18F-Alfatide II PET/CT for Identification of Breast Cancer: A Preliminary Clinical Study.

Abstract

18F-alfatide II has been proven to have excellent clinical translational potential. In this study, we investigated 18F-alfatide II for identifying breast cancer and compared the performances between 18F-alfatide II and 18F-FDG. Methods: Forty-four female patients with suspected primary breast cancer were recruited. PET/CT images using 18F-alfatide II and 18F-FDG were acquired within 7 d. Tracer uptake in breast lesions was evaluated by visual analysis, and semiquantitative analysis with SUVmax and SUVmeanResults: Forty-two breast cancer lesions and 11 benign breast lesions were confirmed by histopathology in 44 patients. Both 18F-alfatide II and 18F-FDG had higher uptake in breast cancer lesions than in benign breast lesions (P < 0.05 for 18F-alfatide II, P < 0.05 for 18F-FDG). The area under the curve of 18F-alfatide II was slightly less than that of 18F-FDG. Both 18F-alfatide II and 18F-FDG had high sensitivity (88.1% vs. 90.5%), high positive predictive value (88.1% vs. 88.4%), moderate specificity (54.5% vs. 54.5%), and moderate negative predictive value (54.5% vs. 60.0%) for differentiating breast cancer from benign breast lesions. By combining 18F-alfatide II and 18F-FDG, the sensitivity and negative predictive value significantly increased to 97.6% and 85.7%, respectively, with positive predictive value slightly increased to 89.1% and no change to the specificity (54.5%). The uptake of 18F-alfatide II (SUVmax: 3.77 ± 1.78) was significantly lower than that of 18F-FDG (SUVmax: 7.37 ± 4.48) in breast cancer lesions (P < 0.05). 18F-alfatide II uptake in triple-negative subtype was significantly lower than that in luminal A and luminal B subtypes. By contrast, human epidermal growth factor receptor-2 (HER-2)-overexpressing subtype had higher 18F-FDG uptake than the other 3 subtypes. There were 8 breast cancer lesions with higher 18F-alfatide II uptake than 18F-FDG uptake, which all had a common characteristic that HER-2 expression was negative and estrogen receptor expression was strongly positive. Conclusion:18F-alfatide II is suitable for clinical use in breast cancer patients. 18F-alfatide II is of good performance, but not superior to 18F-FDG in identifying breast cancer. 18F-alfatide II may have superiority to 18F-FDG in detecting breast cancer with strongly positive estrogen receptor expression and negative HER-2 expression.

• Authors: Jiang Wu, Shaohua Wang, Xianzhong Zhang, Zhaogang Teng, Jingjie Wang, Bryant C Yung, Gang Niu, Hong Zhu, Guangming Lu, Xiaoyuan Chen
• Journal: Journal of nuclear medicine : official publication, Society of Nuclear Medicine (J Nucl Med) Vol. 59 Issue 12 Pg. 1809-1816 (12 2018) ISSN: 1535-5667 [Electronic] United States
• PMID: 29700127 (Publication Type: Clinical Trial, Phase I, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Chemical References

• Fluorine Radioisotopes
• Peptides, Cyclic
• Radiopharmaceuticals
• alfatide II
• Fluorodeoxyglucose F18
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Aged
• Breast Neoplasms (diagnostic imaging, metabolism)
• Double-Blind Method
• False Positive Reactions
• Female
• Fluorine Radioisotopes (pharmacokinetics)
• Fluorodeoxyglucose F18 (pharmacokinetics)
• Humans
• Middle Aged
• Peptides, Cyclic (pharmacokinetics)
• Positron Emission Tomography Computed Tomography (methods)
• Radiopharmaceuticals (pharmacokinetics)
• Receptor, ErbB-2 (metabolism)
• Triple Negative Breast Neoplasms (diagnostic imaging, metabolism)