European journal of nuclear medicine and molecular imaging · 2026
Clinical impact of 18F-FES PET/CT-detected ER-positive conversion in metastatic breast cancer with ER-negative primary tumors.
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Feng Sanxing, Xie Yizhao, Liu Cheng, Li Yumeng, Luo Jincheng, Hu Xichun, Song Shaoli, Wang Biyun, Yang Zhongyi
Аннотация
PURPOSE: Receptor discordance between primary and metastatic breast cancer is increasingly recognized and may influence treatment decisions in metastatic breast cancer (MBC) patients. 18F-fluoroestradiol (18F-FES) PET/CT enables non-invasive whole-body assessment of estrogen receptor (ER) expression and may provide additional information beyond tissue-based evaluation. This study aimed to investigate the clinical significance of 18F-FES-positive conversion in patients with MBC whose primary tumors were ER-negative, and to evaluate the potential role of 18F-FES PET/CT in treatment stratification.
METHODS: This retrospective study screened 1330 patients with metastatic breast cancer who underwent 18F-FES PET/CT, identified 51 patients with ER-negative primary breast tumors, and finally included 40 evaluable patients in the analysis. 18F-FES positivity was defined by focal uptake visually distinguishable from local background together with a lesional SUVmax ≥ 1.8. Progression-free survival (PFS) was estimated using the Kaplan-Meier method and compared using the log-rank test.
RESULTS: 18F-FES-positive conversion occurred in 37.5% (15/40) of patients. Primary progesterone receptor (PR) positivity was more frequent in patients with 18F-FES-positive conversion than in those without conversion (60.0% vs. 24.0%; P = 0.042). After imaging, endocrine-based therapy predominated among patients with 18F-FES-positive conversion whereas chemotherapy was more common in 18F-FES-negative patients. Patients with 18F-FES-positive conversion showed significantly longer PFS than those remaining 18F-FES-negative (median PFS, 15.2 vs. 7.3 months; P = 0.005).
CONCLUSION: ER-positive conversion assessed by 18F-FES PET/CT can occur in clinically selected patients with metastatic breast cancer and ER-negative primary tumors. 18F-FES PET/CT may provide clinically meaningful information for treatment stratification in this patient population.
METHODS: This retrospective study screened 1330 patients with metastatic breast cancer who underwent 18F-FES PET/CT, identified 51 patients with ER-negative primary breast tumors, and finally included 40 evaluable patients in the analysis. 18F-FES positivity was defined by focal uptake visually distinguishable from local background together with a lesional SUVmax ≥ 1.8. Progression-free survival (PFS) was estimated using the Kaplan-Meier method and compared using the log-rank test.
RESULTS: 18F-FES-positive conversion occurred in 37.5% (15/40) of patients. Primary progesterone receptor (PR) positivity was more frequent in patients with 18F-FES-positive conversion than in those without conversion (60.0% vs. 24.0%; P = 0.042). After imaging, endocrine-based therapy predominated among patients with 18F-FES-positive conversion whereas chemotherapy was more common in 18F-FES-negative patients. Patients with 18F-FES-positive conversion showed significantly longer PFS than those remaining 18F-FES-negative (median PFS, 15.2 vs. 7.3 months; P = 0.005).
CONCLUSION: ER-positive conversion assessed by 18F-FES PET/CT can occur in clinically selected patients with metastatic breast cancer and ER-negative primary tumors. 18F-FES PET/CT may provide clinically meaningful information for treatment stratification in this patient population.