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Thallium Scintigraphy in the Evaluation of Mass Abnormalities of the Breast

Department of Nuclear Medicine, Surgery, and Radiology, Cedars-Sinai Medical Center, Los Angeles, California

Correspondence: For correspondence or reprints contact: Alan D. Waxman, MD, Cedars Sinai Medical Center, Nuclear Medicine Department, 8700 Beverly Blvd., Los Angeles, CA 90048.

ABSTRACT

Palpable mass abnormalities of the breast are often difficult to evaluate mammographically, especially in patients with fibrocystic change and dense breasts. The current study evaluates ²⁰¹Tl scintigraphy as a potential test in detecting malignancy and in differentiating malignant from benign masses. Eighty-one female patients underwent thallium scintigraphy of the breast because of palpable breast masses. An additional 30 females with no palpable breast abnormalities were also studied using ²⁰¹Tl. Of 44 patients with palpable breast carcinomas, 42 carcinomas (96%) were detected using ²⁰¹Tl scintigraphy. Three of three patients had other primary breast malignancies that were also detected. In contrast, 19 patients with palpable breast abnormalities shown on biopsy to be benign fibrocystic disease processes were not detectable on thallium studies. Of two patients with fat necrosis, none were detectable. Three of 13 patients had adenomas of the breast (23%) that were detected. The three detectable adenomas were all highly cellular. The smallest detectable carcinoma was an adenocarcinoma measuring 1.3 x 1.1 x 0.9 cm. Thallium-201 scintigraphy of palpable breast lesions is an effective test for evaluation of palpable masses. Sensitivity for detection of malignant masses greater than 1.5 cm is high. Highly cellular adenomas, however, may demonstrate significant ²⁰¹Tl uptake. Benign fibrocystic disease is not detectable with thallium scintigraphy. Thallium scintigraphy of breast lesions is an effective means of differentiating benign from malignant lesions.

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