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Diagnostic Value of ^99mTc-Methylene Diphosphonate and ^99mTc-Pentavalent DMSA Compared with ^99mTc-Sestamibi for Palpable Breast Lesions

¹ Nuclear Medicine Centre, University of Chile, Santiago, Chile
² Nuclear Medicine Centre, University of Uruguay, Montevideo, Uruguay
³ Nuclear Medicine Department, Istanbul University, Istanbul, Turkey
⁴ Nuclear Medicine Department, National Cancer Institute, Bogota, Colombia
⁵ Nuclear Medicine Department, Indraprastha Apollo Hospitals, New Delhi, India
⁶ Nuclear Medicine Department, Hua Shan Hospital, Shanghai Medical University, Shanghai, China
⁷ Medical Oncology Department, University of Uruguay, Montevideo, Uruguay
⁸ Nuclear Medicine Section, Department of Human Health, International Atomic Energy Agency, Vienna, Austria

Different radiopharmaceuticals have been used to detect breast cancer. Among them, sestamibi has been extensively studied and has come to have a well-recognized role in the evaluation of palpable breast lesions. The goal of this study was to compare the diagnostic value of ^99mTc-labeled compounds, such as methylene diphosphonate (MDP) and pentavalent dimercaptosuccinic acid (DMSA-V), with sestamibi for palpable breast lesions, in the scope of a multicenter trial sponsored by the International Atomic Energy Agency. Methods: Patients from 7 countries were included: 47 women (mean age, 54 ± 13 y) examined with MDP and sestamibi and 111 women (mean age, 55 ± 12 y) examined with DMSA-V and sestamibi. Cancer was diagnosed in 41 of 49 lesions from the MDP group and in 78 of 113 lesions from the DMSA-V group. Axillary lymph node involvement was observed in 18 of 30 patients from the first group and in 27 of 53 patients from the second group. Prone scintimammography was performed using a dose of 740 MBq of each tracer, and diagnostic values were calculated from a masked interpretation of scans. Results: In the first group, the sensitivity for sestamibi and MDP studies was 82.9% and 65.9%, respectively, with a specificity of 87.5% and 50%, respectively. In the second group, the sensitivity for sestamibi and DMSA-V studies was 87.2% and 65.4%, respectively, with a specificity of 77.1% and 74.3%, respectively. Regarding axillary involvement, the sensitivity was 33.3% for sestamibi in both groups, whereas the values for MDP and DMSA-V were 16.7% and 7.4%, respectively. In contrast, the specificity for sestamibi was 83.3% and 92.3% for the first and second groups, respectively, and the specificity for MDP and DMSA-V was 91.7% and 100%, respectively. Conclusion: Sestamibi is the most adequate alternative among the mentioned ^99mTc-labeled radiopharmaceuticals for the evaluation of palpable breast lesions.

Key Words: ^99mTc-sestamibi • ^99mTc-methylene diphosphonate • pentavalent ^99mTc-DMSA • scintimammography • breast cancer