Article Figures & Data
Figures
- FIGURE 1.
LBM-adjusted 18F-fluoroestradiol mean SUV (y-axis, log2 scale) for 505 lesions in each of 91 patients (x-axis, sorted by average 18F-fluoroestradiol SUV). Vertical points show within-patient heterogeneity. Horizontal line shows threshold of SUV = 1. FES = fluoroestradiol; LN = lymph node.
- FIGURE 2.
Torso survey images from 3 female patients with metastatic breast cancer from ER+/HER2-negative primary histology (patient in A had PgR-negative primary tumor histology; patients in B and C had PgR-positive). (A) (sagittal view; index 85 in Figs. 1, 3, and 4): 48-y-old with bone-dominant disease with high 18F-fluoroestradiol uptake and high 18F-FDG uptake. (B) (coronal view; index 13 in Figs. 1, 3, and 4): 62-y-old with uniformly low 18F-fluoroestradiol uptake on 18F-fluoroestradiol PET. Three soft-tissue lesions (18F-fluoroestradiol mean SUVLBM of 0.3, 0.5, and 0.7) are identified by arrows. (C) (sagittal view; index 32 in Figs. 1, 3, and 4): 52-y-old with spinal lesion visible on both 18F-fluoroestradiol PET images and 18F-FDG PET images and sternal lesion with visible 18F-FDG but negative 18F-fluoroestradiol PET. FES = fluoroestradiol.
- FIGURE 3.
LBM-adjusted 18F-FDG maximum SUV (y-axis, log2 scale) for 492 lesions in each of 89 patients (x-axis, sorted by average 18F-FDG SUV). FES = fluoroestradiol; LN = lymph node.
- FIGURE 4.
Ratio of 18F-fluoroestradiol maximum SUV and 18F-FDG maximum SUV (y-axis, square root scale) for 492 lesions in each of 89 patients (x-axis, sorted by average 18F-fluoroestradiol SUV). FES = fluoroestradiol; LN = lymph node.
Tables
- TABLE 1.
Patient and Disease Characteristics (n = 91) as Recorded at Time of 18F-Fluoroestradiol PET Scan
Characteristic n Patient population Female 89 (98) Premenopausal (women only, n = 89) 15 (17) Weight Normal (body mass index ≤ 25) 30 (33) Overweight 32 (35) Obese (body mass index > 30) 29 (32) Primary tumor immunohistochemistry and histology ER+ 90 (99) Progesterone receptor–positive (n = 88) 74 (84) HER2/neu–positive 12 (13) Histology Ductal 67 (73) Lobular 18 (20) Ductal and lobular 6 (7) Breast cancer and treatment history Advanced disease 86 (95) Chemotherapy for metastatic breast cancer (n = 82)* 21 (26) Endocrine therapy for metastatic breast cancer (n = 82)* 38 (46) Radiation therapy for metastatic breast cancer (n = 82)* 28 (34) Aromatase inhibitor therapy at time of scan (n = 90) 55 (61) Tumor characteristics† Bone lesions present 67 (74) Soft-tissue lesions present 54 (59) Both bone and soft-tissue lesions present 31 (34) Endocrine therapy after 18F-fluoroestradiol PET Tamoxifen 6 (7) Aromatase inhibitor 60 (66) Aromatase inhibitor and fulvestrant 18 (20) Other or unknown‡ 7 (7) * Patients without advanced disease (n = 5) excluded, history unknown for n = 4.
† Lesions in 18F-fluoroestradiol PET analysis.
‡ Fulvestrant alone, leuprolide acetate, diethylstilbestrol, 4 unknown.
Data in parentheses are percentages. Mean age (±SD) of patient population was 56 ± 11 y (median, 55 y; range, 28–79 y). Mean years since breast cancer diagnosis was 7 ± 6 y (median, 5 y; range, 0–31 y). Mean years since first cancer recurrence (advanced disease only, n = 86) was 2 ± 3 (median, 0.3 y; range, 0–17 y). Mean number of lesions was 5.6 ± 4.0 (median, 4; range, 1–16).
Characteristic n Mean ± SD Median Range Tumor site Soft tissue or lymph node 113 (22) Lung 14 (3) Axial skeleton or spine 225 (45) Long bone or pelvis 153 (30) PET measures (LBM-adjusted) 18F-fluoroestradiol mean SUVLBM 1.9 ± 1.5 1.5 0.0–10.2 18F-fluoroestradiol maximum SUVLBM 2.9 ± 1.9 2.3 0.2–13.0 18F-FDG maximum SUVLBM (n = 492) 3.2 ± 2.2 2.5 0.8–16.5 18F-fluoroestradiol maximum/18F-FDG maximum ratio (n = 492) 1.1 ± 0.9 0.9 0.1–5.6 PET measures (total mass-adjusted) 18F-fluoroestradiol mean SUV 3.0 ± 2.4 2.3 0.0–14.7 18F-fluoroestradiol maximum SUV 4.5 ± 3.1 3.6 0.3–18.7 18F-FDG maximum SUV (n = 492) 5.0 ± 3.4 3.8 1.2–25.0 n = 505 lesions in 91 patients. Data in parentheses are percentages.
- TABLE 3.
Linear Mixed Models with PET Measures as Outcome and Lesion Site, Disease Stage, and Number of Lesions (1–3, 4–6, or 7+) as Fixed Effects, with Random Patient Effects
Estimate* 
(between-patient variance)† (within-patient variance)†Analysis n Bone Lung Soft tissue or lymph node (ICC)†Analysis 18F-fluoroestradiol mean SUVLBM 505 1.07 (0.83–1.38) 0.95 (0.64–1.41) 0.79 (0.61–1.04) 0.73 0.49 0.60 (0.50–0.69) 18F-FDG maximum SUVLBM 492 2.88 (2.43–3.40) 2.01 (1.50–2.70) 2.32 (1.94–2.78) 0.30 0.25 0.54 (0.44–0.64) 18F-fluoroestradiol maximum /18F-FDG maximum ratio 492 0.74 (0.57–0.93) 0.69 (0.43–0.99) 0.66 (0.49–0.86) 0.06 0.03 0.65 (0.56–0.73) With alternate PET measures 18F-fluoroestradiol maximum SUVLBM 505 1.92 (1.57–2.34) 1.38 (1.00–1.90) 1.42 (1.15–1.75) 0.43 0.33 0.57 (0.47–0.66) 18F-fluoroestradiol mean SUV 505 1.60 (1.23–2.08) 1.39 (0.92–2.10) 1.16 (0.88–1.54) 0.80 0.51 0.61 (0.51–0.70) 18F-fluoroestradiol maximum SUV 505 2.88 (2.33–3.55) 2.02 (1.45–2.80) 2.11 (1.69–2.63) 0.50 0.33 0.60 (0.51–0.69) 18F-FDG maximum SUV 492 4.31 (3.62–5.13) 2.92 (2.17–3.94) 3.44 (2.86–4.14) 0.33 0.25 0.56 (0.46–0.66) * Transformed from log2 (18F-fluoroestradiol, 18F-FDG) or square root (ratio) scale used in model.
† Log2 (18F-fluoroestradiol, 18F-FDG) or square root (ratio) scale.
Data in parentheses are 95% CIs. Estimates shown are for patients with advanced disease and 1–3 lesions.
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