Determination of ER status of disease. (IMAGE)
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Determination of ER status of disease. In 59-y-old woman diagnosed with ER-positive lobular BC 2 y previously and treated with tamoxifen, ER-positive bone metastases were identified 1 y after initial diagnosis. She was treated with first-line endocrine therapy in palliative setting. Thereafter, disease became progressive and palbociclib was added. However, after 2 wk of treatment, she presented with pancytopenia. 18F-FES PET was performed to determine whether bone metastases were still expressing ER and whether there was a rationale for another line of endocrine therapy. Increased 18F-FES uptake could be seen in lymph nodes above and below diaphragm and in multiple bone lesions (e.g., spine, costae, scapulae, sternum, and pelvis) (A, maximum-intensity-projection image; B, PET/CT sagittal view; C, PET/CT transversal view of left axillary region; D, PET/CT transversal view of pelvic region with positive inguinal lymph node). In addition, bone marrow involvement was visible. Diagnosis was settled on ER-positive metastatic disease, clinical dilemma was solved, and another line of endocrine therapy could be considered. However, because of bone marrow involvement, chemotherapy was indicated to achieve therapeutic effect more rapidly.
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Image created by J Boers and A.W.J.M. Glaudemans, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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