Elsevier

Academic Radiology

Volume 14, Issue 8, August 2007, Pages 945-950
Academic Radiology

Original investigation
Detection of Ductal Carcinoma in Situ with Mammography, Breast Specific Gamma Imaging, and Magnetic Resonance Imaging: A Comparative Study1

https://doi.org/10.1016/j.acra.2007.04.004Get rights and content

Rationale and Objectives

To evaluate the sensitivity of high-resolution breast-specific gamma imaging (BSGI) for the detection of ductal carcinoma in situ (DCIS) based on histopathology and to compare the sensitivity of BSGI with mammography and magnetic resonance imaging (MRI) for the detection of DCIS.

Materials and Methods

Twenty women, mean 55 years (range 34–76 years), with 22 biopsy-proven DCIS were retrospectively reviewed. After injection of 25–30 mCi (925–1,110 MBq) technetium 99m-sestamibi, patients had BSGI with a high-resolution, small-field-of-view gamma camera in craniocaudal and mediolateral oblique projections. BSGI studies were prospectively classified according to focal radiotracer uptake using a 1 to 5 scale, as normal 1), with no focal or diffuse uptake; benign 2), with minimal patchy uptake; probably benign 3), with scattered patchy uptake; probably abnormal 4), with mild focal radiotracer uptake; and abnormal 5), with marked focal radiotracer uptake. Imaging findings were compared to findings at biopsy or surgical excision. The sensitivity of BSGI, mammography, and when performed, MRI were determined for the detection of DCIS. Breast MRI was performed on seven patients with eight biopsy-proven foci. The sensitivities were compared using a two-tailed t-test and confidence intervals were determined.

Results

Pathologic tumor size of the DCIS ranged from 2 to 21 mm (mean 9.9 mm). Of 22 cases of biopsy-proven DCIS in 20 women, 91% were detected with BSGI, 82% were detected with mammography, and 88% were detected with magnetic resonance imaging. BSGI had the highest sensitivity for the detection of DCIS, although this small sample size did not demonstrate a statistically significant difference. Two cases of DCIS (9%) were diagnosed only after BSGI demonstrated an occult focus of radiotracer uptake in the contralateral breast, previously undetected by mammography. There were two false-negative BSGI studies

Conclusions

BSGI has higher sensitivity for the detection of DCIS than mammography or MRI and can reliably detect small, subcentimeter lesions.

Section snippets

Materials and methods

Between July 2001 and July 2006, 290 underwent clinically indicated BSGI for equivocal or suspicious mammographic findings. Twenty nonpregnant women, mean 55 years (range 34–76 years), were diagnosed with pure DCIS after definitive biopsy or at surgical excision. Retrospective review of these 20 women was performed and constitutes the study population.

BSGI was performed before biopsy to further evaluate an indeterminate breast finding and after biopsy demonstrating DCIS to evaluate for occult

Results

Twenty women with 22 biopsy-proven DCIS lesions were included. DCIS was bilateral in two women, in the right breast in 8 women and in the left breast in 10 women. Pathologic tumor size was available in nine cases, ranging from 2 to 21 mm (mean 9.9 mm). Four DCIS lesions were less than 5 mm in size, two 6–10 mm in size, two 11–20 mm in size, and one greater than 20 mm in size. Of the remaining tumors, 12 were extensive within the breast and size could not be determined; the final DCIS lesions

Discussion

Screening and diagnostic mammography currently are the gold standard for detecting DCIS despite a variable reported sensitivity of 22%–86% (2–5). Microcalcifications are the most common finding, detected in 73%–98% of DCIS, and typically evaluated by vacuum-assisted biopsy using stereotactic guidance (5). Because of the reported low specificity and positive predictive value of mammography, there is a need for adjunct imaging modalities to complement mammography in detection and evaluation of

Acknowledgments

The authors would like to thank Joyce Raub, MS, for performing the BSGI studies and maintaining the patient database. The authors also are grateful for the statistical analysis performed by Shira Fishman, MS, and Kristen Dixon for assistance with manuscript revision.

References (11)

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1

Bristol-Myers Squibb (Billerica, MA) provided grant support for the study and offered the radiotracer as an in-kind donation. No authors are employed by Bristol-Myers Squibb or Dilon Technologies. R.F.B. has stock options in Dilon Technologies and recently joined the Board of Managers and has been on the speaker’s bureau for Bristol-Myers Squibb (previously DuPont Pharmaceuticals). No other authors have any other relationship with Bristol-Myers Squibb or Dilon Technologies. The data reported in this study, as well as the submission of this manuscript, always remained in sole possession of the authors.

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