Abstract
Breast carcinoma is the most common neoplasm found among women in the Western world. Mammography (MM) is the most widely used diagnostic imaging method for screening and diagnosing breast cancer. However, despite technical improvements in recent years, MM has known diagnostic limits; consequently not all breast carcinomas are identified on mammograms, especially if the breast is dense, there is a breast prosthesis or the patient has previously undergone radiation, surgery or biopsy. In addition, the mammographic images of benign and malignant lesions can be similar. Therefore, abnormalities detected on MM frequently result in negative biopsies. Scintimammography (SM) is the functional imaging study of the breast using primarily the radiopharmaceuticals 99mTc-sestamibi and 99mTc-tetrofosmin. The main advantage of SM is that its functional basis makes this technique a useful complement to MM. SM resolves some of the main limitations of MM as it is not affected by changes in breast morphology. Several single-site and multi-centre studies have demonstrated that SM has an improved specificity compared with MM, because it is better able to distinguish malignant from benign breast lesions. Interestingly, except in smaller lesions, a higher sensitivity has been recorded for SM than for MM in most of these studies as well. Adjunctive use of SM when MM is equivocal can reduce the number of unnecessary breast biopsies and identify previously unexpected sites of breast cancer. SM appears unaffected by the anatomical changes seen following chemotherapy and radiotherapy, and so this technique can be particularly useful in monitoring the treatment of breast cancer patients, especially when breast-conserving treatment is given. The main limitation to SM has been the sub-optimal resolution of the standard Anger gamma camera, which makes it difficult to detect lesions of less than 10 mm; however, the development of high-resolution breast-dedicated gamma cameras may offer improvements in this respect. This review will look at the evidence for SM and show how it can become part of the clinical care algorithm in breast cancer.
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References
Jemal A, Tiwari RC, Murray T, et al. Cancer statistics, 2004. CA Cancer J Clin 2004; 54:8–29.
Daniel B. Kopans DB. Mammography screening is saving thousands of lives, but will it survive medical malpractice? Radiology 2004; 230:20–24.
Tabar LK, Vitak B, Chen HHT, Yen MF, Duffy SW, Smith RA. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91:1724–1731.
Berlin L. The missed breast cancer redux: time for educating the public about the limitations of mammography? AJR 2001; 176:1131–1134.
Birdwell RL, Ikeda DM, O’Shaughnessy KF, Sickles EA. Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection. Radiology 2001; 219:192–202.
Holland R, Jan HC, Hendricks L, Mravunac M. Mammographically occult breast cancers: a pathological and radiologic study. Cancer 1983; 52:1810–1819.
Kopans D. The positive predictive value of mammography. AJR 1992; 158:521–526.
Monusturi Z, Herman PG, Carmody DP, et al. Limitations in distinguishing malignant from benign lesions of the breast by systematic review of mammograms. Surg Gynecol Obstet 1991; 173:438–442.
Adler DD, Wahl RL. New methods for imaging the breast: techniques, findings and potential. AJR 1995; 164:19–30.
Jackson VP. The role of US in breast imaging. Radiology 1990; 177:305–311.
Kopans DB. Sonography should not be used for breast cancer screening until its efficacy has been proven scientifically. AJR 2004; 182:489–491.
Buscombe JR, Cwikla JB, Thakrar DS, Hilson AJ. Scintigraphic imaging of breast cancer: a review. Nucl Med Commun 1997; 18:698–709.
Schillaci O, Scopinaro F. Tc-99m sestamibi scintimammography: where is it now? Cancer Biother Radiopharm 1999; 14:417–422.
Schomacker K, Schicha H. Use of myocardial imaging agents for tumour diagnosis—a success story? Eur J Nucl Med 2000; 27:1845–1863.
Carvalho PA, Chiu ML, Kronauge JF, et al. Subcellular distribution and analysis of Tc-99m MIBI in isolated perfused rat hearts. J Nucl Med 1992; 33:1516–1521.
Delmon-Mongeon LI, Piwinica-Worms D, Van der Abbeele AD, et al. Uptake of the cation hexakis (2-methoxyisobutylisonitrile)-technetium-99m by human carcinoma cell lines in vitro. Cancer Res 1990; 50:2198–2202.
Maublant J, Zhang Z, Rapp M, et al. In vitro uptake of technetium-99m-teboroxime in carcinoma cell lines and normal cells: comparison with technetium-99m-sestamibi and thallium-201. J Nucl Med 1993; 34:1949–1952.
Scopinaro F, Schillaci O, Scarpini M, et al. Technetium-99m sestamibi: an indicator of breast cancer invasiveness. Eur J Nucl Med 1994; 21:984–987.
Pwnica-Worms D, Chiu ML, Budding M, et al. Functional imaging of multidrug-resistant P-glycoprotein with an organotechnetium complex. Cancer Res 1993; 53:977–984.
Arbab AS, Koizumi K, Toyama K, Araki T. Uptake of technetium-99m-tetrofosmin, technetium-99m-MIBI and thallium-201 in tumor cell lines. J Nucl Med 1996; 37:1551–1556.
Ballinger JR.99mTc-tetrofosmin for functional imaging of P-glycoprotein modulation in vivo. J Clin Pharmacol 2001; Suppl: 39S–47S.
Van de Wiele C, Rottey S, Goethals I, et al.99mTc sestamibi and 99mTc tetrofosmin scintigraphy for predicting resistance to chemotherapy: a critical review of clinical data. Nucl Med Commun 2003; 24:945–950.
Khalkhali I, Mena I, Jouanne E, et al. Prone scintimammography in patients with suspicion of carcinoma of the breast. J Am Coll Surg 1994; 178:491–497.
Liberman M, Sampalis F, Mulder DS, Sampalis JS. Breast cancer diagnosis by scintimammography: a meta-analysis and review of the literature. Breast Cancer Res Treat 2003; 80:115–126.
Sampalis FS, Denis R, Picard D, et al. International prospective evaluation of scintimammography with (99m)technetium sestamibi. Am J Surg 2003; 185:544–549.
Buscombe JR, Cwikla JB, Holloway B, Hilson AJ. Prediction of the usefulness of combined mammography and scintimammography in suspected primary breast cancer using ROC curves. J Nucl Med 2001; 42:3-8.
Scopinaro F, Schillaci O, Ussof W, et al. A three center study on the diagnostic accuracy of99mTc-MIBI scintimammography. Anticancer Res 1997; 17:1631–1634.
Waxman A, Nagaraj N, Kovalevsky M, et al. Detection of primary breast malignancy with Tc-99m methoxyisobutylisonitrile in patients with non-palpable primary malignancies: the importance of lesion size [abstract]. J Nucl Med 1995; 36:194P.
Mekhmandarov S, Sandbank J, Coehn M, Lelcuk S, Lubin E. Technetium-99m-MIBI scintimammography in palpable and nonpalpable breast lesions. J Nucl Med 1998; 39:86–91.
Tolmos J, Cutrone JA, Wang B, et al. Scintimammographic analysis of nonpalpable breast lesions previously identified by conventional mammography. J Natl Cancer Inst 1998; 90:846–849.
Khalkhali I, Villanueva-Meyer J, Edell SL, et al. Diagnostic accuracy of99mTc-sestamibi breast imaging: multicenter trial results. J Nucl Med 2000; 41:1973–1979.
Buscombe JR, Cwikla JB, Thakrar DS, Hilson AJ. Uptake of Tc-99m MIBI related to tumour size and type. Anticancer Res 1997; 17:1693–1694.
Obwegeser R, Berghammer P, Rodrigues M, et al. A head-to-head comparison between technetium-99m-tetrofosmin and technetium-99m-MIBI scintigraphy to evaluate suspicious breast lesions. Eur J Nucl Med 1999; 26:1553–1559.
Cwikla JB, Buscombe JR, Hilson AJ. Detection of DCIS using99mTc-MIBI scintimammography in patients with suspected primary breast cancer, comparison with conventional mammography. Nucl Med Rev Cent East Eur 2000; 3:41–45.
Schillaci O, Scopinaro F, Danieli R, et al.99Tcm-sestamibi scintimammography in patients with suspicious breast lesions: comparison of SPET and planar images in the detection of primary tumours and axillary lymph node involvement. Nucl Med Commun 1997; 18:839–845.
Tiling R, Tatsch K, Sommer H, et al. Technetium-99m-sestamibi scintimammography for the detection of breast carcinoma: comparison between planar and SPECT imaging. J Nucl Med 1998; 39:849–856.
Buscombe JR, Cwikla JB, Thakrar DS, Parbhoo SP, Hilson AJ. Prone SPET scintimammography. Nucl Med Commun 1999; 20:237–245.
Waxman AD. The role of99mTc methoxyisobutylisonitrile in imaging breast cancer. Semin Nucl Med 1997; 27:40–54.
Spanu A, Schillaci O, Meloni GB, et al. The usefulness of99mTc-tetrofosmin SPECT scintimammography in the detection of small size primary breast carcinomas. Int J Oncol 2002; 21:831–840.
Garin E, Devillers A, Girault S, et al. Scintimammography: better detection of small-sized lesions with tomoscintigraphic than planar images, a phantom study. Nucl Med Commun 2001; 22:1045–1054.
Mankoff DA, Dunnwald LK, Kinahan P. Are we ready for dedicated breast imaging approaches? J Nucl Med 2003; 44:594–595.
Brem RF, Schoonjans JM, Kieper DA, Majewski S, Goodman S, Civelek C. High-resolution scintimammography: a pilot study. J Nucl Med 2002; 43:909–915.
Gupta P, Waxman A, Nguyen K, et al. Correlation of Tc-99m sestamibi uptake with histopathologic characteristics in patients with breast diseases [abstract]. J Nucl Med 1996; 37:250P.
Khalkhali I, Vargas HI. The role of nuclear medicine in breast cancer detection: functional breast imaging. Radiol Clin North Am 2001; 39:1053–1068.
Horne T, Pappo I, Cohenpour M, Mindlin L, Orda R.99Tcm-MIBI scintimammography for the detection of breast malignancies: the contribution of the count ratio to specificity. Nucl Med Commun 1999; 20:511–516.
Buscombe JR, Kolasinska AD Cwikla JB Hilson,A.J.W. Does combining scintimammography and mammography in the primary breast cancers than mammography alone in the under-and over 50s? [abstract]. J Nucl Med 2002; 43:75P.
Prats E, Aisa F, Abos MD, et al. Mammography and 99mTc-MIBI scintimammography in suspected breast cancer. J Nucl Med 1999; 40:296–301.
Polan RL, Klein BD, Richman RH. Scintimammography in patients with minimal mammographic or clinical findings. Radiographics 2001; 21:641–653.
American College of Radiology. Breast imaging reporting and data system (BI-RADS), 2nd edn. Reston, Va: American College of Radiology, 1995.
Thurfjell E. Breast density and the risk of breast cancer. N Engl J Med 2002; 347:866.
Schillaci O, Scopinaro F, Danieli R, et al. Scintimammography with technetium-99m tetrofosmin in suspected breast cancer. Anticancer Res 1997; 17:1623–1626.
Schillaci O, Di Luzio E, Porfiri LM, et al. Role of Tc-99m sestamibi scintimammography in patients with indeterminate mammography due to dense breasts [abstract]. Eur J Nucl Med 1999; 26:986.
Cutrone JA, Khalkhali I, Yospur LS, et al. Tc-99m sestamibi scintimammography for the evaluation of breast masses in patients with radiographically dense breasts. Breast J 1999; 5:383–388.
Khalkhali I, Baum JK, Villanueva-Meyer J, et al.99mTc sestamibi breast imaging for the examination of patients with dense and fatty breasts: multicenter study. Radiology 2002; 222:149–155.
Tiling R, Khalkhali I, Sommer H, et al. Role of technetium-99m sestamibi scintimammography and contrast-enhanced magnetic resonance imaging for the evaluation of indeterminate mammograms. Eur J Nucl Med 1997; 24:1221–1229.
Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 2001; 220:13–30.
McMahon KE, Osborne DR, Davidson AL. Role of breast magnetic resonance imaging in difficult diagnostic situations. Med J Aust 2001; 175:494–497.
Marini C, Cilotti A, Traino AC, et al. Tc 99m-sestamibi scintimammography in the differentiation of benign and malignant breast microcalcifications. Breast 2001; 10:306–312.
Cwikla JB, Buscombe JR, Holloway B, et al. Can scintimammography with99mTc-MIBI identify multifocal and multicentric primary breast cancer? Nucl Med Commun 2001; 22:1287–1293.
Vargas HI, Agbunag RV, Kalinowski A, et al. The clinical utility of Tc-99m sestamibi scintimammography in detecting multicentric breast cancer. Am Surg 2001; 67:1204–1208.
Tillman GF, Orel SG, Schnall MD, Schultz DJ, Tan JE, Solin LJ. Effect of breast magnetic resonance imaging on the clinical management of women with early-stage breast carcinoma. J Clin Oncol 2002; 20:3413–3423.
Cwikla JB, Kolasinska A, Buscombe JR, Hilson AJ. Tc-99m MIBI in suspected recurrent breast cancer. Cancer Biother Radiopharm 2000; 15:367–372.
Yildiz A, Garipagaoglu M, Gungor F, Boz A, Dalmaz G. The role of technetium-99m methoxyisobutyl isonitrile scintigraphy in suspected recurrent breast cancer. Cancer Biother Radiopharm 2001; 16:163–169.
Spanu A, Farris A, Schillaci O, et al. The usefulness of99mTc tetrofosmin scintigraphy in patients with breast cancer recurrences. Nucl Med Commun 2003; 24:145–154.
Cwikla JB,Buscombe JR,Barlow RV, et al. The effect of chemotherapy on the uptake of technetium-99m sestamibi in breast cancer. Eur J Nucl Med 1997; 24:1175–1178.
Takamura Y, Miyoshi Y, Taguchi T, Noguchi S. Prediction of chemotherapeutic response by technetium 99m-MIBI scintigraphy in breast carcinoma patients. Cancer 2001; 92:232–239.
Maini CL, Tofani A, Sciuto R, et al. Technetium-99m-MIBI scintigraphy in the assessment of neoadjuvant chemotherapy in breast carcinoma. J Nucl Med 1997; 38:1546–1551.
Mankoff DA, Dunnwald LK, Gralow JR, Ellis GK, Drucker MJ, Livingston RB. Monitoring the response of patients with locally advanced breast carcinoma to neoadjuvant chemotherapy using [technetium 99m]-sestamibi scintimammography. Cancer 1999; 85:2410–2423.
Mezi S, Primi F, Capoccetti F, Scopinaro F, Modesti M, Schillaci O. In vivo detection of resistance to anthracycline based neoadjuvant chemotherapy in locally advanced and inflammatory breast cancer with technetium-99m sestamibi scintimammography. Int J Oncol 2003; 22:1233–1240.
Allen MW, Hendi P, Schwimmer J, Basset L, Gambhir SS. Decision analysis for the cost-effectiveness of sestamibi scintimammography in minimizing unnecessary biopsies. Q J Nucl Med 2000; 44:168–185.
Luce BR, Simpson K. Methods of cost-effectiveness analysis: areas of consensus and debate. Clin Ther 1995; 17:109–125.
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Schillaci, O., Buscombe, J.R. Breast scintigraphy today: indications and limitations. Eur J Nucl Med Mol Imaging 31 (Suppl 1), S35–S45 (2004). https://doi.org/10.1007/s00259-004-1525-x
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DOI: https://doi.org/10.1007/s00259-004-1525-x