Abstract
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Objectives To evaluate the role of Tc-99m sestamibi scintimammography in predicting the response of neoadjuvant chemotherapy in patients of locally advanced breast cancer (LABC).
Methods We conducted a prospective study and recruited cytological proven patients of LABC. All the patients underwent scintimammography study using 740MBq of Tc-99m sestamibi after measuring tumor size clinically. Early (10 min) and delayed (2 hr) images of diseased and contra-lateral breast in anterior supine and lateral prone views were acquired and wash out rate (WOR) was computed. WOR of >45% was set as the cut off predictive of unfavorable outcome. All patients received 3-4 cycles of neo-adjuvant chemotherapy. Residual tumor size in histopathological specimens were measured. Minimum of 50% reduction in tumor size in the resected specimen was the criteria to define responders.
Results We studied 27 patients who met the inclusion criteria. The age of the participants ranged from 30 to 63 years with a mean (±sd) age of 48.5 (± 10.1) years. Of these 22 (81.5%) patients underwent surgery with histopathologic evaluation of residual tumor size. Pre-therapy Tc-99m sestamibi WOR was 36.8% ± 16.4% (mean ± SD), with values ranging from 8.3%-68.0% and nine patients had WOR >45%. On the basis of histopathological examination, 14 of the 22 patients ( 63.6%) responded to chemotherapy. In patients with WOR>45% the likelihood of chemo-resistance was found to be high (Likelihood ratio: 0.11, 95% confidence interval 0.02-0.81, p=0.01). Sensitivity, specificity, positive and negative predictive values of the test are shown in table 1.
Conclusions Tc-99m sestamibi with WOR >45% is highly predictive of chemo-resistance than WOR ≤45% being predictive of chemo-responsiveness and can be used for predicting tumor response to neo-adjuvant chemotherapy
Predictiveness of test to neoadjuvant chemotherapy (WOR vs Pathological response)
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