Emerging Insights on the Use of FES PET for Women with Lobular Breast Cancer

For patients with estrogen receptor-positive (ER+) lobular breast cancer, the updated National Comprehensive Cancer Network (NCCN) Guidelines recommendation of fluoroestradiol positron emission tomography (FES PET) for staging of recurrent or metastatic disease represents a significant advance in this patient population, according to Sherry Shen, M.D., a breast medical oncologist at the Memorial Sloan Kettering Cancer Center.

“This most recent inclusion in the NCCN guidelines of considering FES PET, particularly for patients with lobular histology in the staging of the disease, is a huge step forward for our field in terms of research,” emphasized Dr. Shen in a recent interview.

“This is the first time there has been a histology specific guideline, and I think it’s based on so much research work showing that FES PET really can image lobular breast cancer particularly well. It’s going to help clinicians utilize this scan more (and) help with insurance coverage for our patients. Ultimately, it's going to help us change our treatment decisions and improve outcomes for patients with lobular breast cancer.”

While fluorodeoxyglucose PET (FDG PET) is commonly utilized for cancer imaging at her facility, Dr. Shen said lower proliferation rates with lobular breast cancer cells can lead to false negatives with FDG PET. In contrast, Dr. Shen noted the estrogen receptor targeted FES PET scan (Cerianna, GE HealthCare) is particularly beneficial for imaging in women with lobular breast cancer.

“ … Over 90 percent of lobular breast cancers over express the estrogen receptor. For ER-positive lobular breast cancers, this FES PET scan does not depend on proliferation rates but kind of hones in on areas where that estrogen receptor is over expressed and can essentially better detect lobular breast cancer throughout the body, which is why it's a really important imaging modality for this disease,” pointed out Dr. Shen, co-lead of the Lobular Breast Cancer Program at Memorial Sloan Kettering Cancer Center.

(Editor’s note: For related content, see “Moving Beyond Mammography for Screening and Staging of Invasive Lobular Carcinoma,” “What New Interventional Radiology Research Reveals About Treatment for Breast Cancer Liver Metastases” and “Researchers Show Higher Breast Cancer Upstaging Rate with 18F-FAPI PET/CT.”)

For more insights from Dr. Shen, watch the video below.