Clinical applications of 99mTc-sestamibi scintimammography
Section snippets
Mechanisms of 99mTc-sestamibi tumoral uptake
In the early 1990s, 99mTc-sestamibi (Cardiolite or Miraluma; Bristol-Myers Squibb Medical Imaging, Billerica, MA) became commercially available and was proposed as an alternative agent to 201thallium for myocardial perfusion imaging studies. Taking advantage of the physical characteristics of the 99mTechnetium labeling, the transition from 201thallium to 99mTc-sestamibi for tumor imaging seemed natural. Muller and coworkers30 in 1987 were the first to report, in an abstract form, the use of 99m
Technical aspects of 99mTc-sestamibi scintimammography
The introduction of 99mTc-sestamibi in clinical research raised more technical questions than any other radionuclide breast imaging procedures did before.41, 42, 43 Although 99mTc-sestamibi scintimammography does not necessitate any specific patients preparation, technologist performing the injection and image acquisition is usually asked to explain the most important technical details to the patients to decrease their level of anxiety. The patient should remove all clothing and jewelry above
Clinical results with 99mTc-sestamibi scintimammography
Although few case reports have been initially described,81, 82, 83 the first study on the use of 99mTc-sestamibi in the detection of breast cancer to be performed in a relatively large number of patients has been reported in 1994. Khalkhali and coworkers41 conducted 99mTc-sestamibi scintimammography in 59 female patients with abnormal mammography and physical examination and scheduled for biopsy or fine-needle aspiration cytology. Prone lateral and posterior oblique planar images were obtained
Clinical applications of scintimammography
So far, the great majority of scintimammographic studies share the same inclusion criteria bias, which is the inclusion of patients having known breast lesion on either mammography or on physical examination with subsequent histopathologic correlation with fine needle, core biopsy, excisional biopsy or surgery. These initial studies had to be performed that way to establish the overall diagnostic accuracy of scintimammography with its advantages and limitations in terms of sensitivity,
Scintimammography in clinical practice
Now that the diagnostic accuracy of scintimammography has been assessed in different groups of patients, that its positive and negative predictive value are relatively high, and that the advantages and limitations of scintimammography are known, more specific studies are necessary to specify the clinical niches of this test. Taking into consideration the above-mentioned advantages of scintimammography clinical algorithms can be developed to position the test where it may act as a useful
Future applications and cost effectiveness
As previously stated, one of the major limiting factor of scintimammography is the spatial resolution of the standard gamma camera. No lesion measuring less than 5 to 7 mm has been detected so far with such imaging system. Given the recent enormous interest of the nuclear medicine community for breast imaging, different dedicated cameras specifically designed for scintimammography are currently under development and tested in various clinical sites. Different collimators, cameras (different
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