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Prognostic Value of ^99mTc-Sestamibi Washout in Predicting Response of Locally Advanced Breast Cancer to Neoadjuvant Chemotherapy

¹ Department of Nuclear Medicine, Regina Elena Cancer Institute, Rome, Italy
² Second Department of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy
³ First Department of Surgical Oncology, Regina Elena Cancer Institute, Rome, Italy
⁴ Department of Pathology, Regina Elena Cancer Institute, Rome, Italy

This study evaluated the role of ^99mTc-sestamibi washout in the prediction of pathologic tumor response to neoadjuvant chemotherapy in 30 patients with locally advanced breast cancer. Methods: Two ^99mTc-sestamibi studies were performed before and after chemotherapy for each patient. Early (10 min) and delayed (240 min) planar breast views were acquired after a 740-MBq ^99mTc-sestamibi intravenous injection, and the washout rate (WOR) was computed. All patients underwent radical mastectomy with pathologic evaluation of the residual tumor size. Results: The pretherapy ^99mTc-sestamibi WOR ranged from 14% to 92% (mean ± SD, 50% ± 18%). At pathologic examination, 15 patients showed no tumor response to chemotherapy and 15 patients showed an objective response to chemotherapy. The pretherapy ^99mTc-sestamibi study predicted chemoresistance (WOR > 45%) in 18 of 30 patients and no chemoresistance (WOR 45%) in 12 of 30 patients. When the WOR cutoff was set at >45%, the prognostic performance of the test was indicated by a sensitivity of 100%; a specificity of 80%; positive and negative predictive values of 83% and 100%, respectively; and a likelihood ratio of 5. The repeatability of the test was good, with 80%–93% interreader agreement ( = 0.57-0.85). Posttherapy ^99mTc-sestamibi studies confirmed the pretherapy study prediction in 29 of 30 patients. Conclusion: ^99mTc-Sestamibi WOR is a reliable test for predicting tumor response to neoadjuvant chemotherapy. In fact, negative findings (WOR 45%) rule out chemoresistance and positive findings (WOR > 45%) indicate a high risk of chemoresistance.

Key Words: ^99mTc-sestamibi • multidrug resistance • neoadjuvant chemotherapy • breast cancer

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