The role of [18F]FES PET/CT in breast cancer management

Cuzzocrea, Marco; Di Micco, Rosa; Colombo, Giorgia Elisabeth; Rizzo, Stefania Maria Rita; Paone, Gaetano; Casati, Virginia; Alkhaldii, Turki; Khajah, Fatemah; Rauh, Claudia; Banys-Paluchowsky, Maggie; Ditsch, Nina; Kuehn, Thorsten; Gentilini, Oreste D.; Treglia, Giorgio; Gasparri, Maria Luisa

doi:10.3390/cancers17101644

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Gasparri_2025_MDPI_cancers_The role of 18F

Journal article

The role of [18F]FES PET/CT in breast cancer management : an umbrella review

Cuzzocrea, Marco Division of Nuclear Medicine, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona and Lugano, Switzerland
Di Micco, Rosa Breast Surgery Unit, IRCSS Ospedale San Raffaele, Milan, Italy
Colombo, Giorgia Elisabeth Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust, London UK - Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale di Lugano, Switzerland
Rizzo, Stefania Maria Rita ORCID Division of Radiology, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Paone, Gaetano ORCID Division of Nuclear Medicine, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona and Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
Casati, Virginia Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale di Lugano, Switzerland
Alkhaldii, Turki Breast Surgery Unit, IRCSS Ospedale San Raffaele, Milan, Italy
Khajah, Fatemah Breast Surgery Unit, IRCSS Ospedale San Raffaele, Milan, Italy
Rauh, Claudia Department of Gynecology, University Hospital Inselspital Bern, Switzerland
Banys-Paluchowsky, Maggie Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Germany
Ditsch, Nina Klinik fuer Gynäkologie und Geburtshilfe, Universitätsklinikum Augsburg, Germany
Kuehn, Thorsten Universitaetsfrauenklinik Ulm, Germany - Faculty of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
Gentilini, Oreste D. Breast Surgery Unit, IRCSS Ospedale San Raffaele, Milan, Italy - Faculty of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
Treglia, Giorgio ORCID Division of Nuclear Medicine, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona and Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Faculty of Biology and Medicine, University of Lausanne, Switzerland
Gasparri, Maria Luisa ORCID Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale di Lugano, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Department of Gynecology and Obstetrics, Centro di Senologia della Svizzera Italiana EOC, Ospedale Italiano di Lugano, Switzerland

2025

Published in:

Cancers. - 2025, vol. 17, no. 10, p. 1644

English Background/Objectives: Breast cancer (BC) is the most commonly diagnosed cancer worldwide. Estrogen receptor (ER) status is a key determinant in the diagnosis and treatment of BC. Although immunohistochemistry (IHC) is the gold standard for ER assessment, it has limitations. This umbrella review aims to evaluate the role of 16α-18F-fluoro-17β-estradiol ([18F]FES) PET/CT as a non-invasive imaging tool for assessing ER expression and its implications in BC management. Methods: A comprehensive search was conducted in PubMed/MEDLINE and Cochrane Library for systematic reviews and meta-analyses published in the last decade. Studies eligible for inclusion evaluated the diagnostic accuracy and clinical utility of [18F]FES PET/CT in BC based on a predefined research question “What is the role of fluoroestradiol ([18F]FES) PET/CT in breast cancer?”. Data extraction and quality assessment were performed independently by two reviewers using the AMSTAR-2 tool. Results: Eight systematic reviews met the inclusion criteria. [18F]FES PET/CT demonstrated high sensitivity (81–94%) and specificity (78–95%) in detecting ER-positive lesions. It provided a real-time, whole-body assessment of ER expression, outperforming IHC in detecting functional ER activity. Additionally, [18F]FES PET/CT showed promise in predicting treatment response and guiding therapy decisions, particularly in metastatic settings. Conclusions: This review highlights the clinical value of [18F]FES PET/CT in BC management, offering a non-invasive alternative for ER assessment with high diagnostic accuracy. Its integration into clinical practice may enhance personalized treatment strategies for BC patients.

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