of 18F-FES to indicate intended management changes.
Results: In total, 238 lesions were analyzed in 19 patients with newly diagnosed ER-positive breast cancer. Lesion detection was achieved in 216 sites with 18F-FES PET and in 197 sites with 18F-FDG PET/CT. These results corresponded to sensitivities of 90.8% for 18F-FES versus 82.8% for 18F-FDG PET/CT in diagnosed lesions. Thirty-five physicians were given the questionnaires referring to the treatment strategy, with 27 of them completing both questionnaires. The application of 18F-FES in addition to 18F-FDG PET/CT changed the management in 26.3% of the 19 patients with newly diagnosed ER-positive breast cancer.
Conclusion: Performing 18F-FES PET/CT in newly diagnosed ER-positive breast cancer patients increases the value of diagnosis equivocal lesions and treatment management compared with 18F-FDG PET/CT.
Implications for practice: This study investigated whether 16a-18F-fluoro-17b-estradiol (18F-FES) positron emission tomography (PET)/computed tomography (CT) affects the clinical management of patients with newly diagnosed estrogen receptor (ER)-positive breast cancer. Physicians completing two questionnaires comparing the clinical impact of 18F-FES and 18F-FDG on individual management plans in patients with newly diagnosed ER-positive breast cancer confirmed that 18F-FES scans led to change in management in 26.3% of the 19 patients with newly diagnosed ER positive breast cancer. This retrospective study indicates the potential impact of 18F-FES PET/CT on intended management of patients with newly diagnosed estrogen receptor positive breast cancer in comparison to 18F-fluoro-2-deoxy-D-glucose PET/CT.
摘要
目的。我们比较了 16a‐18F‐氟代‐17b‐雌二醇(18F‐FES) 正电子发射断层扫描(PET)/计算机断层扫描(CT)和 18F‐氟代‐2‐脱氧‐D‐葡萄糖(18F‐FDG)PET/CT 的临床价值，并研究了 18F‐FES PET/CT 是否会以及如何影响新诊断雌激素受体阳性乳腺癌患者的治疗实施。
材料和方法。我们回顾性分析了 19 例新诊断且免疫组化确认雌激素受体(ER)阳性乳腺癌的女性患者，她们在 1 周内于我们的中心接受了18F‐FES 和 18F‐FDG PET/CT 检查。比较了18F‐FES 和 18F‐FDG 对诊断病变的敏感性。为研究18F‐FES 对新诊断 ER 阳性乳腺癌患者治疗的确切临床影响，我们设计了两种问卷。咨询医生根据 18F‐FDG 报告完成了第一份问卷，提出治疗方案，第二份问卷在审查了18F‐FES 的影像学报告后立即完成，以表明预期的治疗变化。
结果。对 19 例新诊断 ER 阳性乳腺癌患者的共 238 处病变进行了分析。采用 18F‐FES PET 检测了 216 个部位的病变，采用 18F‐FDG PET/CT 检测了 197 个部位的病变。在诊断病变中，这些结果对应于 18F‐FES 的敏感度为 90.8%，而 18F‐FDG PET/CT 的敏感度为 82.8%。35 名医生接受了涉及治疗策略的问卷调查，其中 27 名医生完成了两份问卷调查。在 19 例新诊断 ER 阳性乳腺癌患者中，18F‐FES 连同 18F‐FDG PET/CT 的应用改变了 26.3% 的患者的治疗方法。
结论。与 18F‐FDG PET/CT 相比，对新诊断 ER 阳性乳腺癌患者执行 18F‐FES PET/CT 可提高可疑病变的诊断价值和治疗管理。
实践意义:本研究探讨了 16a‐18F‐氟代‐17b‐雌二醇 (18F‐FES) 正电子发射断层扫描 (PET)/计算机断层扫描 (CT) 是否会影响新诊断雌激素受体 (ER) 阳性乳腺癌患者的临床治疗。完成两份比较 18F‐FES 和 18F‐FDG 对新诊断 ER 阳性乳腺癌患者个体治疗计划临床影响调查问卷的医生证实，在 19 名新诊断 ER 阳性乳腺癌患者中，18F‐FES 扫描导致了 26.3% 的患者的治疗方案发生变化。此项回顾性研究表明，与 18F‐氟代‐2‐脱氧‐D‐葡萄糖 PET/CT 相比，18F‐FES PET/CT 对新诊断雌激素受体阳性乳腺癌患者预期治疗会造成潜在影响。
Keywords: 18F‐FDG; 18F‐FES; Management changes; Newly diagnosed breast cancer.
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