Background
The second most common breast cancer subtype is invasive lobular cancer (ILC). Its locoregional staging is challenging, even when using breast MRI. Different non-[18F]FDG PET tracers have been explored in these patients, and promising results were reported with [18F]FACBC. Nevertheless, no publications directly comparing breast MRI and [18F]FACBC PET are available.

Aim
To compare the performance of prone [18F]FACBC PET/CT and breast MRI for assessing disease extent in the breast and for depicting lymph node metastases in patients with locally advanced ILC.

Methods
Retrospective selection of case series of patients with proven locally advanced luminal-like ILC, who underwent both breast MRI and prone [18F]FACBC PET/CT, according to the local clinical standards.

Results
Eight patients were included. [18F]FACBC PET/CT performed similarly to MRI in T-staging and outperformed MRI in N-staging, especially outside axillary level I/II. [18F]FACBC uptake in the index breast lesion was on average 9 times higher than the breast background. Among the 6 patients submitted to surgery, [18F]FACBC provided the correct T&N staging in 5 patients, confirmed by pathology.

Conclusion
This initial descriptive case series suggests that prone [18F]FACBC PET/CT could be a valuable imaging tool for both local and regional staging of low-grade luminal-like ILC. A larger prospective clinical trial is needed to further evaluate this potential application.