Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. [18F]-FES-PET Imaging
2.3. Image Analysis
2.4. Ultrasound-Guided Biopsy and Histopathological Examination
2.5. Statistical Analysis
3. Results
3.1. Patients
3.2. Visual Assessment of [18F]-FES Uptake
3.3. Quantitative Evaluation of [18F]-FES Uptake
3.4. The Effect of ROI Size
3.5. Background Correction
3.6. Lower and Upper Cut-Off Values
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Parameter | ROI Size | ER+ (n = 17) (Median [IQR]) | ER− (n = 6) (Median [IQR]) | p-Value |
---|---|---|---|---|
SUVmax | whole-tumor | 11.4 [6.9–12.8] | 7.3 [2.9–11.2] | 0.050 |
SUVmean | whole-tumor | 7.3 [4.4–9.5] | 4.3 [1.6–7.4] | 0.093 |
SUVmin | whole-tumor | 3.9 [2.5–7.7] | 2.2 [1.0–4.1] | 0.141 |
SUVmax | two-thirds | 8.7 [4.6–10.8] | 4.6 [2.0–8.1] | 0.069 |
SUVmean | two-thirds | 6.4 [3.6–9.2] | 3.2 [1.3–5.9] | 0.086 |
SUVmin | two-thirds | 3.9 [2.6–8.3] | 2.2 [1.1–4.8] | 0.123 |
SUVmax | one-third | 6.7 [3.6–9.2] | 3.1 [1.4–5.4] | 0.069 |
SUVmean | one-third | 5.2 [3.2–8.6] | 2.5 [1.2–5.1] | 0.059 |
SUVmin | one-third | 4.9 [2.7–8.3] | 2.2 [1.1–4.9] | 0.080 |
TBRmax | whole-tumor | 0.83 [0.64–1.06] | 0.43 [0.18–0.69] | 0.008 |
TBRmean | whole-tumor | 0.56 [0.38–0.83] | 0.27 [0.10–0.44] | 0.030 |
TBRmin | whole-tumor | 0.30 [0.20–0.69] | 0.14 [0.06–0.25] | 0.050 |
TBRmax | two-thirds | 0.58 [0.40–0.94] | 0.27 [0.12–0.51] | 0.036 |
TBRmean | two-thirds | 0.42 [0.30–0.81] | 0.20 [0.08–0.35] | 0.021 |
TBRmin | two-thirds | 0.30 [0.20–0.74] | 0.14 [0.07–0.29] | 0.069 |
TBRmax | one-third | 0.43 [0.31–0.81] | 0.20 [0.09–0.32] | 0.017 |
TBRmean | one-third | 0.36 [0.28–0.77] | 0.16 [0.08–0.30] | 0.014 |
TBRmin | one-third | 0.32 [0.24–0.74] | 0.14 [0.07–0.29] | 0.030 |
Parameter | ROI Size | AUC (95% CI) | Optimal Cut-Off ER+ | Sensitivity (%) | Specificity (%) |
---|---|---|---|---|---|
SUVmax | whole-tumor | 0.83 (0.63–1.00) | ≥4.0 | 100 | 60 |
SUVmean | whole-tumor | 0.76 (0.50–1.00) | ≥2.2 | 94 | 60 |
SUVmin | whole-tumor | 0.73 (0.50–0.97) | ≥1.9 | 83 | 60 |
SUVmax | two-thirds | 0.78 (0.55–1.00) | ≥7.3 | 67 | 80 |
SUVmean | two-thirds | 0.76 (0.51–1.00) | ≥1.7 | 94 | 60 |
SUVmin | two-thirds | 0.73 (0.47–0.99) | ≥1.9 | 89 | 60 |
SUVmax | one-third | 0.78 (0.56–1.00) | ≥2.4 | 89 | 60 |
SUVmean | one-third | 0.78 (0.54–1.00) | ≥1.5 | 94 | 60 |
SUVmin | one-third | 0.75 (0.53–0.96) | ≥3.3 | 65 | 67 |
TBRmax | whole-tumor | 0.91 (0.78–1.00) | ≥0.69 | 78 | 100 |
TBRmean | whole-tumor | 0.82 (0.63–1.00) | ≥0.45 | 61 | 100 |
TBRmin | whole-tumor | 0.77 (0.55–0.99) | ≥0.13 | 83 | 60 |
TBRmax | two-thirds | 0.82 (0.61–1.00) | ≥0.41 | 78 | 80 |
TBRmean | two-thirds | 0.82 (0.62–1.00) | ≥0.33 | 72 | 80 |
TBRmin | two-thirds | 0.74 (0.49–1.00) | ≥0.12 | 89 | 60 |
TBRmax | one-third | 0.83 (0.66–1.00) | ≥0.32 | 72 | 80 |
TBRmean | one-third | 0.83 (0.65–1.00) | ≥0.30 | 72 | 80 |
TBRmin | one-third | 0.79 (0.58–1.00) | ≥0.13 | 89 | 60 |
Parameter | ROI Size | Cut-Off ER− Sensitivity > 90% | Cut-Off ER+ Specificity > 90% | NPV * | PPV ‖ | Equivocal Metastases (%) ‡ |
---|---|---|---|---|---|---|
SUVmax | whole-tumor | <4.9 | ≥11.3 | 75 | 100 | 39 |
SUVmean | whole-tumor | <2.2 | ≥7.7 | 75 | 100 | 48 |
SUVmin | whole-tumor | <1.2 | ≥4.8 | 50 | 100 | 57 |
SUVmax | two-thirds | <2.5 | ≥9.5 | 75 | 100 | 52 |
SUVmean | two-thirds | <1.7 | ≥6.9 | 75 | 100 | 57 |
SUVmin | two-thirds | <1.3 | ≥5.2 | 67 | 100 | 57 |
SUVmax | one-third | <1.6 | ≥6.5 | 67 | 100 | 48 |
SUVmean | one-third | <1.5 | ≥5.8 | 67 | 100 | 61 |
SUVmin | one-third | <1.3 | ≥5.3 | 67 | 100 | 52 |
TBRmax | whole-tumor | <0.33 | ≥0.69 | 75 | 100 | 22 |
TBRmean | whole-tumor | <0.11 | ≥0.45 | 50 | 92 | 39 |
TBRmin | whole-tumor | <0.07 | ≥0.29 | 50 | 100 | 52 |
TBRmax | two-thirds | <0.15 | ≥0.65 | 75 | 100 | 48 |
TBRmean | two-thirds | <0.10 | ≥0.42 | 75 | 100 | 44 |
TBRmin | two-thirds | <0.08 | ≥0.37 | 67 | 100 | 57 |
TBRmax | one-third | <0.10 | ≥0.39 | 50 | 100 | 35 |
TBRmean | one-third | <0.09 | ≥0.34 | 60 | 91 | 30 |
TBRmin | one-third | <0.08 | ≥0.32 | 67 | 100 | 35 |
Parameter | ROI Size | AUC (95% CI) | Optimal Cut-Off ER+ | Sensitivity (%) | Specificity (%) |
---|---|---|---|---|---|
SUVmax | whole-tumor | 0.74 (0.49–0.99) | ≥4.0 | 100 | 50 |
SUVmean | whole-tumor | 0.68 (0.41–0.95) | ≥2.2 | 93 | 50 |
SUVmin | whole-tumor | 0.63 (0.36–0.90) | ≥1.9 | 79 | 50 |
SUVmax | two-thirds | 0.71 (0.47–0.96) | ≥7.8 | 57 | 83 |
SUVmean | two-thirds | 0.69 (0.42–0.96) | ≥1.7 | 93 | 50 |
SUVmin | two-thirds | 0.66 (0.38– 0.92) | ≥1.9 | 86 | 50 |
SUVmax | one-third | 0.70 (0.46–0.95) | ≥2.4 | 86 | 50 |
SUVmean | one-third | 0.71 (0.47–0.96) | ≥1.5 | 93 | 50 |
SUVmin | one-third | 0.69 (0.44–0.94) | ≥1.9 | 86 | 50 |
TBRmax | whole-tumor | 0.85 (0.67–1.00) | ≥0.69 | 71 | 83 |
TBRmean | whole-tumor | 0.76 (0.54–0.98) | ≥0.45 | 57 | 100 |
TBRmin | whole-tumor | 0.73 (0.50–0.96) | ≥0.21 | 71 | 67 |
TBRmax | two-thirds | 0.75 (0.52–0.98) | ≥0.41 | 71 | 67 |
TBRmean | two-thirds | 0.79 (0.57–1.00) | ≥0.33 | 71 | 83 |
TBRmin | two-thirds | 0.70 (0.45–0.96) | ≥0.21 | 71 | 67 |
TBRmax | one-third | 0.80 (0.60– 0.99) | ≥0.32 | 71 | 83 |
TBRmean | one-third | 0.81 (0.61–1.00) | ≥0.30 | 71 | 83 |
TBRmin | one-third | 0.76 (0.54–0.98) | ≥0.21 | 79 | 67 |
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Total (n = 23) | ER+ (n = 17) | ER− (n = 6) | |
---|---|---|---|
Age, years (mean ± SD) | 59 ± 9 | 59 ± 9 | 60 ± 12 |
Previous palliative systemic treatment | |||
Yes | 5 (22%) | 5 (29%) | 0 |
No | 18 (78%) | 12 (71%) | 6 (100%) |
Tumor diameter on CT, mm (median; min-max range) | |||
Longest | 29 [13–76] | 28 [13–67] | 32 [22–76] |
Smallest | 23 [12–62] | 22 [12–62] | 25 [15–42] |
Parameter | ROI Size | AUC (95% CI) | Optimal Cut-Off ER+ | Sensitivity (%) | Specificity (%) |
---|---|---|---|---|---|
SUVmax | whole-tumor | 0.78 (0.55–1.00) | ≥11.4 | 53 | 100 |
SUVmean | whole-tumor | 0.74 (0.51–0.97) | ≥2.2 | 94 | 50 |
SUVmin | whole-tumor | 0.71 (0.48–0.93) | ≥3.9 | 53 | 83 |
SUVmax | two-thirds | 0.76 (0.54–0.97) | ≥7.8 | 65 | 83 |
SUVmean | two-thirds | 0.74 (0.51–0.97) | ≥5.7 | 59 | 83 |
SUVmin | two-thirds | 0.72 (0.48–0.95) | ≥1.9 | 88 | 50 |
SUVmax | one-third | 0.76 (0.55–0.97) | ≥5.4 | 59 | 83 |
SUVmean | one-third | 0.77 (0.55–0.98) | ≥5.0 | 59 | 83 |
SUVmin | one-third | 0.75 (0.53–0.96) | ≥3.3 | 65 | 67 |
TBRmax | whole-tumor | 0.87 (0.72–1.00) | ≥0.69 | 77 | 83 |
TBRmean | whole-tumor | 0.80 (0.62–0.99) | ≥0.45 | 65 | 100 |
TBRmin | whole-tumor | 0.78 (0.58–0.97) | ≥0.21 | 77 | 67 |
TBRmax | two-thirds | 0.79 (0.60–0.99) | ≥0.52 | 65 | 83 |
TBRmean | two-thirds | 0.82 (0.64–1.00) | ≥0.33 | 77 | 83 |
TBRmin | two-thirds | 0.76 (0.54–0.97) | ≥0.21 | 77 | 67 |
TBRmax | one-third | 0.83 (0.67–1.00) | ≥0.32 | 77 | 83 |
TBRmean | one-third | 0.84 (0.68–1.00) | ≥0.30 | 77 | 83 |
TBRmin | one-third | 0.80 (0.62–0.99) | ≥0.21 | 82 | 67 |
Parameter | ROI Size | Cut-Off ER− Sensitivity >90% | Cut-Off ER+ Specificity >90% | NPV * | PPV ‖ | Equivocal Metastases (%) ‡ |
---|---|---|---|---|---|---|
SUVmax | whole-tumor | <4.9 | ≥11.4 | 75 | 90 | 39 |
SUVmean | whole-tumor | <2.2 | ≥7.7 | 75 | 100 | 48 |
SUVmin | whole-tumor | <1.2 | ≥4.8 | 67 | 89 | 48 |
SUVmax | two-thirds | <2.5 | ≥9.5 | 75 | 100 | 52 |
SUVmean | two-thirds | <1.7 | ≥6.9 | 75 | 100 | 57 |
SUVmin | two-thirds | <1.3 | ≥5.2 | 67 | 100 | 57 |
SUVmax | one-third | <1.6 | ≥6.5 | 67 | 100 | 48 |
SUVmean | one-third | <1.5 | ≥5.8 | 67 | 100 | 52 |
SUVmin | one-third | <1.3 | ≥5.3 | 67 | 100 | 52 |
TBRmax | whole-tumor | <0.33 | ≥0.73 | 75 | 100 | 30 |
TBRmean | whole-tumor | <0.14 | ≥0.45 | 75 | 92 | 30 |
TBRmin | whole-tumor | <0.07 | ≥0.29 | 50 | 100 | 52 |
TBRmax | two-thirds | <0.15 | ≥0.65 | 75 | 100 | 48 |
TBRmean | two-thirds | <0.10 | ≥0.42 | 67 | 90 | 43 |
TBRmin | two-thirds | <0.08 | ≥0.37 | 67 | 100 | 57 |
TBRmax | one-third | <0.10 | ≥0.39 | 67 | 100 | 39 |
TBRmean | one-third | <0.09 | ≥0.34 | 50 | 91 | 43 |
TBRmin | one-third | <0.08 | ≥0.32 | 67 | 100 | 48 |
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Boers, J.; Loudini, N.; de Haas, R.J.; Willemsen, A.T.M.; van der Vegt, B.; de Vries, E.G.E.; Hospers, G.A.P.; Schröder, C.P.; Glaudemans, A.W.J.M.; de Vries, E.F.J. Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer. Diagnostics 2021, 11, 2019. https://doi.org/10.3390/diagnostics11112019
Boers J, Loudini N, de Haas RJ, Willemsen ATM, van der Vegt B, de Vries EGE, Hospers GAP, Schröder CP, Glaudemans AWJM, de Vries EFJ. Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer. Diagnostics. 2021; 11(11):2019. https://doi.org/10.3390/diagnostics11112019
Chicago/Turabian StyleBoers, Jorianne, Naila Loudini, Robbert J. de Haas, Antoon T. M. Willemsen, Bert van der Vegt, Elisabeth G. E. de Vries, Geke A. P. Hospers, Carolina P. Schröder, Andor W. J. M. Glaudemans, and Erik F. J. de Vries. 2021. "Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer" Diagnostics 11, no. 11: 2019. https://doi.org/10.3390/diagnostics11112019