Upstaging of Invasive Lobular Cancer With FES PET/CT

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Invasive lobular carcinoma (ILC) is the second most common type of breast cancer.
• Accurate staging is crucial for effective treatment planning in ILC.
• Conventional imaging may sometimes miss or misinterpret metastatic disease.

Purpose of the Study:

• To evaluate the utility of 18F-fluoroestradiol (FES) PET/CT in staging metastatic ILC.
• To assess the role of 18F-FES PET/CT in identifying unsuspected metastatic sites.
• To demonstrate how 18F-FES PET/CT can alter patient management.

Main Methods:

• A patient with known left breast ILC and axillary metastasis underwent staging with 18F-FDG PET/CT.
• Indeterminate findings on 18F-FDG PET/CT prompted further evaluation with 18F-FES PET/CT.
• Biopsy confirmation of suspicious lesions identified by 18F-FES PET/CT.

Main Results:

• 18F-FES PET/CT identified metastatic disease in the right axillary and bilateral cervical lymph nodes.
• These findings were subsequently biopsy-proven.
• The patient was upstaged from stage II to stage IV based on these results.

Conclusions:

• 18F-FES PET/CT is valuable for accurate staging of metastatic ILC.
• This imaging modality can detect occult metastases, leading to significant changes in patient management.
• 18F-FES PET/CT may be an appropriate tool for staging ILC according to current guidelines.