Cover Image

18F-FES PET-CT Scan Turns out a Problem Solving Modality in an ER Positive Metastatic Breast Cancer Patient

Manoj Gupta, Partha S. Choudhury, Maria Dsouza, Robert Louis, Anupama Datta, Anil Mishra


Introduction: Two of three breast cancer patients are estrogen receptor positive. Metastasis can present upfront or developed later. Accurate delineation of all metastatic sites and ruling out a concurrent primary is of prime importance. We present a breast cancer case with multiple unusual sites of potential metastatic involvement, wherein 18F-FES PET-CT played a crucial role in resolving the diagnostic dilemma. 

Case Presentation: Treated case of strongly ER positive 52 year old female breast cancer patient presented with chest wall nodule and contralateral axillary lymphnode. FDG PET-CT showed many uncommon sites (scalp nodules, periampullary mass and lung infiltrates) and unsure about metastasis or inflammatory. FES PET-CT was positive in all these sites thus resolve the diagnostic uncertainty.  

Conclusion: FES PET-CT scan can be of immense use as a problem solving modality in ER positive breast cancer. This case highlights the spectrum of metastatic sites potentially be evaluated by FES PET-CT scan which can play a crucial role in decision making and personalized medicine. However, it is important to remember the occurrence of triple negative cases and ER receptor heterogeneity in metastatic sites. 


Estrogen receptor; Metastatic breast cancer; 18F-FES PET-CT; Scalp nodules; periampullary mass

Full Text:



D'Souza ND, Murthy NS, Aras RY. Projection of cancer incident cases for India-till 2026. Asian Pac J Cancer Prev. 2013, 14:4379-86

Blamey RW, Hornmark-Stenstam B, Ball G, Blichert-Toft M, Cataliotti L, Fourquet A, et al. ONCOPOOL: A European database for 16,944 cases of breast cancer. Eur J Cancer. 2010, 46:56-71

Allred DC, Harvey JM, Berardo M, Clark GM. Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol. 1998, 11:155-168

Glaudemans AW, de Vries EF, Galli F, Dierckx RA, Slart RH, Signore A. The use of (18)F-FDG-PET/CT for diagnosis and treatment monitoring of inflammatory and infectious diseases. Clin Dev Immunol. 2013, 2013:623036

Allred DC, Bustamante MA, Daniel CO, Gaskill HV, Cruz AB Jr. Immunocytochemical analysis of estrogen receptors in human breast carcinomas: evaluation of 130 cases and review of the literature regarding concordance with biochemical assay and clinical relevance. Arch Surg. 1990, 125:107-113.

Mintun MA, Welch MJ, Siegel BA, Mathias CJ, Brodack JW, McGuire AH, et al. Breast cancer: PET imaging of estrogen receptors. Radiology.1988,169:45-48

McGuire AH, Dehdashti F, Siegel BA, Lyss AP, Brodack JW, Mathias CJ, et al. Positron tomographic assessment of 16 alpha-[F] fluoro-17 beta-estradiol uptake in metastatic breast carcinoma. J Nucl Med. 1991,32:1526-1531

Peterson LM, Mankoff DA, Lawton T, Yagle K, Schubert EK, Stekhova S, et al. Quantitative imaging of estrogen receptor expression in breast cancer with PET and F-fluoroestradiol. J Nucl Med. 2008, 49:367-374

Mortimer JE, Dehdashti F, Siegel BA, Katzenellenbogen JA, Fracasso P, Welch MJ. Positron emission tomography with 2-[F] Fluoro-2-deoxy-D-glucose and 16alpha-[18F]fluoro-17beta-estradiol in breast cancer: correlation with estrogen receptor status and response to systemic therapy. Clin Cancer Res. 1996, 2:933-939

Dehdashti F, Mortimer JE, Siegel BA, Griffeth LK, Bonasera TJ, Fusselman MJ, et al. Positron tomographic assessment of estrogen receptors in breast cancer: comparison with FDG-PET and in vitro receptor assays. J Nucl Med. 1995,36:1766-1774

Michel van K, Andor W.J.M. G, Erik F.J. de Vries, Beets-Tan RG, Schröder CP, Dierckx RA, et al. PET Imaging of Estrogen Receptors as a Diagnostic Tool forBreast Cancer Patients Presenting with a Clinical Dilemma. J Nucl Med. 2012, 53:182-190

Smitha P, Sathish B P, Sripathi H, Kudur MH, Vasanth V. Cutaneous metastases from carcinoma breast: The common and the rare. Indian J DermatolVenereolLeprol. 2009, 75:499-502

Timea T, Kornelia K, Laszlo T, Zsolt Lengyel, Tamás Györke , Magdolna Dank Med. Habil et al. PET-CT Imaging in Breast Cancer Patients: New Tracers, Future Directions. J Mol Imaging Dynam. 2013, 2:2-6

Aurilio G, Disalvatore D, Pruneri G, Bagnardi V, Viale G, Curigliano G, et al. A meta-analysis of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 discordance between primary breast cancer and metastases. Eur J Cancer. 2014, 50:277-89


  • There are currently no refbacks.

AJCC-REP (ISSN 2572-5742)Copyright © 2012-2021. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States