Scintimammography in the diagnosis of breast cancer

doi:10.1016/S0002-9610(96)00225-5

The American Journal of Surgery

Volume 172, Issue 5, November 1996, Pages 483-486

https://doi.org/10.1016/S0002-9610(96)00225-5 Get rights and content

Background

Mammography has a positive predictive value in the detection of breast cancer of 15% to 25%. Ten percent of patients with breast cancer present with normal mammograms; however, the false negative rate is increased in younger patients. The purpose of this study was to evaluate the effectiveness of Tc-99m Sestamibi imaging in the diagnosis of breast disease.

Methods

Images were collected on 147 women. Patients were evaluated with a combination of physical examination, sonography, and mammography. Each patient received 20 millicuries of Tc-99m Sestamibi intravenously. Anterior and lateral images were obtained, the latter with the patient prone and the breast in the dependent position.

Results

One hundred seven patients showed no enhancement (negative scan). Seven of these patients were found at biopsy to have carcinoma. Five had ductal carcinoma in-situ (DCIS) with no associated mass, 1 had an incidental 3 mm focus of invasive ductal carcinoma (IDC), and 1 had a 5-cm cystic lesion with IDC. Forty-one patients showed focal enhancement on their scans (positive scan). Thirty-six were found to have either invasive or in-situ cancer. Four of the 5 patients with benign findings had sclerosing adenosis. The positive and negative predictive values for scintimammography in this group of patients were 88% and 93%, respectively. The sensitivity and specificity were 84% and 95%, respectively.

Conclusions

We conclude that scintimammography is a highly specific test that deserves study as a modality to further refine the indications for breast surgery.

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Cited by (36)

Clinical applications of <sup>99m</sup>Tc-sestamibi scintimammography
2005, Seminars in Nuclear Medicine
Citation Excerpt :
It is likely that with the use of dedicated breast imager and/or imaging devices adapted for SPECT imaging, this procedure will play a more significant clinical role. Table 1 summarizes the results of different studies published in the medical literature on 99mTc-sestamibi scintimammography.50–80 There is no significant statistical difference between planar and SPECT 99mTc-sestamibi breast imaging in detection of breast cancer.
Mammography is the imaging modality of choice in detection of early, nonpalpable breast cancer. However, scintimammography may prove to be a very useful adjunct to a nondiagnostic or difficult mammography. Future prospective studies will have to be designed so that the specific clinical applications of scintimammography will be well defined. To be clinically relevant, each niche where scintimammography is potentially indicated should be clearly evaluated and incorporated into an algorithm of investigation of breast cancer, taking into consideration the relative advantages and limitations of scintimammography. Special care to obtain high-quality scintimammographic studies is mandatory. Because poor quality studies may be the major drawback, the nuclear medicine community should remind the lesson learned from radiologic mammography. Furthermore, it is also hoped that significant improvement in the scintigraphic equipment and data acquisition will be seen in a very near future to have more widespread clinical diagnostic applications of scintimammography.
Evaluation of a high-resolution, breast-specific, small-field-of-view gamma camera for the detection of breast cancer
2003, Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment
Purpose: The purpose of our study is to review the state of the art in nuclear medicine imaging of the breast (scintimammography) and to evaluate a novel, high-resolution, breast-specific gamma camera (HRBGC) for the detection of suspicious breast lesions.
Materials and Methods: Fifty patients with 58 breast lesions in whom a scintimammogram was clinically indicated were prospectively evaluated with a general-purpose gamma camera and a HRBGC prototype. Nuclear studies were prospectively classified as negative (normal/benign) or positive (suspicious/malignant) by two radiologists, blinded to mammographic and histologic results with both the conventional and high-resolution. All lesions were confirmed by pathology.
Results: Included in this study were 30 benign and 28 malignant lesions. The sensitivity for detection of breast cancer was 64.3% (18/28) with the conventional camera and 78.6% (22/28) with the HRBGC. Specificity of both systems was 93.3% (28/30). In the 18 nonpalpable cancers, sensitivity was 55.5% (10/18) and 72.2% (13/18) with the general-purpose camera and HRBGC, respectively. In cancers ≤ 1cm, 7of 15 were detected with the general-purpose camera and 10 of 15 with the HRBGC. Four of the cancers (median size, 8.5 mm) detected with the HRBGC were missed by the conventional camera
Conclusion: Evaluation of indeterminate breasts lesions with a high resolution, breast-specific gamma camera results in improved sensitivity for the detection of cancer with greater improvement demonstrated in nonpalpable and ≤1 cm cancers.
Occult breast cancer. Detection and radioguided surgery with <sup>99m</sup>Tc-MIBI
2003, Revista Espanola de Medicina Nuclear
Incluimos en el grupo de carcinoma oculto de mama a aquellas pacientes que se presentan con una metástasis aislada en un ganglio axilar. Presumiblemente, la formación primaria es un carcinoma primitivo de mama, hasta ese momento insospechado y no demostrable clínicamente ni tampoco mediante la mamografía o ecografía. Si ningún método logra confirmar el tumor primario, generalmente este grupo es tratado asumiendo la existencia de un carcinoma oculto de mama. La confirmación de la lesión primaria ha sido buscada mediante varios métodos diagnósticos. La RM (Resonancia Magnética), el PET (Positron Emission Tomography) y hasta el ecodoppler han sido empleados con ese fin, y diversos trabajos presentan resultados alcanzados con los mismos. Nuestro grupo incorpora a la sistemática de estos pacientes la detección y cirugía radioguiada con MIBI (Methoxy Iso Butil Isonitrilo)-^99mTecnecio. Efectuamos una gammagrafía planar y SPECT (Single Photon Emision Computer Tomography) de mama, utilizando el ^99mTc-MIBI como radiotrazador, y en el caso que el procedimiento radioisotópico muestre una imagen funcional compatible con un carcinoma, se lleva a cabo la detección radioguiada intraquirúrgica con detector gamma portátil de la formación descubierta y su pertinente extirpación. En el presente trabajo, mostramos la aplicación del método en 5 casos; se describe la técnica y sus alcances; se exponen sus ventajas en comparación con otros métodos; se comunican los valores dosimétricos encontrados en la realización de la técnica. Consideramos que incorporar la detección y cirugía radioguiada con ^99mTc- MIBI en el diagnóstico y tratamiento del carcinoma oculto de mama, añade una herramienta eficaz e implica un progreso en el abordaje de esta patología.
We include those patients who present with an isolated metastasis of axillary adenopathy in the occult primary breast cancer group. Presumably, the primary tumor is a primitive breast carcinoma, unsuspected until this moment and not clinically demonstrable by mammography or ultrasonography. When no method succeeds in confirming the primary breast lesion, the patients are usually treated assuming the existing of breast cancer. Several diagnostic methods have been used to find the primary breast lesion. Magnetic Resonance imaging (MRI), Positron Emission (PET) and Doppler sonography have been used in this way and several papers present the results reached with them. Our group incorporates detection and radioguided surgery with ^99mTechnetium (^99mTc) methoxyisobutil isonitrile into the study of these patients. Whe perform a planar scintimammography and SPECT (Single Photon Emission Computed Tomography) with ^99mTc-MIBI. If the radioisotopic method shows a functional image compatible with a carcinoma, a gamma detecting probe is then used to locate the lesion and guide its surgical removal. In this paper, we present the application of the technique in 5 cases and describe the technique and its possibilities. Its advantages are explained in comparison with other methods. The dosimetric values found in the performance of the technique are reported. We consider that detection and radioguided surgery with ^99mTc-MIBI in the diagnosis and treatment of occult breast cancer adds an effective tool and means progress in the approach to this disease.
A review of the cost-effectiveness of Tc-99m sestamibi scintimammography in diagnosis of breast cancer in Taiwanese women with indeterminate mammographically dense breast
2002, Surgical Oncology
In general, biopsy is the preferred management method for women with indeterminate mammographically dense breasts. In this review, we describe a decision analysis model comparing technetium-99m methoxyisobutylisonitrile (Tc-99m sestamibi) scintimammography and excisional biopsy as breast cancer evaluation strategies for hypothetical cohorts of estimated 16,000–40,000 women with indeterminate mammographic probability of malignancy because of mammographically dense breasts. In cost-effectiveness analysis, quantitative decision tree sensitivity analysis was used to compare the conventional excision biopsy alone strategy (strategy A) with decision strategy for screening with Tc-99m sestamibi scintimammography before excision biopsy (strategy B) after an indeterminate mammogram. Strategy B showed a cost saving of US dollars 649,600–1,624,000 in reducing the cost of unnecessary biopsies. The total cost of strategy B showed a cost saving of US dollars 123,075–307,776 compared to strategy A. The analysis data indicate that Tc-99m sestamibi scintimammography can save the cost of unnecessary biopsies in Taiwanese women with non-diagnostic mammogram because of mammographically dense breasts.
The role of Tc99m-sestamibi scintimammography in combination with the triple assessment of primary breast cancer
2002, European Journal of Surgical Oncology
Aim: The aim of this study was to evaluate if Tc99m-sestamibi scintimammography in addition to the triple assessment consisting of clinical examination, mammography, breast ultrasonography and fine needle aspiration cytology (FNA) enhances the diagnosis of breast cancer and helps in avoiding unnecessary operative biopsies. Methods: Pre-operational scintimammography was performed within 2 weeks of operation to 46 consecutive patients with abnormal findings in clinical breast examination, mammography or ultrasonography. Three patients had abnormalities in both breasts. Histological diagnosis was obtained in all 49 cases. Results: The histological diagnosis was benign in 18 (37%) cases and malignant in 31 (63%) cases. The overall sensitivity of scintimammography was 77% and the specificity was 61%. The sensitivity of scintimammography was 95% in invasive ductal carcinoma, 50% in invasive lobular carcinoma and 25% in ductal carcinoma in situ. Scintimammography showed 100% sensitivity in cases with invasive carcinoma, with highly suspicious findings for malignancy in the other examinations. The sensitivity was 63% in cases with indeterminate or contradictory findings in mammography, ultrasonography and FNA. Conclusions: Adding scintimammography to the triple assessment does not seem to be helpful in the diagnosis of breast abnormalities because of low sensitivity in malignant cases with a challenging diagnosis by mammography, ultrasonography and FNA, and because of low overall specificity.
Nuclear medicine in primary breast cancer imaging
2002, Clinical Radiology
The application of nuclear medicine techniques to study patients with breast cancer has recently raised its profile, particularly in the investigation ‘indeterminate mammographic lesions’. This review briefly points out some of the difficulties encountered with other more conventional imaging modalities and describes the radionuclide techniques most frequently employed in the investigation of those patients with breast cancer. Both planar and single photon emission tomography methods are discussed including the use of monoclonal antibodies, perfusion ligands, receptor binding hormones and other specific radiotracers, non-specific tumour markers, as well as deoxyglucose and other amino acids labelled with positron emitting radionuclides.Gopalan, D. etal. (2002) Clinical Radiology57, 565–574.

View all citing articles on Scopus

^**: Presented at the 48th Annual Meeting of the Southwestern Surgical Congress, Scottsdale, Arizona, April 28–May 1, 1996.

View full text

Scintimammography in the diagnosis of breast cancer**

Background

Methods

Results

Conclusions

Cancer s tatistics CA

Cancer J Clin

The lifetime risk of devel-oping breast cancer

JNCI

Case control study of factors associated with failure to detect breast cancer by mammography

JNCI

Lawsuits for failure diagnose breast cancer: tumor biology in causation and risk management strategies

Surg Oncol Clin N Am

The abnormal mammogram, Radiographic findings, diagnostic options, pathology and stage of cancer diagnosis

Cancer

Technitium-99m uptake by recurrent Hurtle cell carcinoma of the thyroid

J Nucl Med

Preoperative localization of parathyroid carcinoma using Tc-99m MIBI

Clin Nucl Med

SPECT imaging of pediatric brain tumor with hexakis methoxyisobutyl isonitrile 99m technitium

J Nucl Med

Age as a prognostic factor in breast cancer

Cancer

Breast cancer detection and death rates among women age 40–49 years

Can Med Assoc J

Breast cancer detection in an institution: is mammography detrimental?

Cancer