Head-to-head comparison of 18F-FDG and 18F-FES PET/CT for initial staging of ER-positive breast cancer patients
Peerapon Kiatkittikul, Supanida Mayurasakorn, Chetsadaporn Promteangtrong, Anchisa Kunawudhi, Dheeratama Siripongsatian, Natdanai Hirata, Attapon Jantarato, Natphimol Boonkawin, Sukanya Yaset, P. Kongsakorn, Warunya Phewnual, Chanisa Chotipanich
Abstract
Abstract Purpose To compare the diagnostic performance of 18 F-fluorodeoxyglucose ( 18 F-FDG) and 18 F-fluoroestradiol ( 18 F-FES) positron emission tomography/computed tomography (PET/CT) for initial staging of estrogen receptor (ER) positive breast cancer. Methods Twenty-eight patients with ER-positive breast cancer underwent 18 F-FDG and 18 F-FES PET/CT for initial staging. Diagnostic performance and concordance rates were analyzed for both radiotracers. Semiquantitative parameters of maximum standardized uptake value (SUVmax) and tumor-to-normal ratio (T/N ratio) were compared using Wilcoxon signed-rank test. Factors potentially affecting the degree of radiotracer uptake were analyzed by multi-level linear regression analysis. Results The overall diagnostic performance of 18 F-FES was comparable to 18 F-FDG, except for higher specificity and NPV, with sensitivity, specificity, PPV, NPV, and accuracy of 87.56%, 100%, 100%, 35.14%, and 88.35%, respectively, for 18 F-FES and 83.94%, 30.77%, 94.74%, 11.43%, and 95.37%, respectively, for 18 F-FDG. Diagnostic performance of strong ER expression was better in 18 F-FES but worse for 18 F-FDG. There was a correlation of mucinous cell type and Allred score 7–8 with 18 F-FES uptake, with correlation coefficients of 26.65 (19.28, 34.02), 5.90 (− 0.005, 11.81), and p -value of < 0.001, 0.05, respectively. Meanwhile, luminal B and Ki-67 were related to 18 F-FDG uptake, with correlation coefficients of 2.76 (1.10, 0.20), 0.11 (0.01, 0.2), and p -value of 0.018, 0.025, respectively. Conclusion Diagnostic performance of 18 F-FES is comparable to 18 F-FDG, but better for strongly ER-positive breast cancer. Combination of 18 F-FES and 18 F-FDG would potentially overcome the limitations of each tracer with more accurate staging.