[F]F-FES PET for diagnosis, staging, and endocrine therapy prediction in ER-positive breast cancer: a systematic review and meta-analysis.

Background: This meta-analysis evaluates the diagnostic and staging accuracy of [F]F-FES PET/CT, its ability to detect estrogen receptor (ER) positivity, and its effectiveness in predicting response to endocrine therapy in ER-positive (ER+) breast cancer. A systematic search of PubMed, Embase (OVID), and Web of Science databases was conducted for studies published between 2013 and June 2024. Studies involving ER + breast cancer patients who underwent [F]F-FES PET/CT were included. We analyzed the diagnostic accuracy, ER detection capability, and predictive ability for endocrine therapy response.

Results: Out of 189 studies initially identified, 21 met the inclusion criteria. For diagnosis and staging compared to [F]F-FDG PET (10 studies), [F]F-FES PET/CT demonstrated a sensitivity of 0.75 (95% CI: 0.62-0.85) and a false positive rate (FPR) of 0.27 (95% CI: 0.09-0.50). For ER detection (7 studies), sensitivity was 0.86 (95% CI: 0.71-0.94) with an FPR of 0.45 (95% CI: 0.19-0.73). For predicting response to endocrine therapy (12 studies), [F]F-FES PET/CT showed a sensitivity of 0.79 (95% CI: 0.62-0.89) and an FPR of 0.58 (95% CI: 0.42-0.72).

Conclusions: [F]F-FES PET/CT is valuable for diagnosing and staging ER + breast cancer, assessing ER status, and predicting response to endocrine therapy. Its implementation can improve treatment planning and patient outcomes in breast cancer management.