Liver metastases in breast cancer: [ 18 F]FDG and radioembolization as strategies for diagnosis and treatment

Introduction: This review aims to analyze the role of [18F]FDG PET/CT and transarterial radioembolization (TARE) in managing liver metastases (LM) in breast cancer (BC), from metabolic characterization to treatment, to assess their impact on patient outcomes. Areas covered: A systematic search in PubMed and Embase (up to October 2024) identified studies on [18F]FDG PET imaging for LM in BC. Filters excluded reviews, case reports, and abstracts. Twenty-seven papers were selected, 19 were relative to the accuracy of [18F]FDG PET/CT and 8 to TARE. [18F]FDG PET/CT detected distant metastases in 10-100% of cases and LM in 0.3-38%. In most studies, PET/CT outperformed ceCT in detecting LM, though one study reported higher detection with ceCT (30.3% vs. 21.1%). The overall response rate to TARE was superior to 60%, while the overall survival ranged from 6.1 to 35.4 months, with minor severe adverse events. Expert opinion: [18F]FDG PET/CT has a high accuracy in LM detection and TARE has a high therapeutic potential in metastatic BC. Indeed, the optimization of imaging and personalized treatment strategies may enhance patient outcomes, also by considering the future perspectives.