Integrating PET/CT into breast cancer care: a review of recent developments

Abstract

Introduction: Breast cancer (BC) is the most common malignancy in women, classified by histopathological type, grade, receptor status, and stage. PET/CT, particularly with ¹⁸ F-FDG, plays a vital role in staging, detecting metastases, and assessing treatment response. This review explores the role of PET/CT in BC management and emerging radiotracers for enhanced diagnosis. A comprehensive literature search was conducted in PubMed and Scopus, covering studies from January 2000 to March 2025.

Areas covered: The paper examines how ¹⁸ F-FDG-PET/CT findings are influenced by BC classifications such as histopathological type, grade, receptor status, and stage. FDG uptake varies across subtypes, affecting prognosis and treatment decisions, with limitations noted in hormone receptor-positive cancers. The review also investigates emerging radiotracers, including those targeting estrogen and HER2 receptors, which may improve diagnostic accuracy and potentially replace ¹⁸ F-FDG in specific settings. Additionally, theranostic approaches are highlighted, offering personalized treatment based on molecular profiles.

Expert opinion: We recommend that physicians incorporate pathological analysis, including histopathological type, grade, and molecular status, when selecting the most appropriate radiotracer for BC diagnostics and treatment. Further research and clinical trials on emerging tracers and theranostic agents are essential to confirm their efficacy and safety.

Keywords: 18F-FDG; Breast cancer; PET/CT; clinical implications; emerging radiotracers; theranostics.