Novel Methods and Tracers for Breast Cancer Imaging

https://doi.org/10.1053/j.semnuclmed.2013.02.003Get rights and content

Although positron emission tomography (PET) using [18F]fluorodeoxyglucose (FDG) has an established role in breast cancer staging and monitoring response to therapy, more specifically novel targeted tracers are under investigation and hold promise toward identification of critical molecular targets of therapy. We review herein novel tracers in breast cancer including steroidal endocrine tracers, 16α-[18F]fluoro-17β-estradiol (FES) to measure tumor estrogen receptor density and function and 21-18F-fluoro-16α,17α-[(R)-(1′-α-furylmethylidene)dioxy]-19-norpregn-4-ene-3,20-dione (FFNP) to assay tumor progesterone receptor (PgR) expression, and to asses nuclear proliferation using 3′-deoxy-3′-fluorothymidine (FLT), membrane lipids using 11C- or 18F-labeled choline and amino acid transport using 11C-methionine. These investigational tracers are moving closer to clinical use, and are likely to affect clinical care by aiding in characterization of breast cancer biology, which can have an important effect in the selection of targeted therapy and monitoring responsiveness to such therapy.

Section snippets

Breast Cancer

Breast cancer is the most common malignancy in women, accounting for approximately 29% of all cancers in females. It is estimated that in the year 2012, there will be nearly 226,870 new cases of breast cancer and cause approximately 39,510 breast cancer–related deaths in the United States.1 Breast cancer has several known characteristics that determine aggressiveness and can be used as therapeutic targets as well as a means for monitoring responsiveness to therapy. These features are typically

Steroid Receptor Imaging

Approximately two-thirds of breast cancers are dependent on estrogen or progesterone or both for their growth.2 The stimulatory effect of estrogen and progesterone is mediated through nuclear estrogen receptors (ERs) and PgRs. To control the growth of hormone-dependent breast cancer, these receptors have been targeted by endocrine agents. The most widely used endocrine therapies include aromatase inhibitors (AIs) which deplete estrogen levels in vivo and within the tumor by disrupting estrogen

Conclusion

The modern era of targeted breast cancer treatment mandates assessment of tumor biology. Nuclear imaging tracers in development can help to determine molecular physiology in vivo. Novel tracers in breast cancer as we have reviewed herein have the potential to add meaningful biomarkers to clinical imaging and treatment trials, and portend an evolving clinical tool to study tumor molecular physiology with the potential to aid in diagnosis, treatment selection, drug development, and

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