Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA; Radiology, University of Southern California, Los Angeles, CA.
Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Semin Nucl Med. 2024 Mar;54(2):247-255. doi: 10.1053/j.semnuclmed.2024.01.007. Epub 2024 Feb 16.
Positron Emission Tomography (PET) has been growing in usage for patients with breast cancer, due to an increased number of FDA-approved PET radiotracers pertinent to patients with breast cancer as well as increased prospective evidence for the value of these agents. The leading PET radiotracer for patients with breast cancer is 18F-fluorodeoxyglucose (18F-FDG), which measures glucose metabolism. There is prospective evidence for the use of 18F-FDG PET in systemic staging of newly diagnosed locally advanced breast cancer (stages IIB-IIIC), monitoring breast cancer treatment response, and detecting breast cancer recurrence, particularly in no special type (NST) breast cancer. 16α-18F-fluoro-17β-Fluoroestradiol (18F-FES) is a radiolabeled estrogen which evaluates estrogen receptor (ER) accessible for estrogen binding. There is prospective evidence supporting 18F-FES PET as a predictive biomarker for selecting patients with metastatic breast cancer for endocrine therapies. 18F-FES PET has also been shown to be valuable in the evaluation of ER status of lesions which are difficult to biopsy, for evaluation of ER status in lesions that are equivocal on other imaging modalities, and for selecting optimal dosage of novel ER-targeted systemic therapies in early clinical trials. Multiple investigators have suggested 18F-FES PET will have an increasing role for patients with invasive lobular breast cancer (ILC), which is less optimally evaluated by 18F-FDG PET. Sodium 18F-Fluoride (18F-NaF) evaluates bone turnover and has been effective in evaluation of malignancies which commonly metastasize to bone. In patients with metastatic breast cancer, 18F-NaF PET/CT has demonstrated superior sensitivity for osseous metastases than 99mTc-MDP or CT. In addition to these three FDA-approved PET radiotracers, there are multiple novel radiotracers currently in clinical trials with potential to further increase PET usage for patients with breast cancer.
正电子发射断层扫描(PET)在乳腺癌患者中的应用越来越多,这是由于越来越多的经美国食品和药物管理局(FDA)批准的与乳腺癌患者相关的 PET 放射性示踪剂,以及这些药物的价值的前瞻性证据增加。乳腺癌患者的主要 PET 放射性示踪剂是 18F-氟代脱氧葡萄糖(18F-FDG),它可以测量葡萄糖代谢。有前瞻性证据表明,18F-FDG PET 可用于新诊断的局部晚期乳腺癌(IIB-IIIC 期)的全身分期、监测乳腺癌治疗反应以及检测乳腺癌复发,尤其是非特殊类型(NST)乳腺癌。16α-18F-氟代-17β-氟代雌二醇(18F-FES)是一种放射性标记的雌激素,可评估雌激素受体(ER)是否可用于雌激素结合。有前瞻性证据支持 18F-FES PET 作为选择转移性乳腺癌患者进行内分泌治疗的预测生物标志物。18F-FES PET 还被证明在评估难以活检的病变的 ER 状态、评估其他影像学检查方法不确定的病变的 ER 状态以及选择新型 ER 靶向全身治疗的最佳剂量方面具有价值。多位研究人员认为,18F-FES PET 将在浸润性小叶乳腺癌(ILC)患者中发挥越来越重要的作用,而 18F-FDG PET 对 ILC 的评估效果不佳。18F 氟化钠(18F-NaF)评估骨转换,在评估常转移至骨骼的恶性肿瘤方面非常有效。在转移性乳腺癌患者中,18F-NaF PET/CT 对骨转移的敏感性优于 99mTc-MDP 或 CT。除了这三种经美国食品和药物管理局(FDA)批准的 PET 放射性示踪剂外,还有多种新型放射性示踪剂目前正在临床试验中,有可能进一步增加乳腺癌患者对 PET 的使用。