This study aims to evaluate the detection rate of distant metastases using \[18F\]FES PET/CT in patients with low-grade, ER-positive stage III breast cancer.
Breast cancer is highly prevalent, and approximately 75% of cases are estrogen receptor (ER)-positive. Stage III breast cancer carries a significant risk of distant metastasis; therefore, NCCN and ESMO guidelines recommend systemic staging with CT, bone scan, or 18F-FDG PET/CT. However, 18F-FDG PET/CT demonstrates limited sensitivity in low-grade ER-positive tumors and invasive lobular carcinoma (ILC), and can yield false positives due to inflammatory reaction or reactive hyperplasia. Thus, more accurate imaging modalities are needed in this subgroup. 18F-fluoroestradiol (18F-FES) PET/CT visualizes ER expression and has shown high concordance with histopathology. A phase III study demonstrated 77% sensitivity and 100% specificity for metastatic disease. Emerging evidence suggests that 18F-FES PET/CT may detect distant or regional lymph node metastases more accurately than standard imaging, particularly in ILC and low-grade tumors, and can influence management decisions such as surgery and radiotherapy planning. Accurate identification of regional nodal involvement (axillary, supraclavicular, internal mammary nodes) is essential for determining the extent of axillary surgery after neoadjuvant chemotherapy and for tailoring regional nodal irradiation. Prior studies show that metabolic imaging can alter radiotherapy fields in up to 40% of patients. The primary objective is to determine the patient-based detection rate of qualitative 18F-FES PET/CT for distant metastases. Secondary objectives include evaluating its patient-based sensitivity and specificity for distant metastases; determining the detection rate, sensitivity, and specificity for cN3 lymph node metastases (infraclavicular, supraclavicular, and internal mammary nodes); assessing the rate of management change attributable to 18F-FES PET/CT; and comparing 18F-FES PET/CT with 18F-FDG PET/CT for detection rate, diagnostic accuracy, and management impact. Exploratory analyses will examine the correlation between qualitative and quantitative 18F-FES PET/CT findings and pathological response to neoadjuvant chemotherapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
85
Images for 90 minutes after F-18 FES injection
Asan Medical Center
Seoul, South Korea
RECRUITINGPatient based detection rate of qualitative [18F]FES PET/CT evaluation for distant metastases
Time frame: Baseline (index [18F]FES PET/CT image interpretation performed within 1 week after PET/CT acquisition, prior to initiation of definitive treatment)
Patient-based sensitivity and specificity of qualitative [18F]FES PET/CT evaluation for distant metastases
Time frame: From baseline [18F]FES PET/CT to confirmation of reference standard, assessed up to 6 months (histopathologic confirmation or clinical and imaging follow-up ≥6 months, through multidisciplinary consensus review)
Patient-based detection rate of qualitative [18F]FES PET/CT evaluation for cN3 lymph node metastases
Time frame: Baseline (index [18F]FES PET/CT image interpretation performed within 1 week after PET/CT acquisition, prior to initiation of definitive treatment)
Patient-based sensitivity and specificity of qualitative [18F]FES PET/CT evaluation for cN3 lymph node metastases
Time frame: From baseline [18F]FES PET/CT to confirmation of reference standard, assessed up to 6 months (histopathologic confirmation or clinical and imaging follow-up ≥6 months, through multidisciplinary consensus review)
Patient-based change rate in clinical management based on qualitative 18F-FES PET/CT evaluation
Time frame: From baseline clinical management plan (pre-[18F]FES PET/CT) to final treatment decision after [18F]FES PET/CT, assessed within 4 weeks after PET/CT
Comparative patient-based evaluation of qualitative [18F]FES PET/CT and [18F]FDG PET/CT for detection rate of distant and cN3 lymph node metastases, and rate of change in clinical management
Time frame: Baseline (paired [18F]FES PET/CT and [18F]FDG PET/CT image interpretation performed within 1 week after each PET/CT acquisition)
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Comparative patient-based evaluation of qualitative [18F]FES PET/CT and [18F]FDG PET/CT for sensitivity, specificity of distant and cN3 lymph node metastases, and rate of change in clinical management
Time frame: From baseline PET/CT imaging to confirmation of reference standard, assessed up to 6 months (histopathologic confirmation or clinical and imaging follow-up ≥6 months)