ojrdrtОнкологический журнал: лучевая диагностика, лучевая терапияJournal of oncology: diagnostic radiology and radiotherapy2587-75932713-167XНЕКОММЕРЧЕСКОЕ ПАРТНЕРСТВО «ОБЩЕСТВО ИНТЕРВЕНЦИОННЫХ ОНКОРАДИОЛОГОВ»10.37174/2587-7593-2024-7-2-27-36ojrdrt-361Research ArticleЯДЕРНАЯ МЕДИЦИНАNUCLEAR MEDICINEОсобенности интерпретации данных ПЭТ/КТ с 18F-фторэстрадиолом у пациентов с эстроген-позитивным раком молочной железыFeatures of PET/CT Description with 18F-Fluoroestradiol in Patients with Estrogen-Positive Breast Cancerhttps://orcid.org/0000-0002-2963-4176ПарнасА. В.ParnasA. V.

Парнас Александр Вадимович — аспирант, врач-радиолог отделения радионуклидной диагностики №2 и отделения радионуклидной терапии отдела радионуклидной диагностики и терапии НИИ КиЭР ФГБУ НИМЦ им. Н.Н. Блохина.

115478 Москва, Каширское шоссе, 24

Alexandr V. Parnas.

24 Kashirskoye Shosse, Moscow, 115478

a.parnas@ronc.ruhttps://orcid.org/0000-0003-1632-351XПронинА. И.ProninA. I.

Пронин Артем Игоревич — к.м.н., врач-радиолог, заведующий отделением радионуклидной диагностики № 2, руководитель отдела радионуклидной диагностики и терапии НИИ КиЭР.

115478 Москва, Каширское шоссе, 24

Artem I. Pronin.

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0003-2670-2361РябчиковД. А.RyabchikovD. A.

Рябчиков Денис Анатольевич — д.м.н., заведующий хирургическим отделением абдоминальной онкологии № 5.

115478 Москва, Каширское шоссе, 24

Denis A. Ryabchikov.

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0001-7226-5129ТулинП. Е.TulinP. E.

Тулин Павел Евгеньевич — к.м.н., с.н.с., врач-рентгенолог отделения радионуклидной диагностики № 2 НИИ КиЭР.

115478 Москва, Каширское шоссе, 24

Pavel E. Tulin.

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-4648-2362СубботинА. С.SubbotinA. S.

Субботин Алексей Сергеевич — м.н.с., врач-рентгенолог отделения радионуклидной диагностики № 2 отдела радионуклидной диагностики и терапии НИИ КиЭР.

115478 Москва, Каширское шоссе, 24

Alexey S. Subbotin.

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-5375-2498ИльяковВ. С.IlyakovV. S.

Ильяков Вадим Сергеевич — аспирант, врач-радиолог отделения радионуклидной диагностики № 2 и отделения радионуклидной терапии отдела радионуклидной диагностики и терапии НИИ КиЭР.

115478 Москва, Каширское шоссе, 24

Vadim S. Ilyakov.

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-8197-7248ЧерепановаН. В.CherepanovaN. V.

Черепанова Наталья Владимировна — заместитель руководителя блока по качеству циклотронно-радиохимического блока отделения радионуклидной диагностики № 2 отдела радионуклидной диагностики и терапии.

115478 Москва, Каширское шоссе, 24

Natalya V. Cherepanova.

24 Kashirskoye Shosse, Moscow, 115478

https://orcid.org/0000-0002-5225-1405ПрокофьевЮ. И.ProkofievYu. I.

Прокофьев Юрий Игоревич — заместитель руководителя блока по производству циклотронно-радиохимического блока отделения радионуклидной диагностики № 2 отдела радионуклидной диагностики и терапии.

115478 Москва, Каширское шоссе, 24

Yuri I. Prokofiev.

24 Kashirskoye Shosse, Moscow, 115478

Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава РоссииРоссияN.N. Blokhin National Medical Research Center of OncologyRussian Federation202404072024722736Copyright © Парнас А.В., Пронин А.И., Рябчиков Д.А., Тулин П.Е., Субботин А.С., Ильяков В.С., Черепанова Н.В., Прокофьев Ю.И., 20242024Парнас А.В., Пронин А.И., Рябчиков Д.А., Тулин П.Е., Субботин А.С., Ильяков В.С., Черепанова Н.В., Прокофьев Ю.И.Parnas A.V., Pronin A.I., Ryabchikov D.A., Tulin P.E., Subbotin A.S., Ilyakov V.S., Cherepanova N.V., Prokofiev Y.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.oncoradjournal.ru/jour/article/view/361Цель

Цель: Изучение возможных ошибок при интерпретации и анализе данных ПЭТ/КТ-исследований с 18F-ФЭС, выполненных пациентам с рецептор-эстроген позитивными опухолями молочной железы.

Материал и методы

Материал и методы: Были ретроспективно проанализированы данные 140 пациентов, прошедших ПЭТ/КТ с 18F-ФЭС в отделении радионуклидной диагностики №2 НМИЦ онкологии им Н.Н. Блохина с 2017 по 2023 гг. В исследование включены пациенты с подтвержденным гистологически рецептор-эстроген позитивным раком молочной железы до начала специфического лечения, а также при выявлении прогрессирования или при подозрении на метастатический процесс на этапе стартового обследования.

Результаты

Результаты: Даны рекомендации по оценке и интерпретации различных изменений, выявляемых при проведении ПЭТ/КТ с 18F-ФЭС у пациентов с рецептор-эстроген позитивным раком молочной железы, которые могут вызвать затруднения при анализе результатов исследования.

Заключение

Заключение: Хотя метод ПЭТ/КТ с 18F-ФЭС в нашей стране пока широко не внедрен в клиническую практику, в отдельных учреждениях исследование проводится в рамках научных протоколов и в сложных случаях дифференциальной диагностики. Для более корректной интерпретации данных ПЭТ/КТ с 18F-ФЭС следует учитывать клинико-морфологические особенности в каждом клиническом случае.

Purpose

Purpose: To study possible errors in the interpretation and analysis of PET/CT studies with 18F-FES performed in patients with estrogen receptor-positive breast tumors.

Material and methods

Material and methods: Data PET/CT with 18F-FES from 140 PET patients were retrospectively analyzed from 2017 to 2023. The study included patients with histologically confirmed estrogen receptor-positive breast cancer, before the start of specific treat­ment, as well as when progression is detected or if a metastatic process is suspected at the initial examination stage.

Results

Results: Recommendations are given for the assessment and interpretation of various changes detected during PET/CT with 18F-FES in patients with estrogen receptor-positive breast cancer, which may cause difficulties in analyzing the results of the study.

Conclusion

Conclusion: Although the PET/CT with 18F-FES in our country has not yet been widely introduced into clinical practice, in some institutions the study is carried out within the framework of scientific protocols and in complex cases of differential diagnosis. For a more correct interpretation of PET/CT with 18F-FES should take into account the clinical and morphological features in each clinical case.

рак молочной железыПЭТ/КТ18F-ФЭСфторэстрадиолbreast cancerPET/CT18F-FESfluoroestradiolReferencesСостояние онкологической помощи населению России в 2022 г. Под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой - М.: МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2022. 239 с. ISBN 978-5-85502-283-4.The state of cancer care for the population of Russia in 2022. Kaprin AD, Starinsky VV, Shakhzadova AO (Eds.) — Moscow, 2022. ISBN 978-5-85502-283-4.Khongthong P, Roseweir AK, Edwards J. The NF-KB pathway and endocrine therapy resistance in breast cancer. Endocr-Relat. Cancer 2019;26:R369-R380.Khongthong P, Roseweir AK, Edwards J. The NF-KB pathway and endocrine therapy resistance in breast cancer. Endocr-Relat. Cancer 2019;26:R369-R380.Blamey RW, Hornmark-Stenstam B, Ball G, et al. ONCO-POOL - a European database for 16,944 cases of breast cancer. Eur J Cancer. 2010;46(1):56-71.Blamey RW, Hornmark-Stenstam B, Ball G, et al. ONCO-POOL - a European database for 16,944 cases of breast cancer. Eur J Cancer. 2010;46(1):56-71.Avril S, Muzic RF, Jr, Plecha D, et al. 18F-FDG PET CT for monitoring of treatment response in breast cancer. J Nucl Med. 2016;57(suppl 1):34S-39S. doi: 10.2967/jnumed.115.157875.Avril S, Muzic RF, Jr, Plecha D, et al. 18F-FDG PET CT for monitoring of treatment response in breast cancer. J Nucl Med. 2016;57(suppl 1):34S-39S. doi: 10.2967/jnumed.115.157875.Mintun MA, Welch MJ, Siegel BA, et al. Breast cancer: PET imaging of estrogen receptors. Radiology 1988;169:45-8.Mintun MA, Welch MJ, Siegel BA, et al. Breast cancer: PET imaging of estrogen receptors. Radiology 1988;169:45-8.Dehdashti F, Mortimer JE, Siegel BA, et al. Positron tomographic assessment of estrogen receptors in breast cancer: Comparison with FDG-PET and in vitro receptor assays. J Nucl Med 1995;36:1766-74.Dehdashti F, Mortimer JE, Siegel BA, et al. Positron tomographic assessment of estrogen receptors in breast cancer: Comparison with FDG-PET and in vitro receptor assays. J Nucl Med 1995;36:1766-74.Gemignani ML, Patil S, Seshan VE, et al. Feasibility and predictability of perioperative pet and estrogen receptor ligand in patients with invasive breast cancer. J Nucl Med 2013;54:1697-702.Gemignani ML, Patil S, Seshan VE, et al. Feasibility and predictability of perioperative pet and estrogen receptor ligand in patients with invasive breast cancer. J Nucl Med 2013;54:1697-702.Yang Z, Sun Y, Xu X, et al. The assessment of estrogen receptor status and its intratumoral heterogeneity in patients with breast cancer by using 18F-fluoroestradiol PET/CT. Clin Nucl Med 2017;42:421-7.Yang Z, Sun Y, Xu X, et al. The assessment of estrogen receptor status and its intratumoral heterogeneity in patients with breast cancer by using 18F-fluoroestradiol PET/CT. Clin Nucl Med 2017;42:421-7.Парнас АВ, Пронин АИ, Ильяков ВС и др. ПЭТ/КТ с 18Ғ-фторэстрадиолом: современный взгляд на применение в ядерной медицине. Опухоли женской репродуктивной системы. 2021;17(1):20-6. https://doi.org/10.17650/1994-4098-2021-17-1-20-26.Parnas AV, Pronin AI, Ilyakov VS, et al. [18F]-Fluoroestradiol PET/CT: a modern look at nuclear medicine applications. Tumors of Female Reproductive System. 2021;17(1):20-6. (In Russ.).Choi YW, Munden RF, Erasmus JJ, et al. Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiographics. 2004;24:985-97.Choi YW, Munden RF, Erasmus JJ, et al. Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiographics. 2004;24:985-97.Barnett GC, West CM, Dunning AM, et al. Normal tissue re-actions to radiotherapy: towards tailoring treatment dose by genotype. Nat Rev Cancer. 2009;9:134-42.Barnett GC, West CM, Dunning AM, et al. Normal tissue re-actions to radiotherapy: towards tailoring treatment dose by genotype. Nat Rev Cancer. 2009;9:134-42.Venema CM, de Vries EFJ, van der Veen SJ, et al. Enhanced pulmonary uptake on 18Ғ-ФЭС-ПЭТ/КТ scans after irradiation of the thoracic area: related to fibrosis? EJNMMI Res. 2019 Aug 23;9(1):82. doi: 10.1186/s13550-019-0549-y. PMID: 31444658; PMCID: PMC6708021.Venema CM, de Vries EFJ, van der Veen SJ, et al. Enhanced pulmonary uptake on 18Ғ-ФЭС-ПЭТ/КТ scans after irradiation of the thoracic area: related to fibrosis? EJNMMI Res. 2019 Aug 23;9(1):82. doi: 10.1186/s13550-019-0549-y. PMID: 31444658; PMCID: PMC6708021.van der Veen SJ, Faber H, Ghobadi G, et al. Decreasing irradiated rat lung volume changes dose-limiting toxicity from early to late effects. Int J Radiat Oncol Biol Phys. 2016;94:163-71.van der Veen SJ, Faber H, Ghobadi G, et al. Decreasing irradiated rat lung volume changes dose-limiting toxicity from early to late effects. Int J Radiat Oncol Biol Phys. 2016;94:163-71.Wu Q, Li J, Zhu S, et al. Breast cancer subtypes predict the preferential site of distant metastases: A SEER based study. Oncotarget 2017, 8, 27990-6.Wu Q, Li J, Zhu S, et al. Breast cancer subtypes predict the preferential site of distant metastases: A SEER based study. Oncotarget 2017, 8, 27990-6.Schrijver WAME, Suijkerbuijk, KPM, et al. Receptor conversion in distant breast cancer metastases: A systematic review and meta-analysis. J Natl Cancer Inst. 2018,110:568-80.Schrijver WAME, Suijkerbuijk, KPM, et al. Receptor conversion in distant breast cancer metastases: A systematic review and meta-analysis. J Natl Cancer Inst. 2018,110:568-80.Kennecke H, Yerushalmi R, Woods, R, et al. Metastatic behavior of breast cancer subtypes. J Clin Oncol. 2010;28:3271-7.Kennecke H, Yerushalmi R, Woods, R, et al. Metastatic behavior of breast cancer subtypes. J Clin Oncol. 2010;28:3271-7.Cardoso F, Senkus E, Costa A, et al. 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4). Ann Oncol. 2018;29:1634-57.Cardoso F, Senkus E, Costa A, et al. 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4). Ann Oncol. 2018;29:1634-57.Zardavas D, Irrthum A, Swanton C, Piccart M. Clinical management of breast cancer heterogeneity. Nat Rev Clin. Oncol. 2015;12:381-94.Zardavas D, Irrthum A, Swanton C, Piccart M. Clinical management of breast cancer heterogeneity. Nat Rev Clin. Oncol. 2015;12:381-94.Hammond MEH, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J. Clin. Oncol. 2010;28:2784-95.Hammond MEH, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J. Clin. Oncol. 2010;28:2784-95.Liao GJ, Clark AS, Schubert EK, Mankoff DA. 18F-fluoroestradiol PET: Current status and potential future clinical applications. J Nucl Med. 2016;57:1269-75.Liao GJ, Clark AS, Schubert EK, Mankoff DA. 18F-fluoroestradiol PET: Current status and potential future clinical applications. J Nucl Med. 2016;57:1269-75.Venema CM, Apollonio G, Hospers GAP, et al. Recommendations and technical aspects of 16a-[18F]Fluoro-17e-Estradiol PET to image the estrogen receptor in vivo. Clin Nucl Med. 2016;41:844-51.Venema CM, Apollonio G, Hospers GAP, et al. Recommendations and technical aspects of 16a-[18F]Fluoro-17e-Estradiol PET to image the estrogen receptor in vivo. Clin Nucl Med. 2016;41:844-51.van Kruchten M, Glaudemans AWJM, de Vries EFJ, et al. PET imaging of estrogen receptors as a diagnostic tool for breast cancer patients presenting with a clinical dilemma. J Nucl Med. 2012;53:182-90.van Kruchten M, Glaudemans AWJM, de Vries EFJ, et al. PET imaging of estrogen receptors as a diagnostic tool for breast cancer patients presenting with a clinical dilemma. J Nucl Med. 2012;53:182-90.Boers J, Loudini N, de Haas R.J, et al. Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer. Diagnostics. 2021;11:2019. https://doi.org/10.3390/diagnostics11112019.Boers J, Loudini N, de Haas R.J, et al. Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer. Diagnostics. 2021;11:2019. https://doi.org/10.3390/diagnostics11112019.Mortimer JE, et al. Metabolic flare: indicator of hormone responsiveness in advanced breast cancer. J Clin Oncol. 2001;19:2797-803.Mortimer JE, et al. Metabolic flare: indicator of hormone responsiveness in advanced breast cancer. J Clin Oncol. 2001;19:2797-803.Dehdashti F, et al. Positron emission tomographic assessment of “metabolic flare” to predict response of metastatic breast cancer to antiestrogen therapy. Eur J Nucl Med. 1999;26:51-56.Dehdashti F, et al. Positron emission tomographic assessment of “metabolic flare” to predict response of metastatic breast cancer to antiestrogen therapy. Eur J Nucl Med. 1999;26:51-56.McGuire AH, et al. Positron tomographic assessment of 16 alpha-[18F] fluoro-17 beta-estradiol uptake in metastatic breast carcinoma. J Nucl Med. 1991;32:1526-31.McGuire AH, et al. Positron tomographic assessment of 16 alpha-[18F] fluoro-17 beta-estradiol uptake in metastatic breast carcinoma. J Nucl Med. 1991;32:1526-31.Linden HM, Kurland BF, Peterson LM, et al. Fluoroestradiol positron emission tomography reveals differences in pharmacodynamics of aromatase inhibitors, tamoxifen, and fulvestrant in patients with metastatic breast cancer. Clin Cancer Res. 2011 Jul 15;17(14):4799-805. doi: 10.1158/1078-0432.CCR-10-3321. Epub 2011 Jul 12. PMID: 21750198; PMCID: PMC3139698.Linden HM, Kurland BF, Peterson LM, et al. Fluoroestradiol positron emission tomography reveals differences in pharmacodynamics of aromatase inhibitors, tamoxifen, and fulvestrant in patients with metastatic breast cancer. Clin Cancer Res. 2011 Jul 15;17(14):4799-805. doi: 10.1158/1078-0432.CCR-10-3321. Epub 2011 Jul 12. PMID: 21750198; PMCID: PMC3139698.Cunha GR, Wang YZ, Hayward SW, Risbridger GP. Estrogenic effects on prostatic differentiation and carcinogenesis. Reprod Fertil Dev. 2001;13:285-96.Cunha GR, Wang YZ, Hayward SW, Risbridger GP. Estrogenic effects on prostatic differentiation and carcinogenesis. Reprod Fertil Dev. 2001;13:285-96.Schulze H, Claus S. Histological localization of estrogen receptors in normal and diseased human prostates by immunocytochemistry. Prostate. 1990;16:331-43.Schulze H, Claus S. Histological localization of estrogen receptors in normal and diseased human prostates by immunocytochemistry. Prostate. 1990;16:331-43.Pasquali D, Rossi V, Esposito D, et al. Loss of estrogen receptor beta expression in malignant human prostate cells in primary cultures and in prostate cancer tissues. J Endocrinol Metab. 2001;86:2051-5.Pasquali D, Rossi V, Esposito D, et al. Loss of estrogen receptor beta expression in malignant human prostate cells in primary cultures and in prostate cancer tissues. J Endocrinol Metab. 2001;86:2051-5.Pasquali D, Staibano S, Prezioso D, et al. Estrogen receptor beta expression in human prostate tissue. Mol Cell Endocrinol. 2001;178:47-50.Pasquali D, Staibano S, Prezioso D, et al. Estrogen receptor beta expression in human prostate tissue. Mol Cell Endocrinol. 2001;178:47-50.Lessey BA, Killam AP, Metzger DA, et al. Immunohistochemical analysis of human uterine estrogen and progesterone receptors throughout the menstrual cycle. J Clin Endocrinol Metab. 1988;67:334-40.Lessey BA, Killam AP, Metzger DA, et al. Immunohistochemical analysis of human uterine estrogen and progesterone receptors throughout the menstrual cycle. J Clin Endocrinol Metab. 1988;67:334-40.Kawaguchi K, Fujii S, Konishi I, et al. Immunohistochemical analysis of oestrogen receptors, progesterone receptors and Ki-67 in leiomyoma and myometrium during the menstrual cycle and pregnancy. Virchows Arch A Pathol Anat Histopathol. 1991;419:309-15.Kawaguchi K, Fujii S, Konishi I, et al. Immunohistochemical analysis of oestrogen receptors, progesterone receptors and Ki-67 in leiomyoma and myometrium during the menstrual cycle and pregnancy. Virchows Arch A Pathol Anat Histopathol. 1991;419:309-15.Nisolle M, Gillerot S, Casanas-Roux F, et al. Immunohistochemical study of the proliferation index, oestrogen receptors and progesterone receptors a and B in leiomyomata and normal myometrium during the menstrual cycle and under gonadotrophin-releasing hormone agonist therapy. Hum Reprod. 1999;14:2844-50.Nisolle M, Gillerot S, Casanas-Roux F, et al. Immunohistochemical study of the proliferation index, oestrogen receptors and progesterone receptors a and B in leiomyomata and normal myometrium during the menstrual cycle and under gonadotrophin-releasing hormone agonist therapy. Hum Reprod. 1999;14:2844-50.Sun Young Chae, et al. Journal of Nuclear Medicine April 2017;58(4):563-8. https://doi.org/10.2967/jnumed.116.178368.Sun Young Chae, et al. Journal of Nuclear Medicine April 2017;58(4):563-8. https://doi.org/10.2967/jnumed.116.178368.Peterson L, Manohar P, Wu V, et al. 18F-Fluoroestradiol and 18F-Fluorodeoxyglucose PET imaging in male breast cancer. J Nucl Med. 2018;59 Suppl 1:54.Peterson L, Manohar P, Wu V, et al. 18F-Fluoroestradiol and 18F-Fluorodeoxyglucose PET imaging in male breast cancer. J Nucl Med. 2018;59 Suppl 1:54.

The authors declare that there are no conflicts of interest present.