Quarter-century transformation of oncology positron emission tomography for patients with breast cancer

Abstract

Summary

The discussion of the transformative nature of PET imaging in oncology would be incomplete without a discussion of the role of PET in the care of patients with breast cancer. During the past quarter-century, PET imaging has demonstrated remarkable and growing success in the management of patients with breast cancer. Clearly, the most influential PET radiotracer to date has been 18F-FDG, which has prospective trial evidence supporting its use for systemic staging of breast cancer at initial diagnosis, detecting recurrent disease, and measuring treatment response after therapy. Bone imaging with 18F-NaF has increased and decreased over time, although may still be used for more sensitive detection of bone metastases than gamma bone scan agents. The more recently FDA-approved 18F-FES has its own unique clinical uses, including selection of appropriate patients for endocrine-targeted therapies, assessing lesions that are difficult or dangerous to biopsy, and assessing lesions when other tests are inconclusive. Many investigational radiotracers may further the application of PET in patients with breast cancer by targeting PR, HER2, or FAP. The next quarter-century portends to be as exciting and clinically valuable as the last.