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Article ; Online: Negative 18F-Piflufolastat PET/CT, But Positive 18F-Fluciclovine PET/CT, in a Patient With Biochemically Recurrent Prostate Cancer.

Ulaner, Gary A

2024

Abstract: Abstract: An 83-year-old man with prostate cancer post external beam radiotherapy presented with biochemical recurrence (PSA, 29.7 ng/mL). PSMA-targeted 18F-Piflufolastat PET/CT was performed, but no avid lesions were identified. Given the high PSA and ... ...

Abstract	Abstract: An 83-year-old man with prostate cancer post external beam radiotherapy presented with biochemical recurrence (PSA, 29.7 ng/mL). PSMA-targeted 18F-Piflufolastat PET/CT was performed, but no avid lesions were identified. Given the high PSA and high suspicion for recurrence, an 18F-Fluciclovine PET/CT was performed. Fifteen 18F-fluciclovine-avid pelvic, abdominal, retrocrural, and left supraclavicular nodal metastases were then identified. Although the majority of prostate cancer metastases are avid on PSMA-targeted PET, some metastases are not. This case demonstrates the ability of metabolic tracers such as 18F-Fluciclovine PET to localize and quantitate disease extent in a patient whose metastases are not avid on PSMA-targeted PET.
Language	English
Publishing date	2024-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	197628-x
ISSN	1536-0229 ; 0363-9762
ISSN (online)	1536-0229
ISSN	0363-9762
DOI	10.1097/RLU.0000000000005243
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Article ; Online: Breast Cancer and Physiologic Avidity From Breast Feeding on FDG PET/CT.

Ulaner, Gary A

Clinical nuclear medicine

2023 Volume 48, Issue 5, Page(s) 420–421

Abstract: Abstract: A 35-year-old woman presented with breast cancer diagnosed during pregnancy. Eleven days after delivery, the patient underwent FDG PET/CT for systemic staging. Avidity was seen diffusely in both breasts, with a more avid focus at the site of a ...

Abstract	Abstract: A 35-year-old woman presented with breast cancer diagnosed during pregnancy. Eleven days after delivery, the patient underwent FDG PET/CT for systemic staging. Avidity was seen diffusely in both breasts, with a more avid focus at the site of a biopsy clip in the right breast. There were no lymph nodes or distant metastases. The patient was actively breast feeding, explaining the diffuse breast avidity. This case demonstrates both malignant and benign FDG avidity in the breasts at the same time, with a focal FDG-avid right breast malignancy identified among bilateral breast parenchyma with elevated physiologic FDG-avid secondary to breast feeding.
MeSH term(s)	Female ; Humans ; Adult ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Positron Emission Tomography Computed Tomography ; Fluorodeoxyglucose F18 ; Radiopharmaceuticals ; Breast Feeding ; Positron-Emission Tomography ; Neoplasm Staging
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D) ; Radiopharmaceuticals
Language	English
Publishing date	2023-02-14
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	197628-x
ISSN	1536-0229 ; 0363-9762
ISSN (online)	1536-0229
ISSN	0363-9762
DOI	10.1097/RLU.0000000000004491
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Article ; Online: Women's Health Update: Growing Role of PET for Patients with Breast Cancer.

Ulaner, Gary A / Vaz, Sofia Carrilho

Seminars in nuclear medicine

2024 Volume 54, Issue 2, Page(s) 247–255

Abstract: Positron Emission Tomography (PET) has been growing in usage for patients with breast cancer, due to an increased number of FDA-approved PET radiotracers pertinent to patients with breast cancer as well as increased prospective evidence for the value of ... ...

Abstract	Positron Emission Tomography (PET) has been growing in usage for patients with breast cancer, due to an increased number of FDA-approved PET radiotracers pertinent to patients with breast cancer as well as increased prospective evidence for the value of these agents. The leading PET radiotracer for patients with breast cancer is 18F-fluorodeoxyglucose (18F-FDG), which measures glucose metabolism. There is prospective evidence for the use of 18F-FDG PET in systemic staging of newly diagnosed locally advanced breast cancer (stages IIB-IIIC), monitoring breast cancer treatment response, and detecting breast cancer recurrence, particularly in no special type (NST) breast cancer. 16α-18F-fluoro-17β-Fluoroestradiol (18F-FES) is a radiolabeled estrogen which evaluates estrogen receptor (ER) accessible for estrogen binding. There is prospective evidence supporting 18F-FES PET as a predictive biomarker for selecting patients with metastatic breast cancer for endocrine therapies. 18F-FES PET has also been shown to be valuable in the evaluation of ER status of lesions which are difficult to biopsy, for evaluation of ER status in lesions that are equivocal on other imaging modalities, and for selecting optimal dosage of novel ER-targeted systemic therapies in early clinical trials. Multiple investigators have suggested 18F-FES PET will have an increasing role for patients with invasive lobular breast cancer (ILC), which is less optimally evaluated by 18F-FDG PET. Sodium 18F-Fluoride (18F-NaF) evaluates bone turnover and has been effective in evaluation of malignancies which commonly metastasize to bone. In patients with metastatic breast cancer, 18F-NaF PET/CT has demonstrated superior sensitivity for osseous metastases than 99mTc-MDP or CT. In addition to these three FDA-approved PET radiotracers, there are multiple novel radiotracers currently in clinical trials with potential to further increase PET usage for patients with breast cancer.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/therapy ; Fluorodeoxyglucose F18/therapeutic use ; Positron Emission Tomography Computed Tomography/methods ; Prospective Studies ; Neoplasm Recurrence, Local/drug therapy ; Positron-Emission Tomography/methods ; Women's Health ; Receptors, Estrogen/metabolism ; Receptors, Estrogen/therapeutic use ; Estrogens/therapeutic use ; Fluorine Radioisotopes
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D) ; Fluorine-18 (GZ5I74KB8G) ; Receptors, Estrogen ; Estrogens ; Fluorine Radioisotopes
Language	English
Publishing date	2024-02-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	120248-0
ISSN	1558-4623 ; 0001-2998
ISSN (online)	1558-4623
ISSN	0001-2998
DOI	10.1053/j.semnuclmed.2024.01.007
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Article ; Online: 16α-18F-fluoro-17β-Fluoroestradiol (FES): Clinical Applications for Patients With Breast Cancer.

Ulaner, Gary A

Seminars in nuclear medicine

2022 Volume 52, Issue 5, Page(s) 574–583

Abstract: Estrogen receptor (ER) is highly expressed in 70%-80% of breast cancers and plays a central role in prognosis and treatment selection for patients with breast cancer. The gold standard for determining ER status in breast cancer has been pathology; ... ...

Abstract	Estrogen receptor (ER) is highly expressed in 70%-80% of breast cancers and plays a central role in prognosis and treatment selection for patients with breast cancer. The gold standard for determining ER status in breast cancer has been pathology; however, tissue samples are invasive to obtain and only provide information on individual lesions. It is increasingly recognized that there is often spatial and temporal heterogeneity of ER status between lesions, which limits our ability to make decisions based on only one or a few tissue samples. Likewise, it is increasingly recognized that ER may be present, but not functional, thus knowledge of the ER status on pathology is not sufficient to determine the role ER plays in oncogenesis in individual patients or to make optimal treatment decisions. 16α-18F-fluoro-17β-Fluoroestradiol (FES) is a radiolabeled form of estrogen that binds to ER and allows non-invasive, whole-body evaluation of functional ER. FES has been shown to correlate with ER immunohistochemistry, successfully demonstrate ER heterogeneity, and provide high diagnostic accuracy for the detection of ER-positive tumors. FES was FDA approved May 20, 2020, as a diagnostic agent for the detection of ER-positive lesions as an adjunct to biopsy in patients with recurrent or metastatic breast cancer. FES has demonstrated sensitive detection of ER-positive malignancy in several anatomic sites, including bone, lymph nodes, and brain. Visualization of liver lesions is hampered by physiologic liver and biliary excretion of FES. Potential clinical applications of FES include selecting appropriate patients for hormonal therapies, assessing ER-status in lesions that are difficult to biopsy, solving clinical dilemmas when there are inconclusive results from other diagnostic studies, systemic staging of ER-positive breast cancers with low metabolic activity and not well visualized by FDG, and selecting optimal dosage for current or novel ER-targeted therapies to abrogate ER function and oncogenesis. FES binding to ER is blocked by selective estrogen receptor modulators, such as tamoxifen, and selective estrogen degraders, such as fulvestrant. Patients will need to be withdrawn from these treatments prior to FES imaging. The aim of this review is to provide an overview of FES PET, how it is performed, potential clinical applications, limitations, and what may be on the horizon for this growing tool for the care of patients with breast cancer.
MeSH term(s)	Breast Neoplasms/diagnostic imaging ; Carcinogenesis ; Estradiol/metabolism ; Estradiol/therapeutic use ; Estrogens/therapeutic use ; Female ; Humans ; Positron-Emission Tomography/methods ; Receptors, Estrogen/metabolism ; Receptors, Estrogen/therapeutic use
Chemical Substances	Estrogens ; Receptors, Estrogen ; Estradiol (4TI98Z838E)
Language	English
Publishing date	2022-04-02
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	120248-0
ISSN	1558-4623 ; 0001-2998
ISSN (online)	1558-4623
ISSN	0001-2998
DOI	10.1053/j.semnuclmed.2022.03.002
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Article ; Online: Breast Cancer: Advances in Molecular Imaging.

Ulaner, Gary A / Fowler, Amy M

PET clinics

2023 Volume 18, Issue 4, Page(s) xiii–xiv

MeSH term(s)	Humans ; Female ; Breast Neoplasms/diagnostic imaging ; Mammography/methods ; Molecular Imaging/methods
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Editorial
ZDB-ID	2764575-7
ISSN	1879-9809 ; 1556-8598
ISSN (online)	1879-9809
ISSN	1556-8598
DOI	10.1016/j.cpet.2023.05.003
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Article ; Online: Quarter-Century Transformation of Oncology: Positron Emission Tomography for Patients with Breast Cancer.

Ulaner, Gary A / Vaz, Sofia Carrilho / Groheux, David

PET clinics

2024 Volume 19, Issue 2, Page(s) 147–162

Abstract: PET radiotracers have become indispensable in the care of patients with breast cancer. ...

Abstract	PET radiotracers have become indispensable in the care of patients with breast cancer.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Positron Emission Tomography Computed Tomography/methods ; Positron-Emission Tomography ; Fluorodeoxyglucose F18 ; Bone Neoplasms/diagnostic imaging ; Bone Neoplasms/secondary
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2764575-7
ISSN	1879-9809 ; 1556-8598
ISSN (online)	1879-9809
ISSN	1556-8598
DOI	10.1016/j.cpet.2023.12.002
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Article ; Online: The QIBA Profile for FDG PET/CT: Improving the Value of PET.

Ulaner, Gary A

Radiology

2020 Volume 294, Issue 3, Page(s) 658–659

MeSH term(s)	Biomarkers ; Fluorodeoxyglucose F18 ; Humans ; Neoplasms ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography ; Radiopharmaceuticals
Chemical Substances	Biomarkers ; Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2020-01-07
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80324-8
ISSN	1527-1315 ; 0033-8419
ISSN (online)	1527-1315
ISSN	0033-8419
DOI	10.1148/radiol.2019192409
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Article ; Online: False-Positive for Pulmonary Emboli on Ventilation/Perfusion Scan Due to Improper Patient Positioning During Tracer Administration.

Ulaner, Gary A / Grigore, Catalan

Clinical nuclear medicine

2022 Volume 48, Issue 1, Page(s) 95–97

Abstract: Abstract: A 67-year-old woman presented with shortness of breath and a ventilation/perfusion scan was performed. Initial images demonstrated mismatched bilateral apical defects that would be classified as high probability for pulmonary emboli. However, ... ...

Abstract	Abstract: A 67-year-old woman presented with shortness of breath and a ventilation/perfusion scan was performed. Initial images demonstrated mismatched bilateral apical defects that would be classified as high probability for pulmonary emboli. However, it was unusual that the defects were only in the bilateral apices. Investigation discovered that 99m Tc-MAA was administered while the patient was in a seated position. Repeat scan the following day with the patient in the correct, supine, position during 99m Tc-MAA administration demonstrated no defects. In this case, incorrect patient positioning could have resulted in an incorrect diagnosis of pulmonary emboli and inappropriate treatment of the patient.
MeSH term(s)	Female ; Humans ; Aged ; Tomography, X-Ray Computed ; Pulmonary Embolism/diagnostic imaging ; Ventilation-Perfusion Scan ; Perfusion ; Patient Positioning ; Technetium Tc 99m Aggregated Albumin ; Ventilation-Perfusion Ratio ; Lung
Chemical Substances	Technetium Tc 99m Aggregated Albumin
Language	English
Publishing date	2022-09-21
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	197628-x
ISSN	1536-0229 ; 0363-9762
ISSN (online)	1536-0229
ISSN	0363-9762
DOI	10.1097/RLU.0000000000004391
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Article ; Online: PET/CT for Patients With Breast Cancer: Where Is the Clinical Impact?

Ulaner, Gary A

AJR. American journal of roentgenology

2019 Volume 213, Issue 2, Page(s) 254–265

Abstract: OBJECTIVE. ...

Abstract	OBJECTIVE.
MeSH term(s)	Axilla/diagnostic imaging ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Female ; Humans ; Lymphatic Metastasis/diagnostic imaging ; Neoplasm Staging ; Positron Emission Tomography Computed Tomography
Language	English
Publishing date	2019-05-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	82076-3
ISSN	1546-3141 ; 0361-803X ; 0092-5381
ISSN (online)	1546-3141
ISSN	0361-803X ; 0092-5381
DOI	10.2214/AJR.19.21177
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Article ; Online: Evaluation of Treatment Response in Patients with Breast Cancer.

Muzahir, Saima / Ulaner, Gary A / Schuster, David M

PET clinics

2023 Volume 18, Issue 4, Page(s) 517–530

Abstract: Breast cancer (BC) remains one of the leading causes of death among women. The management and outcome in BC are strongly influenced by a multidisciplinary approach, which includes available treatment options and different imaging modalities for accurate ... ...

Abstract	Breast cancer (BC) remains one of the leading causes of death among women. The management and outcome in BC are strongly influenced by a multidisciplinary approach, which includes available treatment options and different imaging modalities for accurate response assessment. Among breast imaging modalities, MR imaging is the modality of choice in evaluating response to neoadjuvant therapy, whereas F-18 Fluorodeoxyglucose positron emission tomography, conventional computed tomography (CT), and bone scan play a vital role in assessing response to therapy in metastatic BC. There is an unmet need for a standardized patient-centric approach to use different imaging methods for response assessment.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/therapy ; Breast Neoplasms/pathology ; Positron Emission Tomography Computed Tomography/methods ; Radiopharmaceuticals ; Fluorodeoxyglucose F18 ; Positron-Emission Tomography
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2764575-7
ISSN	1879-9809 ; 1556-8598
ISSN (online)	1879-9809
ISSN	1556-8598
DOI	10.1016/j.cpet.2023.04.007
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