[Molecular imaging and radioligand in breast cancer]

Molecular imaging plays a crucial role in the diagnosis, staging, and monitoring of breast cancer. The most commonly used tracer at present is 18F-FDG, a marker of cellular metabolism, making 18F-FDG PET/CT a major imaging modality in the management of breast neoplasms. However, this tracer has limitations, particularly for low-grade ductal or lobular neoplasms, which exhibit low avidity for 18F-FDG. The 68Ga-FAPI tracer, which targets activated fibroblasts and whose uptake is independent of tumor aggressiveness, is currently under investigation and could serve as an excellent alternative to 18F-FDG in certain cases. Additionally, new tracers targeting novel biological pathways of the tumor, including hormonal receptors or HER2, are being developed. These tracers enable whole-body assessment of specific biomarker expressions on cancer cells, offering a more precise understanding of the disease. This approach could help tailor treatments to the molecular characteristics of each tumor, enabling personalized strategies that improve therapeutic efficacy and patient quality of life. Finally, inspired by the model of 177Lu-PSMA used in prostate cancer, researchers are exploring the potential to couple these tracers with therapeutic agents to develop targeted radionuclide therapy for breast neoplasms.