Positron Emission Tomography (PET) is becoming an increasingly important tool in managing breast cancer.
This shift is largely due to more PET radiotracers being approved by the FDA specifically for breast cancer and a growing body of evidence supporting their effectiveness.
The most commonly used PET radiotracer for breast cancer is 18F-fluorodeoxyglucose (18F-FDG), which is effective for staging, monitoring treatment response, and detecting recurrence of the disease, especially in certain types of breast cancer.
Another radiotracer, 16α-18F-fluoro-17β-Fluoroestradiol (18F-FES), is used to assess the estrogen receptor status in tumors, helping to select patients for hormone-based therapies. It’s particularly useful for evaluating hard-to-biopsy lesions or when other imaging tests provide unclear results. Sodium 18F-Fluoride (18F-NaF) is used to look at bone turnover, offering a more sensitive detection of bone metastases than traditional methods.
Despite the potential of 18F-FDG PET in breast cancer management, its widespread clinical use has been relatively recent.
As a recent survey of the imaging tech describes, this delay was partly due to earlier guidelines discouraging its use, but recent guidelines from major cancer networks have begun to support its use for certain breast cancer cases.
These changes, along with the approval of 18F-FES and 18F-NaF for specific uses in breast cancer, have contributed to the growing adoption of PET imaging in this field. Beyond these, there are several novel PET radiotracers under clinical investigation that could further enhance the detection, staging, and treatment monitoring of breast cancer.
While the majority of breast cancers occur in women, PET imaging is considered just as beneficial for the rare cases in men.
Advances in PET imaging technology and the development of specific radiotracers have made it possible to visualize cancer cells based on their metabolic activity or specific receptor presence, such as glucose metabolism by 18F-FDG or estrogen receptor availability by 18F-FES. This enables more precise staging, treatment planning, and monitoring of disease progression or response to therapy.
18F-FDG PET is particularly useful for assessing newly diagnosed advanced breast cancer, evaluating treatment response, and detecting recurrence. 18F-FES PET plays a crucial role in selecting patients for endocrine therapies by identifying estrogen receptor-positive tumors, even in challenging cases where biopsy is difficult or other imaging results are inconclusive.
Additionally, 18F-NaF PET/CT has proven more sensitive than other methods for identifying bone metastases, a common concern in metastatic breast cancer.
