Emerging Technologies, Challenges and Opportunities:

Role of Imaging in Breast Cancer

Homer A. Macapinlac, MD

Molecular Imaging• Visualization, characterization and quantification of biologic processes taking place at the cellular and sub-cellular levels

• Nuclear Medicine Tracers: PET, SPECT • X rays: CT• Sound: US• Light: Optical bioluminesence/fluoresence• Magnetism: MRI

Bone Scan

GLUTGLUT--11

K3

K4

Hexokinase

Cancer Cell

Glucose-6-phosphatase

18FDG-1-P

Glycogen

18F-fru-6-P

Glycolysis

18FDG-6-phospho-glucono-lactone

HMPshunt

18FDG

Vascular

K1

K2

18FDG 18FDG-6P

HIF1a(hypoxia)

Angiogenesis, bFGF,PDGF-BB, EGFR

Macheda, J Cellular Physiology 2005; 202:654-662Bos Histopathology 2005;46:31-36

18FDG β+β-p

γ

γPET/CT

Reduction in FDG retention isAssociatedwith a Pathologic Response

and Improved Survival

Breast Cancer

FLT PET at 1 week post Chemotherapy: in Breast Cancer

Kenny L , et. al. Eur J Nucl Med Mol Imaging. 2007 Sep;34(9):1339-47.

(RGD) peptide radioligand 18F-AH111585 in Breast Cancer.Kenny LM et.al.J Nucl Med. 2008 Jun;49(6):879-86.

Fluoroestradiol PET Her2 PET

JCO June 20, 2006 vol. 24 no. 18 2793-2799 JCO July 20, 2010 vol. 28 no. 21 e355-e356