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

Rosa Sciuto, MD1, Rosella Pasqualoni, MD1, Serenella Bergomi, MD1, Germana Petrilli, MD1, Patrizia Vici, MD2, Franca Belli, MD2, Claudio Botti, MD3, Marcella Mottolese, PhD4 and Carlo L. Maini, MD1

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



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  		FIGURE 1. Pretherapy (A and B) and posttherapy (C and D) 99mTc-sestamibi studies (lateral views of right breast in prone position) of patient 30, who showed no response to chemotherapy at pathologic examination. Pretherapy study (A, early image; B, delayed image) evidenced high 99mTc-sestamibi WOR (51%), predicting high MDR expression. Early posttherapy image (C) confirmed negative response to chemotherapy, because tracer uptake persisted in tumoral region. Corresponding delayed image (D) showed evident decrease in tracer uptake, confirming high WOR and high MDR expression.

 


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  		FIGURE 2. Pretherapy (A and B) and posttherapy (C and D) 99mTc-sestamibi studies (lateral views of left breast in prone position) of patient 29, who showed positive response to chemotherapy at pathologic examination. Pretherapy study evidenced very intense and diffuse tracer uptake both in tumor and in axillary nodes in early image (A) and low 99mTc-sestamibi WOR (30%) in delayed image (B), predicting low MDR expression. Early posttherapy image (C) confirmed positive response to chemotherapy, showing small area of residual tracer uptake in tumoral region and evident decrease of tracer uptake in axilla. Uptake remained substantially unmodified in corresponding delayed image (D).

 




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