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Microwave-assisted One-pot Synthesis of N-succinimidyl-4-[18F]fluorobenzoate [18F]SFB
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18F-Fluoroestradiol: Current Applications and Future Directions.

Sophia R O'Brien1, Christine E Edmonds1, Shannon M Lanzo1

  • 1From the Department of Radiology, Division of Breast Imaging (S.R.O., C.E.E.) and Division of Nuclear Medicine Imaging and Therapy (S.R.O., S.M.L., J.K.W., D.A.M., A.R.P.), Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein-Radiology Administration, Philadelphia, PA 19104.

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|February 23, 2023
PubMed
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Fluorine 18 (18F) fluoroestradiol (FES) PET imaging offers a non-invasive method to assess estrogen receptor (ER) status in metastatic breast cancer, improving treatment decisions and overcoming biopsy limitations.

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Radiochemistry

Background:

  • Breast cancer is a leading cause of cancer death, with 80% of cases being hormone receptor (HR) positive.
  • Estrogen receptor (ER) status guides treatment, but biopsy assessment has limitations like sampling error and inability to assess heterogeneity.
  • Limitations of biopsy assessment include sampling errors, false negatives, and challenges with biopsy sites or inaccessible metastases.

Purpose of the Study:

  • To review the approved uses of 18F-fluoroestradiol (FES) PET imaging in the United States for ER-positive breast cancer.
  • To highlight FES PET as a tool for precision medicine in optimizing breast cancer patient care.
  • To discuss FES PET's role in identifying target lesions, assessing ER-positive disease in vivo, and evaluating ER heterogeneity.

Main Methods:

  • Utilizes the PET radiotracer fluorine 18 (18F) fluoroestradiol (FES).
  • FES binds to ER in the nucleus of ER-expressing cells.
  • Enables whole-body in vivo assessment of ER expression, complementing biopsy.

Main Results:

  • FES PET allows for in vivo assessment of ER expression throughout the body.
  • It aids in identifying target lesions for biopsy and evaluating ER-positive disease.
  • FES PET is effective in assessing spatial and temporal ER heterogeneity across metastatic sites.

Conclusions:

  • 18F-fluoroestradiol (FES) PET imaging is an approved adjunct to biopsy for ER-positive recurrent or metastatic breast cancer.
  • FES PET provides a comprehensive assessment of ER expression, addressing limitations of traditional biopsy methods.
  • This imaging modality represents a significant advancement in precision medicine for breast cancer management.