Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and.
Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Nucl Med. 2021 Sep 1;62(9):1214-1220. doi: 10.2967/jnumed.120.256826. Epub 2021 May 14.
Breast cancer (BC) is a heterogeneous disease in which estrogen receptor (ER) expression plays an important role in most tumors. A clinical dilemma may arise when a metastasis biopsy to determine the ER status cannot be performed safely or when ER heterogeneity is suspected between tumor lesions. Whole-body ER imaging, such as 16α-F-fluoro-17β-estradiol (F-FES) PET, may have added value in these situations. However, the role of this imaging technique in routine clinical practice remains to be further determined. Therefore, we assessed whether the physician's remaining clinical dilemma after the standard workup was solved by the F-FES PET scan. This retrospective study included F-FES PET scans of patients who had (or were suspected to have) ER-positive metastatic BC and for whom a clinical dilemma remained after the standard workup. The scans were performed at the University Medical Center of Groningen between November 2009 and January 2019. We investigated whether the physician's clinical dilemma was solved, defined either as solving the clinical dilemma through the F-FES PET results or as basing a treatment decision directly on the F-FES PET results. In addition, the category of the clinical dilemma was reported, as well as the rate of F-FES-positive or -negative PET scans, and any correlation to the frequency of solved dilemmas was determined. One hundred F-FES PET scans were performed on 83 patients. The clinical dilemma categories were inability to determine the extent of metastatic disease or suspected metastatic disease with the standard workup ( = 52), unclear ER status of the tumor ( = 31), and inability to determine which primary tumor caused the metastases ( = 17). The dilemmas were solved by F-FES PET in 87 of 100 scans (87%). In 81 of 87 scans, a treatment decision was based directly on F-FES PET results (treatment change, 51 scans; continuance, 30 scans). The frequency of solved dilemmas was not related to the clinical dilemma category ( = 0.334). However, the frequency of solved dilemmas was related to whether scans were F-FES-positive ( = 63) or F-FES-negative ( = 37; < 0.001). For various indications, the F-FES PET scan can help to solve most clinical dilemmas that may remain after the standard workup. Therefore, the F-FES PET scan has added value in BC patients who present the physician with a clinical dilemma.
乳腺癌（BC）是一种异质性疾病，其中雌激素受体（ER）表达在大多数肿瘤中起着重要作用。当无法安全进行转移活检以确定 ER 状态，或者怀疑肿瘤病变之间存在 ER 异质性时，可能会出现临床困境。全身 ER 成像，如 16α-F-氟-17β-雌二醇（F-FES）PET，在这些情况下可能具有附加价值。然而，这种成像技术在常规临床实践中的作用仍有待进一步确定。因此，我们评估了标准检查后医生的临床困境是否通过 F-FES PET 扫描得到解决。这项回顾性研究包括在格罗宁根大学医学中心进行的 F-FES PET 扫描，这些扫描用于患有（或疑似患有）ER 阳性转移性 BC 的患者，并且在标准检查后仍存在临床困境。扫描时间为 2009 年 11 月至 2019 年 1 月。我们调查了医生的临床困境是否通过 F-FES PET 结果得到解决，定义为通过 F-FES PET 结果解决临床困境，或直接根据 F-FES PET 结果做出治疗决策。此外，还报告了临床困境的类别，以及 F-FES 阳性或阴性 PET 扫描的比例，并确定了与解决困境的频率的任何相关性。在 83 名患者中进行了 100 次 F-FES PET 扫描。临床困境的类别为标准检查无法确定转移性疾病的范围或疑似转移性疾病（n = 52）、肿瘤 ER 状态不明（n = 31）和无法确定哪个原发肿瘤引起了转移（n = 17）。F-FES PET 解决了 100 次扫描中的 87 次（87%）。在 87 次扫描中，有 81 次直接根据 F-FES PET 结果做出了治疗决策（治疗改变 51 次，继续治疗 30 次）。解决困境的频率与临床困境类别无关（ = 0.334）。然而，解决困境的频率与扫描是 F-FES 阳性（n = 63）还是 F-FES 阴性（n = 37；<0.001）有关。对于各种适应症，F-FES PET 扫描有助于解决标准检查后可能仍存在的大多数临床困境。因此，F-FES PET 扫描在为医生带来临床困境的 BC 患者中具有附加价值。
