OtherClinical Investigations

Inconclusive Triple Diagnosis in Breast Cancer Imaging: Is There a Place for Scintimammography?

Isabelle Mathieu, Stéphane Mazy, Bernard Willemart, Michel Destine, Gilbert Mazy and Max Lonneux
Journal of Nuclear Medicine October 2005, 46 (10) 1574-1581;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A) X-ray mammogram, profile views. Polycystic dysplasia of both breasts. (Left) Suspicious lesion in supraareolar region of right breast, corresponding to ductal carcinoma on FNA. (Right) Left breast is dense, especially in superoexternal part of gland. Multiple cysts are seen with ultrasound but no suggestive lesion was evident. (B) SM (planar lateral views) shows bilateral uptake (left, right breast; right, left breast). (C) Axial SPECT views show bilateral lesions (arrows). SPECT allowed precise localization of tumors and oriented large-core biopsy of left breast lesion (open arrow, invasive ductal carcinoma).

  • FIGURE 2.
    FIGURE 2.

    Patient with suggestion of recurrence: comedocarcinoma surgery 2 y earlier, multicystic dysplasia, more pronounced in superoexternal part of left breast. (A) SM (planar lateral views) shows no frank abnormalities. (B and C) Coronal (B) and sagittal (C) SPECT images show moderate but focal uptake in left breast (arrow). Core biopsy confirmed presence of tumor recurrence (in situ ductal carcinoma).

  • FIGURE 3.
    FIGURE 3.

    Highly dysplastic breasts in 48-y-old woman. (A) X-ray mammogram showed dense tissue in superoexternal part of left breast (class III). Ultrasound-guided FNA shows benign material. (B) SM (planar lateral views) shows high uptake of 99mTc-MIBI in upper external part of left breast. Invasive lobular carcinoma was confirmed at surgery. (C) SM-SPECT acquisition. Axial (top) and coronal (bottom) slices show tumor in left breast.

Tables

  • TABLE 1

    Diagnostic Performance of SM

    GroupSensitivity (%)Specificity (%)PPV (%)NPV (%)Accuracy (%)
    Overall (n = 118)88.4677980.580
    1: Initial diagnosis (n = 37)9570.57992.383.7
    2: Suspicion of recurrence (n = 48)8165.65487.571
    3: Assessment of multifocality (n = 26)731001008388
    4: Detection of unknown primary (n = 7)75nananana

    • PPV = positive predictive value; NPV = negative predictive value; na = not applicable.

  • TABLE 2

    Comparison Between Planar Imaging and SM-SPECT in Whole Series (n = 118)

    ParameterPlanar imagingSM-SPECT
    Sensitivity (%)72.488.4*
    Specificity (%)79.567†
    Negative predictive value (%)6780.5
    Positive predictive value (%)83.379
    Accuracy (%)75.480†

    • ↵* P < 0.05, McNemar test.

    • ↵† P = not significant, McNemar test.

  • TABLE 3

    Comparison of Sensitivity for Cancer Detection (n = 69) Between Planar Imaging and SPECT According to Tumor Size

    LesionnPlanar imagingSPECT
    T1a0——
    T1b1911/19 (58)14/19 (74)
    T1c2315/23 (65)21/23 (91)*
    ≥T22724/27 (89)26/27 (96)

    • ↵* P < 0.05, McNemar test.

    • T1a, ≤5 mm; T1b, >0.5 ≤1 cm; T1c, >1 ≤2 cm; T2, >2 ≤5 cm.

      Values in parentheses are percentages.

  • TABLE 4

    Impact of Positive SM on Management of 30 Patients with Doubtful or Contradictory TD

    Patient no.TD resultsDecision based on positive SM result
    ACR classFNA
    1IVBenignMicrobiopsy of RSEQ: in situ ductal carcinoma
    2IVBenignMicrobiopsy of RIMQ: in situ ductal carcinoma
    3IIIBenignMicrobiopsy of RSIQ: invasive ductal carcinoma
    4IIIBenignSurgery of LSMQ: lobular carcinoma
    5IIIBenignSurgery of LSEQ: lobular carcinoma
    6V (L)II (R)Invasive ductal carcinoma (L)Microbiopsy of RSMQ: lobular carcinoma
    7IVBenignSurgery of LSEQ: lobular carcinoma
    8V (R)III (L)Invasive ductal carcinoma (R)Microbiopsy of LSEQ: invasive ductal carcinoma
    9Previous R mastectomyPositive axillary lymph node, negative at scar levelSM positive at scar level, leading to repeated FNA: invasive ductal carcinoma
    10IVBenignMicrobiopsy of LSMQ: in situ ductal carcinoma
    11IVCellular atypia, inconclusiveMicrobiopsy of LSQ: invasive ductal carcinoma
    12IIIInconclusiveSurgery: lobular carcinoma of RIEQ
    13IVDoubtfulMicrobiopsy of LSEQ: invasive ductal carcinoma
    14IIICellular atypia, inconclusiveMicrobiopsy of LSEQ: lobular and invasive ductal carcinoma
    15IVDoubtful, epitheliosis?Microbiopsy of RIEQ: invasive ductal carcinoma
    16IIIDoubtful, hyperplasiaMicrobiopsy of LSEQ: invasive ductal carcinoma
    17IIIDoubtful, hyperplasia2 foci, leading to surgery: multicentric invasive ductal carcinoma
    18IVNo materialSurgery of RSEQ: lobular carcinoma
    19VInvasive ductal carcinoma2 positive foci: microbiopsy showing multicentric carcinoma (invasive ductal and in situ ductal)
    20IVDoubtfulMicrobiopsy of RSQ: invasive ductal carcinoma
    21IVDoubtful, cellular atypiaMicrobiopsy of LSEQ: invasive ductal carcinoma
    22IVDoubtful, cellular atypiaMicrobiopsy of LSEQ: invasive ductal carcinoma
    23IVDoubtful, hyperplasiaSurgery of LIIQ: comedocarcinoma
    24VInvasive ductal carcinoma2 foci showing multicentricity, confirmed by surgery (invasive and in situ ductal carcinoma)
    25IVNo materialMicrobiopsy of LSEQ: lobular carcinoma
    26IVDoubtfulSurgery of LIEQ: lobular carcinoma
    27IIIDoubtfulSurgery of LSEQ: comedocarcinoma
    28IIIDoubtfulMicrobiopsy of RSEQ: invasive ductal carcinoma
    29IIIDoubtfulSurgery of retroareolar region: invasive ductal carcinoma
    30IVDoubtful, hyperplasiaMicrobiopsy of RSEQ: invasive ductal carcinoma

    • RSEQ = R superoexternal quadrant; LSEQ = L superoexternal quadrant; LIEQ = L inferoexternal quadrant; LIIQ = L inferointernal quadrant; LSQ = L superior quadrant; RSQ = R superior quadrant; RSMQ = R superomedial quadrant; RSIQ = R superointernal quadrant; RSEQ = R superoexternal quadrant; RIMQ = R inferomedial quadrant; LSMQ = L superomedial quadrant; RIEQ = R inferoexternal quadrant.

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