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As molecular imaging use expands for patients with breast cancer, it is important for breast radiologists to have a basic understanding of molecular imaging, including PET. Although breast radiologists may not directly interpret such studies, basic knowledge of molecular imaging will enable the radiologist to better direct diagnostic workup of patients as well as discuss diagnostic imaging with the patient and other treating physicians. Several new tracers are now available to complement imaging glucose metabolism with FDG. Because it provides a noninvasive assessment of disease status across the whole body, PET offers specific advantages over tissue-based assays. Paired with targeted therapy, molecular imaging has the potential to guide personalized treatment of breast cancer, including guiding dosing during drug trials as well as predicting and assessing clinical response. This review discusses the current established applications of FDG, which remains the most widely used PET radiotracer for malignancy, including breast cancer, and highlights potential areas for expanded use based on recent research. It also summarizes research to date on the U.S. Food and Drug Administration (FDA)–approved PET tracer 16α-18F-fluoro-17β-estradiol (FES), which targets ER, including the current guidelines from the Society of Nuclear Medicine and Molecular Imaging on the appropriate use of FES-PET/CT for breast cancer as well as areas of active investigation for other potential applications. Finally, the review highlights several of the most promising novel PET tracers that are poised for clinical translation in the near future.

Since the publication of the first issue of Nature Reviews Clinical Oncology, we have witnessed advances in multiple research areas that have culminated in improved outcomes for many cancer types, although substantial unmet needs remain for a majority of patients worldwide. Here, we have asked experts in several key specialities to reflect on the progress from the past 20 years and propose the next steps to enable further advances. Although we are aware that this Viewpoint cannot provide full coverage of the vast field that is clinical oncology, we hope that these messages inspire a diverse range of readers.

Individuals with ultrarare disorders pose a structural challenge for healthcare systems since expert clinical knowledge is required to establish diagnoses. In TRANSLATE NAMSE, a 3-year prospective study, we evaluated a novel diagnostic concept based on multidisciplinary expertise in Germany. Here we present the systematic investigation of the phenotypic and molecular genetic data of 1,577 patients who had undergone exome sequencing and were partially analyzed with next-generation phenotyping approaches. Molecular genetic diagnoses were established in 32% of the patients totaling 370 distinct molecular genetic causes, most with prevalence below 1:50,000. During the diagnostic process, 34 novel and 23 candidate genotype–phenotype associations were identified, mainly in individuals with neurodevelopmental disorders. Sequencing data of the subcohort that consented to computer-assisted analysis of their facial images with GestaltMatcher could be prioritized more efficiently compared with approaches based solely on clinical features and molecular scores. Our study demonstrates the synergy of using next-generation sequencing and phenotyping for diagnosing ultrarare diseases in routine healthcare and discovering novel etiologies by multidisciplinary teams.

To help operators perform their diagnosis tasks more efficiently, the authors put forward a novel methodology introducing a new type of model, dedicated to operations, co‐created in parallel with the design models, in the preliminary stages of system development, using the language semantics of behavior trees. In this paper, the authors present the need for this new model type as expressed by the industry and justify their choice for adopting behavior trees, while illustrating in detail the proposed methodology.

Imaging glucose metabolism with [18F]fluorodeoxyglucose positron emission tomography has transformed the diagnostic and treatment algorithms of numerous malignancies in clinical practice. The cancer phenotype, though, extends beyond dysregulation of this single pathway. Reprogramming of other pathways of metabolism, as well as altered perfusion and hypoxia, also typifies malignancy. These features provide other opportunities for imaging that have been developed and advanced into humans. In this review, we discuss imaging metabolism, perfusion, and hypoxia in cancer, focusing on the underlying biology to provide context. We conclude by highlighting the ability to image multiple facets of biology to better characterize cancer and guide targeted treatment.

Wissenschaftsbasierte und verständliche Gesundheitsinformationen sind ein Kernelement der Evidenzbasierten Medizin und von Public Health. Ziel ist es, informierte Entscheidungen zu ermöglichen, die auf realistischen Einschätzungen von Gesundheitsrisiken sowie von Nutzen und Schaden möglicher Interventionen beruhen. In Deutschland wurden während der COVID-19-Pandemie die Standards für eine evidenzbasierte Risikokommunikation wenig beachtet. Häufig war die öffentliche Berichterstattung einseitig, unvollständig und missverständlich. Bedrohungsszenarien haben emotionalen Stress und unnötige Angst ausgelöst. Eine systematische und umfassende Aufarbeitung der Pandemiemaßnahmen ist auch in Deutschland dringlich geboten. Dabei müsste eine kritisch-konstruktive Analyse der medialen Risikokommunikation von Expert*innen, Politiker*innen und Medien ein zentrales Element der Aufarbeitung sein. Die Ergebnisse sollen helfen, aus der vergangenen Pandemie zu lernen, um für künftige Krisen besser vorbereitet zu sein.

THE GOAL OF online social networks is to help create connections between people (online and offline), to connect people to communities of interest, and to provide a forum for advancing culture. Social networks advance these causes by providing a platform for free expression by anyone, whether they are well-known figures or your next-door neighbor. Unfortunately, open platforms for free expression can be used for malicious purposes. People and organizations can distribute misinformation and hate speech and can use the platform to commit crimes such as selling illegal drugs, coordinating sex trafficking, or child exploitation. [ABSTRACT FROM AUTHOR]

Mitochondrial dysfunction is a hallmark of cellular senescence and many age-related neurodegenerative diseases. We therefore investigated the relationship between mitochondrial function in peripheral blood cells and cerebral energy metabolites in young and older sex-matched, physically and mentally healthy volunteers. Cross-sectional observational study involving 65 young (26.0 ± 0.49 years) and 65 older (71.7 ± 0.71 years) women and men recruited. Cognitive health was evaluated using established psychometric methods (MMSE, CERAD). Blood samples were collected and analyzed, and fresh peripheral blood mononuclear cells (PBMCs) were isolated. Mitochondrial respiratory complex activity was measured using a Clarke electrode. Adenosine triphosphate (ATP) and citrate synthase activity (CS) were determined by bioluminescence and photometrically. N-aspartyl-aspartate (tNAA), ATP, creatine (Cr), and phosphocreatine (PCr) were quantified in brains using 1H- and 31P-magnetic resonance spectroscopic imaging (MRSI). Levels of insulin-like growth factor 1 (IGF-1) were determined using a radio-immune assay (RIA). Complex IV activity (CIV) (− 15%) and ATP levels (− 11%) were reduced in PBMCs isolated from older participants. Serum levels of IGF-1 were significantly reduced (− 34%) in older participants. Genes involved in mitochondrial activity, antioxidant mechanisms, and autophagy were unaffected by age. tNAA levels were reduced (− 5%), Cr (+ 11%), and PCr (+ 14%) levels were increased, and ATP levels were unchanged in the brains of older participants. Markers of energy metabolism in blood cells did not significantly correlate with energy metabolites in the brain. Age-related bioenergetic changes were detected in peripheral blood cells and the brains of healthy older people. However, mitochondrial function in peripheral blood cells does not reflect energy related metabolites in the brain. While ATP levels in PBMCs may be be a valid marker for age-related mitochondrial dysfunction in humans, cerebral ATP remained constant.

The etiology of colonic emergencies includes a wide-ranging and diverse set of pathologic conditions. Fortunately, for the surgeon treating a patient with one of these emergencies, the surgical management of these various causes is limited to choosing among proximal diversion, segmental colectomy with or without proximal diversion, or a total abdominal colectomy with end ileostomy (or rarely, an ileorectal anastomosis). The nuanced complexity in these situations usually revolves around the nonsurgical and/or endoscopic options and deciding when to proceed to the operating room.

Successful rescue after elective surgery is associated with increased healthcare costs, but costs vary widely. Treating all rescue events the same may overlook targeted opportunities for improvement. The purpose of this study was to predict high-cost rescue after elective colorectal surgery.

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In this paper we provide a summary of the workshop on Link Discovery: Issues, Approaches and Applications (LinkKDD-2005) held in conjunction with ACM SIGKDD 2005, on August 21stin Chicago, Illinois, USA. We report in detail about the research issues addressed in the talks at the workshop.

Contemporary environmental health sciences draw on large-scale longitudinal studies to understand the impact of environmental exposures and behavior factors on the risk of disease and identify potential underlying mechanisms. In such studies, cohorts of individuals are assembled and followed up over time. Each cohort generates hundreds of publications, which are typically neither coherently organized nor summarized, hence limiting knowledge-driven dissemination. Hence, we propose a Cohort Network, a multilayer knowledge graph approach to extract exposures, outcomes, and their connections. We applied the Cohort Network on 121 peer-reviewed papers published over the past 10 years from the Veterans Affairs (VA) Normative Aging Study (NAS). The Cohort Network visualized connections between exposures and outcomes across different publications and identified key exposures and outcomes, such as air pollution, DNA methylation, and lung function. We demonstrated the utility of the Cohort Network for new hypothesis generation, e.g., identification of potential mediators of exposure–outcome associations. The Cohort Network can be used by investigators to summarize the cohort’s research and facilitate knowledge-driven discovery and dissemination.

Flüssigbiopsien („liquid biopsy“, LB) ermöglichen die wenig invasive und wiederholbare Materialgewinnung von Tumorpatienten aus verschiedenen Körperflüssigkeiten wie beispielsweise dem Blut, Urin oder Liquor. Mithilfe der LB können dann intakte Tumorzellen oder Produkte von Tumorzellen wie RNA, DNA, extrazelluläre Vesikel oder Proteine untersucht werden. Die Möglichkeiten, die sich durch den Einsatz von LB-Methoden ergeben, beinhalten die Früherkennung, Risikostratifizierung, Therapiesteuerung und Rückfallerkennung von (soliden) Tumoren. Trotz des enormen Potenzials ist der Einsatz der LB derzeit auf klinische Studien und wenige zugelassene Tests begrenzt. Eine flächendeckende Implementierung der LB in die klinische Routine verspricht eine individuellere Tumortherapie mit verbesserten Detektions- und Überlebensraten. Im Folgenden präsentieren die Autoren einen Überblick über die häufigsten Methoden und stellen die derzeitige Studienlage kritisch dar. Ebenso werden potenzielle Hürden und Bemühungen auf dem Weg zur standardmäßigen klinischen Implementierung diskutiert.

•Understanding the career path of current colon and rectal surgery (CRS) program directors (PDs) can help aspiring PDs reach their goal•The younger PDs were 50% female, compared to 7% in the senior CRS PDs.•CRS PDs are overwhelming personally and professionally satisfied.•Leadership in general surgery residency, CRS residency, and/or professional organizations is extremely common among CRS PDs.

An 81-year-old man with known metastatic prostate cancer with recent biochemical progression underwent a PSMA PET/CT (18F-piflufolastat) for restaging. Review of the images demonstrated an acute or chronic left cerebral convexity subdural hematoma on CT with corresponding radiotracer activity throughout the collection on PET. Analysis of the patient’s prior imaging showed that this subdural hematoma had significantly increased in size when compared with a head CT obtained 2 months prior. The patient was referred to a nearby emergency department and underwent repeat imaging and subdural drain placement. Unfortunately, the patient died secondary to rapid reaccumulation of subdural blood products after intervention.

Given that cancer mortality is usually a result of late diagnosis, efforts in the field of early detection are paramount to reducing cancer-related deaths and improving patient outcomes. Increasing evidence indicates that metastasis is an early event in patients with aggressive cancers, often occurring even before primary lesions are clinically detectable. Metastases are usually formed from cancer cells that spread to distant non-malignant tissues via the blood circulation, termed circulating tumour cells (CTCs). CTCs have been detected in patients with early stage cancers and, owing to their association with metastasis, might indicate the presence of aggressive disease, thus providing a possible means to expedite diagnosis and treatment initiation for such patients while avoiding overdiagnosis and overtreatment of those with slow-growing, indolent tumours. The utility of CTCs as an early diagnostic tool has been investigated, although further improvements in the efficiency of CTC detection are required. In this Perspective, we discuss the clinical significance of early haematogenous dissemination of cancer cells, the potential of CTCs to facilitate early detection of clinically relevant cancers, and the technological advances that might improve CTC capture and, thus, diagnostic performance in this setting.

Genetics and biology may influence the age of onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to age of onset of AN and to investigate the genetic associations between age of onset of AN and age at menarche.

In this study we aimed to identify the molecular genetic cause of a progressive multisystem disease with prominent lipodystrophy.

Background: Higher intakes of fruit, vegetables, and dark fish may prevent sudden cardiac death and arrhythmias, but the exact mechanisms are not fully understood. Objective: We examined whether high consumption of fruit, vegetables, and dark fish would be associated with beneficial changes in heart rate variability (HRV). Design: HRV variables were measured among 586 older men with 928 total observations from November 2000 to June 2007 in the Normative Aging Study, a community-based longitudinal study of aging. Dietary intake was evaluated with a self-administered semi-quantitative food-frequency questionnaire and categorized into quartiles. Results: After controlling for potential confounders, intake of green leafy vegetables was positively associated with normalized high-frequency power and inversely associated with normalized low-frequency power (P for trend < 0.05). These significant associations were retained after further adjustment for healthy lifestyle factors, such as physical activity and use of multivitamins. No significant association was seen between HRV measures and intakes of other fruit and vegetables, vitamin C, carotenoids, tuna and dark-meat fish, or n-3 (omega-3) fatty acids. An effect modification of intake of noncitrus fruit by obesity and of total vegetables and cruciferous vegetables by cigarette smoking was seen, which warrants further investigation. Conclusion: These findings suggest that higher intake of green leafy vegetables may reduce the risk of cardiovascular disease through favorable changes in cardiac autonomic function.

This work deals with multiobjective optimization problems using Genetic Algorithms (GA). A MultiObjective GA (MOGA) is proposed to solve multiobjective problems combining both continuous and discrete variables. This kind of problem is commonly found in chemical engineering since process design and operability involve structural and decisional choices as well as the determination of operating conditions. In this paper, a design of a basic MOGA which copes successfully with a range of typical chemical engineering optimization problems is considered and the key points of its architecture described in detail. Several performance tests are presented, based on the influence of bit ranging encoding in a chromosome. Four mathematical functions were used as a test bench. The MOGA was able to find the optimal solution for each objective function, as well as an important number of Pareto optimal solutions. Then, the results of two multiobjective case studies in batch plant design and retrofit were presented, showing the flexibility and adaptability of the MOGA to deal with various engineering problems. Keywords: Multiobjective genetic algorithm; Multiobjective optimization; Batch plant design; Pareto sort procedure

Background: The chemokine and bone marrow-homing receptor CXCR4 has been implicated in metastatic dissemination of various cancers. We investigated CXCR4 expression in esophageal cancer specimens and its association with survival, lymph node microinvolvement, and bone marrow micrometastasis. Methods: We analyzed frozen tumor specimens from 136 patients with completely resected esophageal cancer for CXCR4 expression by immunohistochemistry. Lymph node microinvolvement and bone marrow micrometastasis were assessed by immunohistochemistry with monoclonal antibodies Ber-EP4 (against epithelial cell adhesion molecule) and pancytokeratin A45-B/B3 (against several cytokeratins), respectively. Associations between CXCR4 expression and clinicopathologic features, including tumor stage, histologic grade, lymph node metastasis and micro-involvement, bone marrow micrometastasis, and survival, were investigated with Fisher's test, log-rank test, and Cox multivariable analysis. All statistical tests were two-sided. Results: CXCR4 protein was expressed in 75 (55%) of 136 esophageal tumors examined. CXCR4 expression was statistically significantly associated with reduced median overall and disease-specific survival, compared with CXCR4 non-expression (P

Objective: 'Mild cognitive impairment' refers to cognitive deficits in older age that exceed age-related cognitive decline but do not fulfill criteria for dementia. Affected subjects are assumed to be at higher risk for the development of dementia, such as Alzheimer's disease. However, little is known about the group of young-old subjects with respect to the prevalence and natural course of cognitive decline. Method: Within the population-based Interdisciplinary Longitudinal Study on Adult Development and Aging, neuropsychological functioning was assessed in 500 community-dwelling young-old subjects of two German urban regions who were born during 1930-1932. The participants were carefully screened for physical and mental health and reexamined 4 years later. The concept of 'aging-associated cognitive decline' was applied. Results: At baseline, 13.4% of the subjects fulfilled criteria for aging-associated cognitive decline. Four years later, the prevalence rates for rose to 23.6%; 52.3% of the subjects initially classified as having aging-associated cognitive decline retained the diagnosis at follow-up. Although subjects with aging-associated cognitive decline showed a reduced performance in all neuropsychological domains addressed, a significant decline was confined to delayed verbal memory test performance during the 4-year follow-up period in relation to comparison subjects. Aging-associated cognitive decline did not predict conversion to dementia during the follow-up interval. Conclusions: In young-old community-dwelling individuals, aging-associated cognitive decline is a frequent condition with a high temporal stability. During a 4-year follow-up, subjects with aging-associated cognitive decline deteriorated specifically in measures of episodic memory, underscoring the value of the respective deficits in characterizing 'mild cognitive impairment.'

Objective: Neuropathological evidence suggests that the earliest changes in Alzheimer's disease selectively affect the parahippocampal regions of the brain. This study was conducted to determine if otherwise healthy elderly subjects with mild cognitive impairment had structural volume deficits affecting the parahippocampal gyrus. Method: Magnetic resonance imaging (MRI) was used to compare global and regional brain volumes in 21 subjects with mild cognitive deficits defined according to the criteria for aging-associated cognitive decline, 22 cognitively intact comparison subjects, and 12 patients with Alzheimer's disease. Results: Compared with the cognitively intact subjects, the subjects with aging-associated cognitive decline had a significantly smaller mean volume of the right parahippocampal gyrus. The subjects with aging-associated cognitive decline had a mean parahippocampal volume that was intermediate between that of the Alzheimer's disease patients and that of the cognitively intact subjects. Conclusions: Parahippocampal atrophy underlies the observed cognitive deficits in aging-associated cognitive decline. These findings support the hypothesis that aging-associated cognitive decline represents a preclinical stage of Alzheimer's disease.

Many monogenic disorders cause a characteristic facial morphology. Artificial intelligence can support physicians in recognizing these patterns by associating facial phenotypes with the underlying syndrome through training on thousands of patient photographs. However, this ‘supervised’ approach means that diagnoses are only possible if the disorder was part of the training set. To improve recognition of ultra-rare disorders, we developed GestaltMatcher, an encoder for portraits that is based on a deep convolutional neural network. Photographs of 17,560 patients with 1,115 rare disorders were used to define a Clinical Face Phenotype Space, in which distances between cases define syndromic similarity. Here we show that patients can be matched to others with the same molecular diagnosis even when the disorder was not included in the training set. Together with mutation data, GestaltMatcher could not only accelerate the clinical diagnosis of patients with ultra-rare disorders and facial dysmorphism but also enable the delineation of new phenotypes.

A 14-year-old girl presented with right lower quadrant pain. A 99mTc-pertechnetate scan with SPECT/CT was performed to exclude a Meckel's diverticulum. The images demonstrated focal tracer uptake in the right midabdomen, which appeared early and decreased over time. However, SPECT/CT revealed that this uptake corresponded to the right renal pelvis, which was located more inferior than expected. This case emphasizes the importance of recognizing anatomic variants that may cause focal tracer uptake, as well as leveraging an understanding of tracer kinetics to inform a diagnosis.

Congenital anomalies of the kidneys and urinary tract (CAKUT) constitute the leading cause of chronic kidney disease in children. In total, 174 monogenic causes of isolated or syndromic CAKUT are known. However, syndromic features may be overlooked when the initial clinical diagnosis of CAKUT is made. We hypothesized that the yield of a molecular genetic diagnosis by exome sequencing (ES) can be increased by applying reverse phenotyping, by re-examining the case for signs/symptoms of the suspected clinical syndrome that results from the genetic variant detected by ES.

Hintergrund: Nichtmedikamentöse Interventionen für Menschen mit Demenz sollen die Lebensqualität und das Wohlbefinden steigern, psychopathologische und Verhaltenssymptome lindern und auch den versorgenden Angehörigen Unterstützungsmöglichkeiten und Resilienzförderung bieten. Vor dem Hintergrund der ausbleibenden Erfolge im Bereich der pharmakologisch-therapeutischen Forschung haben diese Ansätze zunehmend an Bedeutung gewonnen. Ziel: Aktuelle Übersicht der wichtigsten nichtmedikamentösen Interventionen für Menschen mit Demenz und der diesbezüglichen Empfehlungen zur therapeutischen Anwendung. Material und Methoden: Narratives Review unter Berücksichtigung des aktuellen Forschungsstands und der S3-Leitlinie „Demenzen“ der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Ergebnisse und Schlussfolgerungen: Die vielversprechendsten Interventionen aus diesem therapeutischen Spektrum sind Maßnahmen zur Förderung zentraler kognitiver Funktionen, Angebote zur Steigerung und Stabilisierung des körperlichen Aktivitätsniveaus sowie kreativtherapeutische Angebote zur Förderung von Kommunikationsfähigkeit und sozialer Teilhabe. Inzwischen werden viele dieser psychosozialen Interventionen durch den Einsatz digitaler Zugänge weiterentwickelt. Gemeinsam ist ihnen, dass sie sich an den individuellen kognitiven und körperlichen Ressourcen der Betroffenen orientieren, Lebensqualität und Stimmung verbessern sowie Partizipation und Selbstwirksamkeit fördern sollen. Neben den psychosozialen Interventionen haben in den vergangenen Jahren auch ernährungsbezogene Ansätze („medical food“) und die nichtinvasive Neurostimulation Potenziale im Rahmen der nichtmedikamentösen Demenztherapie erkennen lassen.

RationaleThe biochemical mechanisms underlying lung function are incompletely understood.ObjectivesTo identify and validate the plasma metabolome of lung function using two independent adult cohorts: discovery—the European Prospective Investigation into Cancer–Norfolk (EPIC-Norfolk, n=10 460) and validation—the VA Normative Aging Study (NAS) metabolomic cohort (n=437).MethodsWe ran linear regression models for 693 metabolites to identify associations with forced expiratory volume in one second (FEV1) and the ratio of FEV1to forced vital capacity (FEV1/FVC), in EPIC-Norfolk then validated significant findings in NAS. Significance in EPIC-Norfolk was denoted using an effective number of tests threshold of 95%; a metabolite was considered validated in NAS if the direction of effect was consistent and p<0.05.Measurements and main resultsOf 156 metabolites that associated with FEV1in EPIC-Norfolk after adjustment for age, sex, body mass index, height, smoking and asthma status, 34 (21.8%) validated in NAS, including several metabolites involved in oxidative stress. When restricting the discovery sample to men only, a similar percentage, 18 of 79 significant metabolites (22.8%) were validated. A smaller number of metabolites were validated for FEV1/FVC, 6 of 65 (9.2%) when including all EPIC-Norfolk as the discovery population, and 2 of 34 (5.9%) when restricting to men. These metabolites were characterised by involvement in respiratory track secretants. Interestingly, no metabolites were validated for both FEV1and FEV1/FVC.ConclusionsThe validation of metabolites associated with respiratory function can help to better understand mechanisms of lung health and may assist the development of biomarkers.

In order to mitigate the impact of the transportation sector on climate change, light and ecological parts must be designed. A lifecycle oriented design methodology with C02footprint minimization of parts used in various transports is presented in this work. Only material production and use phase are considered in this work, to have a better understanding of the different contributions. Simultaneous topological design and material choice are investigated for 2D examples. The results show that considering out-of-plane thickness as a variable, both problems can now be decoupled for simple load cases. It is shown that a very simple material index depending only on the type of transport can be used. An optimal volume fraction is obtained, specific only to each topology problem, but unrelated to the material chosen or the loads applied. The method is promising for fast ecodesign and its simple implementation enables easy future improvements.

Purpose: This expert review describes the development and foundational studies of [18F]fluoroestradiol (18F-FES) in the setting of imaging estrogen receptor (ER)-positive breast cancer. We detail the current and emerging clinical applications of 18F-FES PET/CT, emphasizing the underlying biology of the radiotracer. We conclude with a discussion of future applications of 18F-FES PET/CT in breast cancer and other malignancies. Methods: This review is based on a selection of foundational and recent publications available on PubMed. Results: Developed in the 1980s, 18F-FES targets the ER, representing the first receptor-targeted PET radiotracer for oncologic imaging. Over the course of the next few decades, studies established the tracer as an in vivo measure of estrogen expression. In 2016, 18F-FES was approved for clinical use in France in patients with recurrent, initially ER-positive breast cancer in whom biopsy is deemed impossible. In 2020, 18F-FES was approved in the USA for the detection of ER-positive lesions as an adjunct to biopsy to help guide management in patients with recurrent or metastatic breast cancer. Numerous clinical trials are currently underway investigating expanded uses for 18F-FES in breast cancer patients as well as other patient populations. Discussion: Currently approved for clinical use in France and the USA in patients with recurrent or metastatic ER-positive breast cancer, 18F-FES PET/CT can inform treatment decisions in this patient population. Investigational uses of 18F-FES PET/CT include answering specific clinical questions in the setting of an equivocal conventional workup, serving as a biomarker to predict treatment response, staging newly diagnosed disease, and assessing ER blockade. Conclusion: As a non-invasive in vivo marker of a biologically relevant structure, and a drug target, 18F-FES has advanced precision medicine, with potential for an even greater impact in the coming years.