The Role of [¹⁸F]FES PET/CT in Breast Cancer Management: An Umbrella Review

Marco Cuzzocrea¹, Rosa Di Micco², Giorgia Elisabeth Colombo^{3

4}, Stefania Maria Rita Rizzo^{5

6}, Gaetano Paone^{1

6}, Virginia Casati⁴, Turki Alkhaldii², Fatemah Khajah², Claudia Rauh⁷, Maggie Banys-Paluchowsky⁸, Nina Ditsch⁹, Thorsten Kuehn^{10

11}, Oreste D Gentilini^{2

12}, Giorgio Treglia^{1

6

13}, Maria Luisa Gasparri^{4

6

14}

Affiliations

¹ Division of Nuclear Medicine, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Athos Gallino 12, 6500 Bellinzona and Via Tesserete 46, 6900 Lugano, Switzerland.
² Breast Surgery Unit, IRCSS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
³ Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK.
⁴ Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland.
⁵ Division of Radiology, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900 Lugano, Switzerland.
⁶ Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Via Buffi 13, 6900 Lugano, Switzerland.
⁷ Department of Gynecology, University Hospital Inselspital Bern, Theodor-Kocher-Haus Friedbühlstrasse 19, 3010 Bern, Switzerland.
⁸ Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.
⁹ Klinik fuer Gynäkologie und Geburtshilfe, Universitätsklinikum Augsburg, Brustzentrum, Stenglinstraße 2, 86156 Augsburg, Germany.
¹⁰ Department of Surgery, Die Filderklinik, Im Haberschlai 7, 70794 Filderstadt, Germany.
¹¹ Universitaetsfrauenklinik Ulm, Prittwitzstraße 43, 89081 Ulm, Germany.
¹² Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy.
¹³ Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
¹⁴ Department of Gynecology and Obstetrics, Centro di Senologia della Svizzera Italiana EOC, Ospedale Italiano di Lugano, Via Pietro Capelli 1, 6962 Lugano, Switzerland.

PMID: 40427142
PMCID: PMC12110083
DOI: 10.3390/cancers17101644

Review

The Role of [¹⁸F]FES PET/CT in Breast Cancer Management: An Umbrella Review

Marco Cuzzocrea et al. Cancers (Basel). 2025.

. 2025 May 13;17(10):1644.

doi: 10.3390/cancers17101644.

Authors

Affiliations

¹ Division of Nuclear Medicine, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Athos Gallino 12, 6500 Bellinzona and Via Tesserete 46, 6900 Lugano, Switzerland.
² Breast Surgery Unit, IRCSS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
³ Department of Obstetrics and Gynaecology, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Rd., London SW10 9NH, UK.
⁴ Department of Gynaecology and Obstetrics, Ente Ospedaliero Cantonale (EOC), Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland.
⁵ Division of Radiology, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900 Lugano, Switzerland.
⁶ Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Via Buffi 13, 6900 Lugano, Switzerland.
⁷ Department of Gynecology, University Hospital Inselspital Bern, Theodor-Kocher-Haus Friedbühlstrasse 19, 3010 Bern, Switzerland.
⁸ Department of Gynaecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.
⁹ Klinik fuer Gynäkologie und Geburtshilfe, Universitätsklinikum Augsburg, Brustzentrum, Stenglinstraße 2, 86156 Augsburg, Germany.
¹⁰ Department of Surgery, Die Filderklinik, Im Haberschlai 7, 70794 Filderstadt, Germany.
¹¹ Universitaetsfrauenklinik Ulm, Prittwitzstraße 43, 89081 Ulm, Germany.
¹² Faculty of Medicine, Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy.
¹³ Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
¹⁴ Department of Gynecology and Obstetrics, Centro di Senologia della Svizzera Italiana EOC, Ospedale Italiano di Lugano, Via Pietro Capelli 1, 6962 Lugano, Switzerland.

PMID: 40427142
PMCID: PMC12110083
DOI: 10.3390/cancers17101644

Abstract

Background/Objectives: Breast cancer (BC) is the most commonly diagnosed cancer worldwide. Estrogen receptor (ER) status is a key determinant in the diagnosis and treatment of BC. Although immunohistochemistry (IHC) is the gold standard for ER assessment, it has limitations. This umbrella review aims to evaluate the role of 16α-18F-fluoro-17β-estradiol ([¹⁸F]FES) PET/CT as a non-invasive imaging tool for assessing ER expression and its implications in BC management. Methods: A comprehensive search was conducted in PubMed/MEDLINE and Cochrane Library for systematic reviews and meta-analyses published in the last decade. Studies eligible for inclusion evaluated the diagnostic accuracy and clinical utility of [¹⁸F]FES PET/CT in BC based on a predefined research question "What is the role of fluoroestradiol ([¹⁸F]FES) PET/CT in breast cancer?". Data extraction and quality assessment were performed independently by two reviewers using the AMSTAR-2 tool. Results: Eight systematic reviews met the inclusion criteria. [¹⁸F]FES PET/CT demonstrated high sensitivity (81-94%) and specificity (78-95%) in detecting ER-positive lesions. It provided a real-time, whole-body assessment of ER expression, outperforming IHC in detecting functional ER activity. Additionally, [¹⁸F]FES PET/CT showed promise in predicting treatment response and guiding therapy decisions, particularly in metastatic settings. Conclusions: This review highlights the clinical value of [¹⁸F]FES PET/CT in BC management, offering a non-invasive alternative for ER assessment with high diagnostic accuracy. Its integration into clinical practice may enhance personalized treatment strategies for BC patients.

Keywords: PET; [18F]FES PET/CT; breast cancer; estrogen receptor; positron emission tomography.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

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The Role of [¹⁸F]FES PET/CT in Breast Cancer Management: An Umbrella Review

Affiliations

The Role of [¹⁸F]FES PET/CT in Breast Cancer Management: An Umbrella Review

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

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