Al<sup>18</sup>F-NOTA-HER2-BCH versus <sup>18</sup>F-FDG PET/CT in evaluating newly diagnosed HER2-low breast cancer patients.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 40208315.
- Also identified by DOI 10.1007/s00259-025-07251-w.
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Abstract
To assess the diagnostic performance and the whole-body heterogeneity of HER2 expression on Al<sup>18</sup>F-NOTA-HER2-BCH PET/CT in patients with HER2-low breast cancer. In this prospective study conducted from November 2021 to March 2024, participants with HER2-low breast cancer underwent both Al<sup>18</sup>F-NOTA-HER2-BCH and <sup>18</sup>F-FDG PET/CT. Participants were pathologically confirmed as HER2-low (immunohistochemistry score of 1 + or 2 + without HER2 gene amplification on in situ hybridization). PET/CT images were acquired 3.5 h after injection of 200 MBq of Al<sup>18</sup>F-NOTA-HER2-BCH. The maximum standardized uptake value (SUVmax) and target-to-background ratios (TBR) were used to quantify tracer uptake. Fifty-two participants with HER2-low breast cancer (mean age, 53.0 ± 11.0; 52 females) underwent Al<sup>18</sup>F-NOTA-HER2-BCH and <sup>18</sup>F-FDG PET/CT with paired tumor biopsies. No adverse events occurred. The median SUVmax and TBR of 52 HER2-low biopsy lesions on Al<sup>18</sup>F-NOTA-HER2-BCH PET/CT were lower than that on <sup>18</sup>F-FDG PET/CT (6.6 vs. 10.5, P <.001; 8.0 vs. 10.6, P =.009). A total of 269 suspicious lesions were detected, <sup>18</sup>F-FDG PET/CT depicted more suspected HER2-low positive lesions in breast (100% vs. 100%), chest wall (100% vs. 100%), lymph node (83.9% vs. 77.7%), bone (100% vs. 93.2%), liver (66.7% vs. 52.4%) and lung (86.7% vs. 75.0%) than Al<sup>18</sup>F-NOTA-HER2-BCH PET/CT. Additionally, clear interindividual and intraindividual differences on Al<sup>18</sup>F-NOTA-HER2-BCH tracer uptake was noted between participants, between different metastases in the same participants, even within different organ systems. The visualization of HER2-low breast cancer with Al<sup>18</sup>F-NOTA-HER2-BCH PET/CT was feasible and safe. The observed intra- and inter-individual heterogeneity in the uptake of Al<sup>18</sup>F-NOTA-HER2-BCH indicates its potential use as a noninvasive tool for assessing disease heterogeneity and identifying patients who may derive clinical benefit from HER2-targeted therapies.
Medical subject headings
- Positron Emission Tomography Computed Tomography
- Breast Neoplasms
- Erb-b2 Receptor Tyrosine Kinases
- Fluorodeoxyglucose F18
- Heterocyclic Compounds, 1-Ring
- Heterocyclic Compounds