The role of 99mTc-sestamibi and other conventional radiopharmaceuticals in breast cancer diagnosis

doi:10.1016/S0001-2998(99)80027-0

Seminars in Nuclear Medicine

Volume 29, Issue 1, January 1999, Pages 16-40

https://doi.org/10.1016/S0001-2998(99)80027-0 Get rights and content

The wide availability and the extensive use of screening mammography have resulted in an earlier diagnosis of breast cancer and in a significant reduction in the relative risk of dying from this disease. Despite technical improvements and major advantages associated with the use of mammography (and breast ultrasound), this procedure has some limitations in clinical practice, especially in women with dense breast tissue, implants, severe dysplastic disease, or significant architectural distorsion following breast surgery or radiation therapy. Different noninvasive imaging techniques have been evaluated to overcome these limitations. Nuclear medicine also has been actively involved in the detection of breast cancer, using various types of radiopharmaceuticals. Currently, there are three radiotracers commonly used for breast imaging or scintimammography in either clinical practice or research: ^99mTc-sestamibi and ^99mTc-tetrofosmin (two agents used for myocardial perfusion imaging) and ^99mTc-MDP (methylene diphosphonate, used for bone scintigraphy). ^99mTc-sestamibi was the first radiopharmaceutical to be approved by the FDA for scintimammography. Several prospective studies have shown that the overall sensitivity of ^99mTc-sestamibi scintimammography in detection of breast cancer was 85%, the specificity was 89%, and the positive and negative predictive values were 89% and 84% respectively. Similar numbers have been demonstrated for ^99mTc-tetrofosmin and ^99mTc-MDP scintimammography. Although not indicated as a screening procedure for the detection of breast cancer, scintimammography may play a useful and significant role in various specific clinical indications such as nondiagnostic or difficult mammography, and evaluation of high-risk patients, tumor response to chemotherapy, and axillary lymph node metastatic involvement.

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Dedicated breast gamma imaging uses semiconductor-based gamma cameras in a mammographic configuration to visualize the uptake of 99mTc-sestamibi. Sestamibi, originally developed as a cardiac tracer, is approved by the US Food and Drug Administration for breast cancer imaging, accumulating selectively in breast tumors rather than the surrounding normal breast tissue.4 There are 3 different commercially available dedicated gamma camera systems.
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In MBI, the radiotracer uptake is proportional to blood flow and mitochondrial activity as well as other physiologic factors, resulting in preferential uptake by cancer cells. The Food and Drug Administration initially approved the use of technetium-99m sestamibi for scintimammography in 1997, and although a conventional gamma camera was employed to image the breast at that time, the technology demonstrated good sensitivity and specificity for tumors larger than 15 mm.7,8 However, the inability to reliably image subcentimeter cancer and to directly compare to mammography markedly limited the integration of scintimammography into clinical practice.
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The role of 99mTc-sestamibi and other conventional radiopharmaceuticals in breast cancer diagnosis

Sem Nucl Med

Lancet

J Steroid Biochem

Cancer Letter

Semin Nucl Med

Nucl Med Biol

Am J Surg

Sem Nucl Med

The positive predictive value of mammography

AJR

Occult breast cancer: prevalence and radiographic detectability

Radiology

The prevalence of carcinoma in palpable versus impalpable, mammographically detected lesions

AJR

The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit

J Epidemiol Community Health

Mammographic features of early breast cancer

AJR

False-negative mammograms in patients with breast cancer

Can J Surg

Preoperative localization of clinically occult breast lesions: experience at a referral hospital

Radiology

Delayed diagnosis of breast cancer as a result of normal mammograms

Arch Surg

New methods for imaging the breast: techniques, findings and potential

AJR

Measurement of radioactive phosphorus in breast tumors in situ: a possible diagnostic procedure

Radiology

Breast Scintigraphy

Breast cancer imaging with mouse monoclonal antibodies

Eur J Nucl Med

Indium-111-labeled B72.3 monoclonal antibody in the detection and staging of breast cancer: a phase I study

J Nucl Med

Radioimmunoscintigraphy of metastatic breast carcinoma

Eur J Surg Oncology

Diagnosis of breast carcinoma with radiolabeled monocolonal antibodies (MoAbs) to carcinoembryonic antigen (CEA) and human milk fat globulin (MHFG)

Cancer Investigation

The use of monoclonal antibody 791T/36 in the immunoscintigraphy of primary and metastatic carcinoma of the breast

Clin Oncol

Dynamic indium-111-pentetreotide scintigraphy in breast cancer

J Nucl Med

Synthesis and pharmacological characterization of 4-[125I]-N-(N-Benzylpiperidinyl)-4-iodobenzamide: a high affinity receptor ligand for potential imaging of breast cancer

Cancer Res

Images of estrogen receptor-positive breast tumors produced by estradiol labeled with iodine I 123 at 16 alpha

Arch Surg

Tc-99m-DTPA breast scintigraphy: where does it stand?

Radiol Diagn

Breast scintigraphy with 99mTc-diethylene triamine penta-acetic acid for the detection of malignant disease

Br J Surg

Uptake of technetium-99m sulfur colloid by a breast carcinoma

Clin Nucl Med

Primary breast lymphoma detected with SPECT using Gallium-67-citrate

J Nucl Med

Breast cancer: PET imaging of estrogen receptors

Radiology

[18F] Fluorodeoxyglucose scintigraphy in diagnosis and follow-up of treatment in advance breast cancer

Eur J Nucl Med

Assessment of 21-[18F] Fluoro-16-ethyl-19-norprogesterone as a positron-emitting radiopharmaceutical for the detection of progestin receptors in human breast carcinomas

J Nucl Med

Positron emission tomography with fluorine-18-deoxyglucose in the detection and staging of breast cancer

Cancer

Evaluation of preoperative chemotherapy using PET with Fluorine-18-Fluorodeoxyglycose in breast cancer

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Clinical evaluation of tumor imaging with thallium-201 chloride

Radiology

Mechanism of 201 T1 uptake in tumours

Eur J Nucl Med

201T1 scintigraphy in the staging of lung cancer, breast cancer and lymphoma

Nu Med Comm

Thallium scintigraphy in the evaluation of mass abnormalities of the breast

J Nucl Med

A complementary role for thallium-201 scintigraphy with mammography in the diagnosis of breast cancer

J Nucl Med

Evaluation of palpable breast masses with 201T1 scintigraphy

Brit J Radiol

The use of thallium-201 in the preoperative detection of breast cancer: an adjunct to mammography and ultrasonography

Eur J Nucl Med

Imaging of malignant tumors with Tc-99m MIBI SPECT

Eur J Nucl Med

The role of ^99mTc-sestamibi and other conventional radiopharmaceuticals in breast cancer diagnosis