乳腺癌18F-FES雌激素受体PET技术和应用标准

doi:10.19401/j.cnki.1007-3639.2023.08.009

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (8): 801-808.doi: 10.19401/j.cnki.1007-3639.2023.08.009

• 指南与共识 • 上一篇

乳腺癌¹⁸F-FES雌激素受体PET技术和应用标准

杨忠毅¹(), 许晓平¹, 王明伟¹, 张勇平¹, 杨建伟², 陈跃³, 徐文贵⁴, 李亚明⁵, 章英剑¹, 宋少莉¹()

1.复旦大学附属肿瘤医院核医学科，复旦大学上海医学院肿瘤学系，复旦大学生物医学影像研究中心，上海分子影像探针工程技术研究中心，上海 200032
2.河南省肿瘤医院PET中心，河南郑州 450008
3.西南医科大学附属医院核医学科，四川泸州 646000
4.天津医科大学肿瘤医院分子影像及核医学诊疗科，天津 300060
5.中国医科大学附属第一医院核医学科，辽宁沈阳 110001

收稿日期:2023-05-03 修回日期:2023-06-25 出版日期:2023-08-30 发布日期:2023-09-01
通信作者: 宋少莉（ORCID: 0000-0003-2544-7522），主任医师，教授，复旦大学附属肿瘤医院核医学科主任。
作者简介:杨忠毅（ORCID: 0000-0001-6195-9942），博士，副主任医师，复旦大学附属肿瘤医院核医学科主任助理。
基金资助:
上海市2022年度“科技创新行动计划”技术标准项目(22DZ2204500)

The specification and use of ¹⁸F-FES PET in breast cancer

YANG Zhongyi¹(), XU Xiaoping¹, WANG Mingwei¹, ZHANG Yongping¹, YANG Jianwei², CHEN Yue³, XU Wengui⁴, LI Yaming⁵, ZHANG Yingjian¹, SONG Shaoli¹()

1. Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Center for Biomedical Imaging, Fudan University, Shanghai Engineering Research Center for Molecular Imaging Probes, Shanghai 200032, China
2. PET Center, Henan Cancer Hospital, Zhengzhou 450008, Henan Province, China
3. Department of Nuclear Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
4. Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
5. Department of Nuclear Medicine, the Frist Hospital of China Medical University, Shenyang 11000l, Liaoning Province, China

Received:2023-05-03 Revised:2023-06-25 Published:2023-08-30 Online:2023-09-01
Contact: SONG Shaoli

摘要/Abstract

摘要：

约2/3的乳腺癌患者病灶为雌激素受体（estrogen receptor，ER）阳性。在活体内无创检测ER，并对其生物活性进行动态监测对作出个体化治疗决策至关重要。国内已有系列临床前和临床研究提示16α-¹⁸F-17β-氟雌二醇（16α-¹⁸F-17β-fluoroestradiol，¹⁸F-FES）正电子发射体层成像（positron emission tomography，PET）可用于ER表达分析，但尚缺乏相应技术规范。本技术标准由国内开展¹⁸F-FES PET研究与应用的专家共同执笔，参考自身经验及国内外该领域研究进展后共同商议制定。本技术标准介绍了¹⁸F-FES的合成方法和质量控制要求，给出其临床应用场景的推荐，并进行分级。此外，从显像前准备、显像流程、图像分析（正常生物分布、ER阳性和阴性的判定、病灶部位、影响因素、假阴性和假阳性、报告书写）等全流程系统、详尽给出了专家建议，指出了该显像技术的局限性，并对未来应用前景予以展望。该技术标准的制定旨在推动¹⁸F-FES PET技术在国内的规范化应用，实现报告解读一致、结果互认、指标可比，为乳腺癌精准诊疗提供重要的分子影像技术支撑。

关键词: 乳腺癌, 正电子发射体层成像, 16α-¹⁸F-17β-氟雌二醇, 技术标准, 应用

Abstract:

Estrogen receptor (ER) is overexpressed in approximately 2/3 of breast cancer patients’ lesions. Noninvasive detection of ER in vivo and dynamic monitoring of ER are crucial for individualized treatment decision-making. 16α-¹⁸F-17β-fluoroestradiol (¹⁸F-FES) positron emission tomography (PET) has been used in a variety of preclinical and clinical studies to detect ER expression. However, there is still a lack of technical specifications in China. This technical specification was jointly written by domestic experts who had experience of ¹⁸F-FES PET imaging and was formed through consultation based on their own experience and research progress in this field both domestically and internationally. This technical specification introduced the synthesis method and quality control requirements of ¹⁸F-FES, recommended its clinical application scenarios, and classified them. In addition, experts’ suggestions were provided throughout the entire process systemically and detailly, including pre-imaging preparation, imaging process, image analysis (normal biological distribution, determination of ER positive and negative, lesion detection, influencing factors, false negative and false positive, report requirements), and the limitations of this imaging technique were proposed. The future application prospects were also discussed. This specification aimed to promote the standardized application of ¹⁸F-FES PET in China, achieve repeatability and comparability, and provide important molecular imaging technical support for accurate diagnosis and treatment of breast cancer.

Key words: Breast cancer, Positron emission tomography, 16α-¹⁸F-17β-fluoroestradiol, Specification, Application

中图分类号:

R737.9

杨忠毅, 许晓平, 王明伟, 张勇平, 杨建伟, 陈跃, 徐文贵, 李亚明, 章英剑, 宋少莉. 乳腺癌¹⁸F-FES雌激素受体PET技术和应用标准[J]. 中国癌症杂志, 2023, 33(8): 801-808.

YANG Zhongyi, XU Xiaoping, WANG Mingwei, ZHANG Yongping, YANG Jianwei, CHEN Yue, XU Wengui, LI Yaming, ZHANG Yingjian, SONG Shaoli. The specification and use of ¹⁸F-FES PET in breast cancer[J]. China Oncology, 2023, 33(8): 801-808.

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推荐内容	推荐水平	证据水平
诊断和分期
活体内评估病灶ER表达，尤其是难以活检的部位^{[10⇓⇓-13]}	I	A
对活组织病理学检查已明确为ER阳性的乳腺癌，¹⁸F-FES PET有望提高诊断和分期的准确性，尤其是对于传统影像学手段或¹⁸F-FDG无法明确性质的病灶^[14⇓-16]	Ⅱa	B
临床治疗决策指导
双原发肿瘤转移来源的辅助诊断^[15,17]	Ⅱb	C
病灶良恶性辅助定性^[18]	Ⅱb	C
疗效预测
通过ER异质性和（或）治疗前后变化的动态观察，可用于氟维司群、CDK4/6抑制剂等药物早期疗效预测^{[5,19⇓⇓⇓ -23]}	Ⅱa	B
药代动力学研究
基于治疗前后ER表达差异进行新药疗效学观察，为临床剂量爬坡提供定量依据^{[24⇓⇓⇓-28]}	Ⅱa	C

体重（kg）	注射剂量
体重（kg）	100-150 MBq	>150 MBq
0-60	2 min	1 min
60-90	4 min	2 min
>90	6 min	3 min

乳腺癌¹⁸F-FES雌激素受体PET技术和应用标准

The specification and use of ¹⁸F-FES PET in breast cancer

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