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Open Access 01-12-2020 | Breast Cancer | Original research

Visual and quantitative evaluation of [¹⁸F]FES and [¹⁸F]FDHT PET in patients with metastatic breast cancer: an interobserver variability study

Authors: Lemonitsa H. Mammatas, Clasina M. Venema, Carolina P. Schröder, Henrica C. W. de Vet, Michel van Kruchten, Andor W. J. M. Glaudemans, Maqsood M. Yaqub, Henk M. W. Verheul, Epie Boven, Bert van der Vegt, Erik F. J. de Vries, Elisabeth G. E. de Vries, Otto S. Hoekstra, Geke A. P. Hospers, C. Willemien Menke-van der Houven van Oordt

Published in: EJNMMI Research | Issue 1/2020

Abstract

Purpose

Correct identification of tumour receptor status is important for treatment decisions in breast cancer. [¹⁸F]FES PET and [¹⁸F]FDHT PET allow non-invasive assessment of the oestrogen (ER) and androgen receptor (AR) status of individual lesions within a patient. Despite standardised analysis techniques, interobserver variability can significantly affect the interpretation of PET results and thus clinical applicability. The purpose of this study was to determine visual and quantitative interobserver variability of [¹⁸F]FES PET and [¹⁸F]FDHT PET interpretation in patients with metastatic breast cancer.

Methods

In this prospective, two-centre study, patients with ER-positive metastatic breast cancer underwent both [¹⁸F]FES and [¹⁸F]FDHT PET/CT. In total, 120 lesions were identified in 10 patients with either conventional imaging (bone scan or lesions > 1 cm on high-resolution CT, n = 69) or only with [¹⁸F]FES and [¹⁸F]FDHT PET (n = 51). All lesions were scored visually and quantitatively by two independent observers. A visually PET-positive lesion was defined as uptake above background. For quantification, we used standardised uptake values (SUV): SUV_max, SUV_peak and SUV_mean.

Results

Visual analysis showed an absolute positive and negative interobserver agreement for [¹⁸F]FES PET of 84% and 83%, respectively (kappa = 0.67, 95% CI 0.48–0.87), and 49% and 74% for [¹⁸F]FDHT PET, respectively (kappa = 0.23, 95% CI − 0.04–0.49). Intraclass correlation coefficients (ICC) for quantification of SUV_max, SUV_peak and SUV_mean were 0.98 (95% CI 0.96–0.98), 0.97 (95% CI 0.96–0.98) and 0.89 (95% CI 0.83–0.92) for [¹⁸F]FES, and 0.78 (95% CI 0.66–0.85), 0.76 (95% CI 0.63–0.84) and 0.75 (95% CI 0.62–0.84) for [¹⁸F]FDHT, respectively.

Conclusion

Visual and quantitative evaluation of [¹⁸F]FES PET showed high interobserver agreement. These results support the use of [¹⁸F]FES PET in clinical practice. In contrast, visual agreement for [¹⁸F]FDHT PET was relatively low due to low tumour-background ratios, but quantitative agreement was good. This underscores the relevance of quantitative analysis of [¹⁸F]FDHT PET in breast cancer.

Trial registration

ClinicalTrials.gov, NCT01988324. Registered 20 November 2013, https://clinicaltrials.gov/ct2/show/NCT01988324?term=FDHT+PET&draw=1&rank=2.

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Title: Visual and quantitative evaluation of [18F]FES and [18F]FDHT PET in patients with metastatic breast cancer: an interobserver variability study
Authors: Lemonitsa H. Mammatas
Clasina M. Venema
Carolina P. Schröder
Henrica C. W. de Vet
Michel van Kruchten
Andor W. J. M. Glaudemans
Maqsood M. Yaqub
Henk M. W. Verheul
Epie Boven
Bert van der Vegt
Erik F. J. de Vries
Elisabeth G. E. de Vries
Otto S. Hoekstra
Geke A. P. Hospers
C. Willemien Menke-van der Houven van Oordt
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Breast Cancer
Breast Cancer
Estrogens
Androgens
Published in: EJNMMI Research / Issue 1/2020
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/s13550-020-00627-z

At a glance: The STEP trials

Springer Medicine

Visual and quantitative evaluation of [¹⁸F]FES and [¹⁸F]FDHT PET in patients with metastatic breast cancer: an interobserver variability study

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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