Mortimer J E, Dehdashti F, Siegel B A, Katzenellenbogen J A, Fracasso P, Welch M J
Divisions of Nuclear Medicine and Radiation Sciences, Edward Mallinckrodt Institute of Radiology, St. Louis, Missouri 63110, USA.
Clin Cancer Res. 1996 Jun;2(6):933-9.
We assessed the value of positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) and 16alpha-[18F]fluoro-17beta-estradiol (FES) in women with breast cancer for predicting response to systemic therapy. Results of FES-PET were correlated with estrogen receptor (ER) status. Forty-three women with locally advanced or metastatic breast cancer underwent FDG-PET and FES-PET prior to institution of systemic therapy. All patients had measurable disease and had tumors submitted for ER determination. Cancers were considered functionally hormone sensitive if the standardized uptake value of the lesion on FES-PET was >/=1.0 (FES+) and hormone resistant if the standardized uptake value was <1.0 (FES-). Information obtained by FES-PET was compared with the results of ER assays. The tumor response to chemotherapy and hormonal therapy was correlated with intensity of uptake by both FDG-PET and FES-PET. The ER status of the breast cancers was negative (ER-) in 20 patients, positive (ER+) in 21 patients, and unknown in 2 patients. All 20 of the ER- tumors were also FES-. However, of the 21 ER+ tumors, 16 were FES+ and 5 were FES-. Thirty patients were treated initially with chemotherapy, and 21 (70%) demonstrated objective responses. We were unable to correlate the response to chemotherapy with information obtained by FDG-PET or FES-PET. Thirteen patients were treated with hormone therapy, and 8 (61%) responded to that therapy. Only 1 of the 5 patients whose tumors were ER+ but FES- received hormone therapy, and this treatment resulted in disease stabilization only. Multiple sites of disease were assessed by FES-PET in 17 patients with metastatic breast cancer. Functional hormone sensitivity, defined by FES-PET, was concordant with multiple lesions in 13 (76%). Ten patients with locally advanced breast cancer developed recurrent disease. The initial site of recurrence was the breast in 5 patients. Of the 5 patients with systemic recurrence, 4 had disease detected at the site of recurrence on the pretreatment FDG-PET study but not detected on pretreatment computed tomography. In our experience, FDG-PET imaging is more sensitive than conventional imaging methods, including computed tomography, in staging women with breast cancer. When compared with the in vitro assay of ER status, FES-PET has an apparent sensitivity of 76% and specificity of 100%. Our finding of a subset of patients who have tumors that are ER+ and FES- suggests that the functional assessment of hormone sensitivity by PET imaging can identify patients with ER+ disease whose tumors are likely to be hormone refractory.
我们评估了采用2-[18F]氟-2-脱氧-D-葡萄糖（FDG）和16α-[18F]氟-17β-雌二醇（FES）的正电子发射断层扫描（PET）在乳腺癌女性中预测全身治疗反应的价值。FES-PET的结果与雌激素受体（ER）状态相关。43例局部晚期或转移性乳腺癌女性在开始全身治疗前接受了FDG-PET和FES-PET检查。所有患者均有可测量的病灶，且肿瘤均送检以确定ER。如果FES-PET上病灶的标准化摄取值≥1.0（FES+），则癌症被认为在功能上对激素敏感；如果标准化摄取值<1.0（FES-），则认为对激素耐药。将FES-PET获得的信息与ER检测结果进行比较。肿瘤对化疗和激素治疗的反应与FDG-PET和FES-PET的摄取强度相关。20例患者的乳腺癌ER状态为阴性（ER-），21例为阳性（ER+），2例未知。所有20例ER-肿瘤也均为FES-。然而，在21例ER+肿瘤中，16例为FES+，5例为FES-。30例患者最初接受化疗，其中21例（70%）表现出客观反应。我们无法将化疗反应与FDG-PET或FES-PET获得的信息相关联。13例患者接受激素治疗，8例（61%）对该治疗有反应。在5例肿瘤为ER+但FES-的患者中，只有1例接受了激素治疗，且该治疗仅使疾病稳定。17例转移性乳腺癌患者通过FES-PET评估了多个疾病部位。由FES-PET定义的功能激素敏感性在13例（76%）患者中与多个病灶一致。10例局部晚期乳腺癌患者出现复发疾病。5例患者的复发初始部位为乳腺。在5例发生全身复发的患者中，4例在治疗前FDG-PET研究中复发部位有疾病检出，但在治疗前计算机断层扫描中未检出。根据我们的经验，在对乳腺癌女性进行分期时，FDG-PET成像比包括计算机断层扫描在内的传统成像方法更敏感。与ER状态的体外检测相比，FES-PET的表观敏感性为76%，特异性为100%。我们发现有一部分患者的肿瘤为ER+但FES-，这表明通过PET成像对激素敏感性进行功能评估可以识别出ER+疾病且肿瘤可能对激素难治的患者。
