18F-FES Whole-Body Imaging Protocol for Evaluating Tumor Estrogen Receptor Status in Patients with Recurrent or Metastatic Breast Cancer

J Nucl Med Technol. 2023 Sep;51(3):188-193. doi: 10.2967/jnmt.122.265272. Epub 2023 Jul 11.


In September 2020, the Journal of Nuclear Medicine and Technology published a continuing education article, "Breast Cancer: Evaluating Tumor Estrogen Receptor Status with Molecular Imaging to Increase Response to Therapy and Improve Patient Outcomes," that reviewed a promising new PET tracer, 16α-18F-fluoro-17β-fluoroestradiol (18F-FES). This tracer had the potential to be a valuable tool for medical oncologists and breast surgeons in noninvasively evaluating the estrogen receptor site status of their patients' recurrent tumor and secondary metastatic lesions. In May 2020, 18F-FES received Food and Drug Administration approval and began being marketed by Zionexa using the trade name Cerianna and manufactured by PETNET. In May 2021, GE Healthcare acquired Zionexa, and Cerianna and is now being marketed by GE Healthcare and is still being manufactured by PETNET. This article will review the 18F-FES package insert information and imaging protocol, as well as important guidelines for imaging with 18F-FES.

Keywords: 18F-fluoroestradiol; Cerianna; breast cancer; estrogen receptor imaging; patient outcomes.

MeSH terms

  • Breast Neoplasms* / pathology
  • Estradiol
  • Female
  • Humans
  • Neoplasm Recurrence, Local
  • Positron-Emission Tomography / methods
  • Receptors, Estrogen
  • Review Literature as Topic
  • Whole Body Imaging


  • Receptors, Estrogen
  • Estradiol