New guidelines for estrogen receptor imaging in breast cancer patients using FES PET

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Association of Nuclear Medicine (EANM) have issued a new standard/practice guideline for estrogen receptor imaging of breast cancer patients using FES PET. The standard/guideline, published before printing on The Journal of Nuclear Medicineintended to assist physicians in recommending, performing, interpreting and reporting the results of ¹⁸F-FES PET studies for breast cancer patients.

More than two million women worldwide are diagnosed with breast cancer each year. The estrogen receptor (ER) contributes significantly to the formation and progression of breast cancer and is therefore an important target for therapy. Approximately 70 percent of breast cancers will express ER, and determination of ER expression by tissue analysis is part of the standard of care for those newly diagnosed with breast cancer.

Many studies suggest that ¹⁸F-FES PET—which is approved for clinical use in France and the United States—offers advantages in evaluating tumor ER expression, predicting response to ER-targeted therapies, and clarifying equivocal staging and resection results in patients with ER-expressing cancers. It may also be useful in the staging of invasive lobular breast cancer and ER-expressing low-grade invasive ductal cancers and, in some cases, may replace biopsy.

The procedure guideline/practice standard includes information on common clinical indications, procedure specifications, patient selection and preparation, tracer administration and imaging, and imaging interpretation and reporting. It also presents standardized quality control, quality assurance and imaging procedures for ¹⁸F-FES PET.

“Accuracy, precision, repeatability and reproducibility for both clinical patient management and use ¹⁸F-FES in multicenter trials is important,” the authors emphasize. “The availability of a standardized imaging procedure will help promote appropriate use ¹⁸F-FES PET and enhance subsequent research.”

The SNMMI/EANM periodically sets new standards/guidelines for the practice of nuclear medicine to help advance the science of nuclear medicine and provide effective and safe medical care to patients. Each standard/guideline, which represents a policy statement from the SNMMI/EANM, undergoes a thorough consensus process during which it undergoes extensive revision.

This article was published online in December 2023.