Abstract | PURPOSE: Determining the estrogen receptor (ER) status is essential in metastatic breast cancer (MBC) management. Whole-body ER imaging with 16α-[18F]fluoro-17β- estradiol positron emission tomography ([ 18F]FES-PET) is increasingly used for this purpose. To establish the clinical validity of the [ 18F]FES-PET, we studied the diagnostic accuracy of qualitative and quantitative [ 18F]FES-PET assessment to predict ER expression by immunohistochemistry in a metastasis. METHODS: In a prospective multicenter trial, 200 patients with newly diagnosed MBC underwent extensive workup including molecular imaging. For this subanalysis, ER expression in the biopsied metastasis was related to qualitative whole-body [ 18F]FES-PET evaluation and quantitative [ 18F]FES uptake in the corresponding metastasis. A review and meta-analysis regarding [ 18F]FES-PET diagnostic performance were performed. RESULTS: Whole-body [ 18F]FES-PET assessment predicted ER expression in the biopsied metastasis with good accuracy: a sensitivity of 95% (95% CI, 89 to 97), a specificity of 80% (66 to 89), a positive predictive value (PPV) of 93% (87 to 96), and a negative predictive value (NPV) of 85% (72 to 92) in 181 of 200 evaluable patients. Quantitative [ 18F]FES uptake predicted ER immunohistochemistry in the corresponding metastasis with a sensitivity/specificity of 91%/69% and a PPV/NPV of 90%/71% in 156 of 200 evaluable patients. For bone metastases, PPV/NPV was 92%/81%. Meta-analysis with addition of our data has increased diagnostic performance and narrowed the 95% CIs compared with previous studies with a sensitivity/specificity of both 86% (81 to 90 and 73 to 93, respectively). CONCLUSION: In this largest prospective series so far, we established the clinical validity of [ 18F]FES-PET to determine tumor ER status in MBC. In view of the high diagnostic accuracy of qualitatively assessed whole-body [ 18F]FES-PET, this noninvasive imaging modality can be considered a valid alternative to a biopsy of a metastasis to determine ER status in newly MBC (ClinicalTrials.gov identifier: NCT01957332).
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Authors | Jasper J L van Geel, Jorianne Boers, Sjoerd G Elias, Andor W J M Glaudemans, Erik F J de Vries, Geke A P Hospers, Michel van Kruchten, Evelien J M Kuip, Agnes Jager, Willemien C Menke-van der Houven van Oordt, Bert van der Vegt, Elisabeth G E de Vries, Carolina P Schröder, IMPACT-Metastatic Breast Consortium |
Journal | Journal of clinical oncology : official journal of the American Society of Clinical Oncology
(J Clin Oncol)
Vol. 40
Issue 31
Pg. 3642-3652
(11 01 2022)
ISSN: 1527-7755 [Electronic] United States |
PMID | 35584346
(Publication Type: Meta-Analysis, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Estradiol
- Receptors, Estrogen
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Topics |
- Humans
- Female
- Estradiol
- Breast Neoplasms
(pathology)
- Receptors, Estrogen
(metabolism)
- Positron Emission Tomography Computed Tomography
(methods)
- Positron-Emission Tomography
(methods)
- Multicenter Studies as Topic
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