Article Figures & Data
Figures
- FIGURE 1.
Patient 1. History: ER+, HER2-negative, T2N0M0 left breast lobular carcinoma treated with neoadjuvant chemotherapy, surgery, adjuvant chemotherapy, radiation therapy, and 5 y of hormone therapy (tamoxifen). Eight years after treatment completion, T10 and T12 fractures emerged, and cancer antigen 15-3 was 3,500 U/mL (reference level, <25 U/mL). Outcome: all lesions expressed ERs on 18F-FES PET/CT. Accumulation was higher for 18F-FES than for 18F-FDG, probably because of lobular histology. Some lesions were barely seen with 18F-FDG. Treatment: aromatase inhibitor (exemestane), with lesion stabilization and cancer antigen 15-3 reduction from 3,500 to 1,50 U/mL 2 y after treatment began. (Reprinted from (10).)
- FIGURE 2.
Patient 2. History: ER+, progesterone receptor–negative, HER2-negative lobular carcinoma with initial bone metastases. Outcome: lesion heterogeneity (18F-FES PET/CT scan showing both 18F-FES–positive lesions [red arrows] and 18F-FES–negative lesions [blue arrows]). No uptake was seen on 18F-FES PET/CT scan for lesions that showed uptake on second 18F-FDG PET/CT scan (blue arrows). 18F-FES–positive lesions corresponded to progressive lesions seen with 18F-FDG (yellow arrows), potentially explaining progression with hormone therapy. Treatment: aromatase inhibitor (blocks ERs), which resulted in reduction or disappearance of 18F-FES PET signal; radiation therapy on T9 and left iliac bone; and exemestane, resulting in bone progression on L5 and left iliac bone. (Reprinted from (10).)
- FIGURE 3.
Normal increased uptake of 18F-FES in liver (1), gastrointestinal tract (2), kidneys (3), urinary bladder (4), and injected vessel (5). Uptake in injected vessel, seen in most patients, is probably due to sticking of tracer to vessel wall or endothelial cells (2). (Courtesy of DRA Imaging.)
- FIGURE 4.
Abnormal uptake of 18F-FES. Although 18F-FDG WB imaging is not helpful in visualizing brain metastasis, 18F-FES WB imaging is. (A) WB 18F-FES image from vertex to mid thighs, with increased uptake in chest and brain. (B) Extra image of skull that clearly illustrates the 2 brain metastatic lesions (2). (Courtesy of DRA Imaging.)
Tables
- TABLE 1.
Appropriate-Use Guidelines for 14 Clinical Scenarios (7) in Which 18F-FES PET Might Be Used
Scenario Appropriateness of use Score Appropriate (scores of 7–9) 8 For assessing ER status when lesions are difficult to biopsy or biopsy is nondiagnostic 8 9 For considering second line of endocrine therapy after progression of metastatic disease 8 10 For considering endocrine therapy at initial diagnosis of metastatic disease 8 14 For detecting ER status when findings of other imaging tests are equivocal or suggestive 8 May be appropriate (scores of 4–6) 2 For diagnosing malignancy of unknown primary when biopsy is nonfeasible or nondiagnostic 5 5 For routine staging of extraaxillary nodes and distant metastases 5 6 For staging invasive lobular carcinoma and low-grade invasive ductal carcinoma 5 7 For assessing ER status, in lieu of biopsy, in lesions that are easily accessible for biopsy 5 13 For detecting lesions in suspected or known recurrent or metastatic breast cancer 5 Rarely appropriate (scores of 1–3) 1 For diagnosing primary breast cancer 2 3 For routine staging of primary tumor (T staging) 1 4 For routine staging of axillary nodes 3 11 For considering endocrine therapy at initial diagnosis of primary breast cancer 1 12 For measuring response to therapy 1 Acquisition parameter Specification Standard/preferred/optional PET scanner type 2 or 3 dimensional Standard Energy peak 511 keV Standard Energy window 18F-fluorine Standard Patient position Supine with arms above head, if possible Standard Injection-to-scan time 20–80 min after injection Standard 80 min Preferred Acquisition area WB (thighs to vertex) Standard Acquisition time 20–30 min Standard Number of bed positions 6–8 Standard Time per bed position 3–4 min Standard Category Reimbursement service Investigation of benefits Aid in determining patient’s health insurance coverage Billing and coding assistance Provide guidance for billing and coding requirements Claims assistance Help in navigating through claims process Preservice and postservice appeals Aid in assisting with and expediting these appeals Prior-authorization support and status monitoring Help with initiating and monitoring prior-authorization requests from insurance companies (prefill request on your behalf) Medical necessity support Provide support to establish medical necessity Peer-to-peer preparation Provide one-on-one collaborative training and strategies to assist health-care provider in seeking 18F-FES insurance coverage
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- Article
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- Abstract
- MECHANISM OF ACTION, PHARMACODYNAMICS, AND PHARMACOKINETICS
- PATIENT SELECTION
- APPROPRIATE-USE CRITERIA FOR ER-TARGETED PET
- CLINICAL INDICATION AND LIMITATIONS OF USE
- PATIENT PREPARATION
- DOSE AND ADMINISTRATION
- ACQUISITION AND PROCESSING PARAMETERS
- 18F-FES TRACER DISTRIBUTION PATTERNS
- IMAGE INTERPRETATION
- WARNINGS, PRECAUTIONS, AND ADVERSE REACTIONS
- USE IN SPECIAL PATIENT POPULATIONS
- BENEFITS OF 18F-FES ER IMAGING
- SUPPORT WITH 18F-FES ACCESS
- CONCLUSION
- DISCLOSURE
- ACKNOWLEDGMENTS
- Footnotes
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