The Assessment of Estrogen Receptor Status and Its Intratumoral Heterogeneity in Patients With Breast Cancer by Using 18F-Fluoroestradiol PET/CT

Aim: The aim of this study was to investigate the clinical value of 18F-fluoroestradiol (18F-FES) PET/CT in the assessment of the estrogen receptor (ER) and its intratumoral heterogeneity in breast cancer patients. Methods: Forty-six female patients (50 lesions) with histologically confirmed invasive breast cancer who underwent both 18F-FES and 18F-FDG PET/CT in our center were retrospectively included. All the patients enrolled were scheduled to undergo biopsy. The 18F-FES and FDG uptakes were compared with pathological features (tumor size, ER, progesterone receptor, human epidermal growth factor receptor 2, and Ki67%). The optimal threshold to discriminate ER-positive and ER-negative lesions was determined by receiver operating characteristic curve analysis. Furthermore, we observed the intratumoral heterogeneity by a heterogeneity index (SUVmax/SUVmean) and compared the results with the Chang-Gung Image Texture Analysis. Results: There was good agreement between 18F-FES uptake and ER, progesterone receptor, and human epidermal growth factor receptor 2 expression (P

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