TABLE 1.

Reporting ER Imaging of Breast Cancer Using [18F]FES PET/CT

CategoryDescription
Required descriptions of findings on…Quality of PET image, including any technical issues
Visual analysis of clinically relevant findings, including…
 All sites of increased nonphysiologic focal uptake greater than local background suggestive of ER-positive lesions
 Any abnormal diffuse increased uptake
 Incidental findings with focal uptake, with further investigation suggested when needed
 Lesions identified by other imaging modalities as (suspected) tumor but not showing enhanced uptake (reported as [probable] ER-negative lesions)
Quantitative analysis of sites of suspected disease, including where active disease is expected on basis of correlative imaging but visual inspection does not show uptake above background
Detailed qualitative interpretation, specific to indication and individual clinical data, taking into consideration physiologic biodistribution of [18F]FES
Synthesis of overall report impressionSummary of patient history, including current and prior medications targeted to ER-expressing breast cancer
Summary of technical components of scan, including injected activity and uptake time
Description of areas with physiologic uptake, metabolism, and excretion of [18F]FES
Identification and description of sites of qualitatively abnormal uptake above background that are suspected of being ER-expressing breast cancer, including anatomic localization on CT, qualitative level of uptake, and size of lesion by CT when relevant
Quantitative uptake for sites identified by qualitative interpretation, noting that [18F]FES SUVmax > 1.5 is suggestive of ER expression
Description of suspected false-positive or nonspecific findings
Description of sites where uptake may be absent in lesions observed by other available imaging techniques
Summary of heterogeneity of uptake across sites of known disease with reference to other correlative imaging, and specific discussion of concordance with contemporaneous [18F]FDG PET/CT findings when available
Specific mention of qualitative and quantitative uptake by equivocal lesions, with conclusion on whether questioned lesions are ER-positive or -negative
If [18F]FES PET is acquired for therapy purposes, specific mention of overall qualitative and quantitative ER status of metastases, including heterogeneity of expression
For interpreting physicians, section on limitations and pitfalls of [18F]FES PET