18F-Fluoroestradiol PET

The biology and pharmacokinetics of 18F-fluoroestradiol are reviewed and the potential clinical applications and possible future uses of 18F-fluoroestradiol PET are discussed.

Course ID: Q00496 Category:
Modalities: , , , ,


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This course has been approved for 1.75 Category A credits.
No discipline-specific Targeted CE credit is currently offered by this course.


  1. Introduction
  2. 18F-FES Structure, Synthesis, Pharmacokinetics, and Safety
  3. Correlation of 18F-FES Uptake and Tumor ER Expression
  4. Baseline 18F-FES Uptake as a Predictor of Response to Endocrine Safety
  5. Ability of 18F-FES PET to Assess Whole-body Tumor Burden and Heterogeneity of Disease
  6. Utility of 18F-FES PET in Assessing In Vivo Pharmacodynamics
  7. Non-Breast Cancer Uses of 18F-FES
    1. Uterine Endometrium and Myometrium
    2. Epithelial Ovarian Cancer
    3. Other Uses
  8. Potential Clinical Uses
    1. Breast Cancer Detection and Staging
    2. Predicting Response to Endocrine Therapy
    3. Barriers to Widespread Clinical Use of 18F-FES PET
  9. Conclusion


Upon completion of this course, students will:

  1. know the traditional assessment method for ER expression in breast cancer
  2. understand the importance of determining a breast tumor’s ER status
  3. know when 18F-FDG PET/CT is recommended for breast cancer assessment
  4. know the potential use cases for 18F-FES PET when used in conjunction with 18F-FDG PET
  5. be familiar with the elements that were part of early efforts to develop an ER-targeting radiotracer
  6. know the properties that make 18F an optimal PET imaging radiotracer
  7. identify a major issue with 18F-moxestrol in comparison to 18F-FES
  8. be familiar with the uptake process of 18F-FES
  9. know the critical organ for 18F-FES dose
  10. be familiar with the early studies demonstrating associations between 18F-FES uptake and various lab results
  11. be familiar with the methods of the Peterson et al. studies and their findings
  12. know the factors that can affect tumor 18F-FES uptake, as well as those shown to not have an effect on its uptake
  13. know the suggested specific activity of 18F-FES for patient injection
  14. understand the advantages of endocrine therapy for patients with ER-positive breast cancer
  15. be familiar with 18F-FES PET study findings for use as a predictor of response to endocrine therapy
  16. understand the role of 18F-FES PET in the assessment of the theory that long-term antiestrogen therapy may induce estrogen hypersensitivity
  17. be familiar with the use of 18F-FDG PET for predicting endocrine therapy response
  18. know the advantages of both serial 18F-FDG and pre-therapy 18F-FES to predict endocrine responsiveness
  19. know the value and meaning of determining discordant 18F-FDG and 18F-FES uptake upon PET imaging
  20. know why determining discordant in vitro ER expression and 18F-FES uptake is important
  21. understand the meaning behind a finding for a patient who has both 18F-FES positive and negative lesions
  22. understand why 18F-FES PET could represent an important adjunct for ER expression monitoring at time of disease progression or throughout a course of treatment
  23. be familiar with the various breast cancer treatment methods and how they affect ER and in turn affect 18F-FES uptake
  24. be familiar with the findings from a study of fulvestrant dose levels in murine xenographs that suggest that changes in ER availability occur before detectable changes in tumor metabolism and growth
  25. be familiar with the uptake patterns of 18F-FES and 18F-FDG in uterine endometrial hyperplasia, as well as in both low-grade and high-grade endometrial cancers
  26. know the utility for 18F-FES PET in the differentiation of benign uterine leiomyomas from malignant uterine sarcomas
  27. be familiar with the various potential roles for 18F-FES PET imaging for epithelial ovarian cancers
  28. know the reasons why 18F-FES PET is unlikely to supersede 18F-FDG PET as the primary PET tool for breast cancer staging
  29. understand how clinicians currently often base their choice of endocrine therapy and how 18F-FES PET can better inform their therapeutic approach
  30. know the barriers to more widespread use of 18F-FES PET