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11-03-2025 | Breast Cancer | Review Article

Head-to-Head comparison of [18F]FES and [18F]FDG PET/CT in breast cancer patients: has a new era come?

Authors: Priscilla Guglielmo, Rosario Mazzola, Shadya Sara Darwish, Francesco Valenti, Tommaso Martino De Pas, Lucia Setti, Manuela Bonacina, Massimo Maria Grassi, Laura Evangelista

Published in: European Journal of Nuclear Medicine and Molecular Imaging

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Abstract

Purpose

This review systematically compared, in a head-to-head manner, the diagnostic and prognostic performance of [18F]FDG and [18F]FES PET/CT in breast cancer (BC) patients.

Methods

A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases up to January 2025, without temporal limitations or restrictions on the number of patients in the included studies, to identify relevant articles comparing the diagnostic value of [18F]FDG and [18F]FES PET in BC patients. Selected imaging studies were analyzed using a modified version of the Critical Appraisal Skills Programme checklist dedicated to systematic reviews.

Results

A total of 20 papers were evaluated. Based on the CASP analysis, the quality of the study was variable. Totally, 806 patients affected by BC underwent both [18F]FDG and [18F]FES PET. Different setting of disease were considered, such as staging/diagnostic and prognostic value. In the initial staging of disease, [18F]FES PET/CT seemed to be more accurate than [18F]FDG. In the prognostic field, [18F]FES expression was a positive factor for the better prognosis, in particular when the amount of [18F]FDG uptake was low. [18F]FES seemed to be promising as a molecular agent in patients affected by invasive lobular BC.

Conclusion

These findings underscore the potential of [18F]FES as a complementary imaging biomarker to [18F]FDG, advocating for further studies to standardize PET metrics and refine their combined clinical utility.
Literature
1.
10.
go back to reference Aurilio G, Disalvatore D, Pruneri G, Bagnardi V, Viale G, Curigliano G, Adamoli L, Munzone E, Sciandivasci A, De Vita F, et al. A Meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases. Eur J Cancer. 2014;50:277–89. https://doi.org/10.1016/j.ejca.2013.10.004.CrossRefPubMed Aurilio G, Disalvatore D, Pruneri G, Bagnardi V, Viale G, Curigliano G, Adamoli L, Munzone E, Sciandivasci A, De Vita F, et al. A Meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases. Eur J Cancer. 2014;50:277–89. https://​doi.​org/​10.​1016/​j.​ejca.​2013.​10.​004.CrossRefPubMed
14.
go back to reference Mankoff D, Balogová S, Dunnwald L, Dehdashti F, DeVries E, Evangelista L, Van Kruchten M, Vaz SC, Fowler A, Linden H, et al. Summary: SNMMI procedure standard/EANM practice guideline for estrogen receptor imaging of patients with breast cancer using 16α-[18 F]Fluoro-17β-Estradiol PET. J Nucl Med. 2024;65:221–3. https://doi.org/10.2967/jnumed.123.266938.CrossRefPubMed Mankoff D, Balogová S, Dunnwald L, Dehdashti F, DeVries E, Evangelista L, Van Kruchten M, Vaz SC, Fowler A, Linden H, et al. Summary: SNMMI procedure standard/EANM practice guideline for estrogen receptor imaging of patients with breast cancer using 16α-[18 F]Fluoro-17β-Estradiol PET. J Nucl Med. 2024;65:221–3. https://​doi.​org/​10.​2967/​jnumed.​123.​266938.CrossRefPubMed
17.
go back to reference Bottoni G, Piccardo A, Fiz F, Siri G, Matteucci F, Rocca A, Nanni O, Monti M, Brain E, Alberini JL, et al. Heterogeneity of bone metastases as an important prognostic factor in patients affected by oestrogen receptor-positive breast cancer. The role of combined [18F]Fluoroestradiol PET/CT and [18F]Fluorodeoxyglucose PET/CT. Eur J Radiol. 2021;141:109821. https://doi.org/10.1016/j.ejrad.2021.109821.CrossRefPubMed Bottoni G, Piccardo A, Fiz F, Siri G, Matteucci F, Rocca A, Nanni O, Monti M, Brain E, Alberini JL, et al. Heterogeneity of bone metastases as an important prognostic factor in patients affected by oestrogen receptor-positive breast cancer. The role of combined [18F]Fluoroestradiol PET/CT and [18F]Fluorodeoxyglucose PET/CT. Eur J Radiol. 2021;141:109821. https://​doi.​org/​10.​1016/​j.​ejrad.​2021.​109821.CrossRefPubMed
23.
25.
27.
go back to reference Chae SY, Son HJ, Lee DY, Shin E, Oh JS, Seo SY, Baek S, Kim JY, Na SJ, Moon DH. Comparison of diagnostic sensitivity of [18F]Fluoroestradiol and [18F]Fluorodeoxyglucose positron emission tomography/computed tomography for breast cancer recurrence in patients with a history of estrogen receptor-positive primary breast cancer. EJNMMI Res. 2020;10:54. https://doi.org/10.1186/s13550-020-00643-z.CrossRefPubMedPubMedCentral Chae SY, Son HJ, Lee DY, Shin E, Oh JS, Seo SY, Baek S, Kim JY, Na SJ, Moon DH. Comparison of diagnostic sensitivity of [18F]Fluoroestradiol and [18F]Fluorodeoxyglucose positron emission tomography/computed tomography for breast cancer recurrence in patients with a history of estrogen receptor-positive primary breast cancer. EJNMMI Res. 2020;10:54. https://​doi.​org/​10.​1186/​s13550-020-00643-z.CrossRefPubMedPubMedCentral
31.
go back to reference Covington MF, Hoffman JM, Morton KA, Buckway B, Boucher KM, Rosenthal RE, Porretta JM, Brownson KE, Matsen CB, Vaklavas C, et al. Prospective pilot study of 18 F-Fluoroestradiol PET/CT in patients with invasive lobular carcinomas. Am J Roentgenol. 2023;221:228–39. https://doi.org/10.2214/AJR.22.28809.CrossRef Covington MF, Hoffman JM, Morton KA, Buckway B, Boucher KM, Rosenthal RE, Porretta JM, Brownson KE, Matsen CB, Vaklavas C, et al. Prospective pilot study of 18 F-Fluoroestradiol PET/CT in patients with invasive lobular carcinomas. Am J Roentgenol. 2023;221:228–39. https://​doi.​org/​10.​2214/​AJR.​22.​28809.CrossRef
32.
go back to reference Bottoni G, Fiz F, Puntoni M, Matteucci F, Monti M, DeCensi A, Nanni O, Brain E, Alberini JL, Dib B, et al. Diagnostic effectiveness of [18F]Fluoroestradiol PET/CT in oestrogen receptor-positive breast cancer: the key role of histopathology. Evidence from an international multicentre prospective study. Eur J Nucl Med Mol Imaging. 2023;50:2477–85. https://doi.org/10.1007/s00259-023-06173-9.CrossRefPubMed Bottoni G, Fiz F, Puntoni M, Matteucci F, Monti M, DeCensi A, Nanni O, Brain E, Alberini JL, Dib B, et al. Diagnostic effectiveness of [18F]Fluoroestradiol PET/CT in oestrogen receptor-positive breast cancer: the key role of histopathology. Evidence from an international multicentre prospective study. Eur J Nucl Med Mol Imaging. 2023;50:2477–85. https://​doi.​org/​10.​1007/​s00259-023-06173-9.CrossRefPubMed
33.
go back to reference Iqbal R, Yaqub M, Bektas HO, Oprea-Lager DE, de Vries EGE, Glaudemans AWJM, Aftimos P, Gebhart G, Beelen AP, Schuit RC, et al. [18F]FDG and [18F]FES PET/CT imaging as a biomarker for therapy effect in patients with metastatic ER+ Breast cancer undergoing treatment with rintodestrant. Clin Cancer Res. 2023;29:2075–84. https://doi.org/10.1158/1078-0432.CCR-22-2720.CrossRefPubMed Iqbal R, Yaqub M, Bektas HO, Oprea-Lager DE, de Vries EGE, Glaudemans AWJM, Aftimos P, Gebhart G, Beelen AP, Schuit RC, et al. [18F]FDG and [18F]FES PET/CT imaging as a biomarker for therapy effect in patients with metastatic ER+ Breast cancer undergoing treatment with rintodestrant. Clin Cancer Res. 2023;29:2075–84. https://​doi.​org/​10.​1158/​1078-0432.​CCR-22-2720.CrossRefPubMed
36.
go back to reference van Geel JJL, Moustaquim J, Boers J, Elias SG, Smeets EMM, Knip JJ, Glaudemans AWJM, de Vries EFJ, Hospers GAP, van Kruchten M, et al. Intrapatient 16α-[18 F]Fluoro-17β-Estradiol PET heterogeneity as a prognostic factor for endocrine therapy response and survival in patients with estrogen receptor-positive metastatic breast cancer. J Nucl Med. 2025;66:194–200. https://doi.org/10.2967/jnumed.124.268984.CrossRefPubMed van Geel JJL, Moustaquim J, Boers J, Elias SG, Smeets EMM, Knip JJ, Glaudemans AWJM, de Vries EFJ, Hospers GAP, van Kruchten M, et al. Intrapatient 16α-[18 F]Fluoro-17β-Estradiol PET heterogeneity as a prognostic factor for endocrine therapy response and survival in patients with estrogen receptor-positive metastatic breast cancer. J Nucl Med. 2025;66:194–200. https://​doi.​org/​10.​2967/​jnumed.​124.​268984.CrossRefPubMed
39.
Metadata
Title
Head-to-Head comparison of [18F]FES and [18F]FDG PET/CT in breast cancer patients: has a new era come?
Authors
Priscilla Guglielmo
Rosario Mazzola
Shadya Sara Darwish
Francesco Valenti
Tommaso Martino De Pas
Lucia Setti
Manuela Bonacina
Massimo Maria Grassi
Laura Evangelista
Publication date
11-03-2025
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-025-07186-2