Al18F-NOTA-HER2-BCH affibody PET imaging accurately map HER2 positive lesions of breast cancer

Introduction: Background: Fluorine 18-labeled anti-HER2 affibody PET/CT could noninvasive detect of HER2 expression in vivo.

Purpose: To compare Al¹⁸F-NOTA-HER2-BCH PET/CT and ¹⁸F-FDG PET/CT in evaluating HER2-positive lesions of breast cancer.

Methods: In this prospective study conducted from June 2020 to July 2023, images from participants with HER2-positive breast cancer who underwent both Al¹⁸F-NOTA-HER2-BCH and ¹⁸F-FDG PET/CT examinations were analyzed. Participants pathologically confirmed HER2-positive (IHC 3+ or IHC 2+ followed by FISH showing HER2 amplification). The focus uptake was quantified by maximum standardized uptake value (SUVmax) and target-to-background ratios (TBR), and the differents were compared using Wilcoxon sign rank tests.

Results: Fourty-two participants (median age, 56 years) were evaluated. The correlation coefficient within the ICC group is 0.96 (95% CI: 0.95-0.98). Al¹⁸F-NOTA-HER2-BCH performed better in visual assessment than ¹⁸F-FDG (P = .0007). Two patients demonstrated positive lesions only on Al¹⁸F-NOTA-HER2-BCH. Primary tumors in 2 patients, lymph node metastases in 4 patients, bone metastases in 4 patients and liver metastases in 3 patients were visualized only on Al¹⁸F-NOTA-HER2-BCH. Lung metastases in 1 patient was visualized only on ¹⁸F-FDG. Al¹⁸F-NOTA-HER2-BCH depicted more suspected HER2-positive lesions in primary tumors (26 vs 21), lymph nodes (170 vs 130), bone (92 vs 66), and liver (55 vs 27) than ¹⁸F-FDG. From semiquantitative evaluation, the SUVmax and TBR of primary tumors, lymph nodes, bone and liver metastases at Al¹⁸F-NOTA-HER2-BCH PET/CT were all higher than those at ¹⁸F-FDG PET/CT (P < .05). Although there were no significant statistical difference in chest wall and lung metastases of SUVmax and TBR between Al¹⁸F-NOTA-HER2-BCH and ¹⁸F-FDG (P > .05).

Conclusions: Al¹⁸F-NOTA-HER2-BCH PET/CT may outperform ¹⁸F-FDG PET/CT in staging or re-staging breast cancer, particularly in the detection of lesions in the primary, lymph nodes, bone, and liver.

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