Clinical applications of 99mTc-sestamibi scintimammography

https://doi.org/10.1053/j.semnuclmed.2004.11.002Get rights and content

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.

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

References (106)

  • D.B. Kopans

    The positive predictive value of mammography

    AJR Am J Roentgenol

    (1992)
  • S.R. Pollei et al.

    Occult breast cancerPrevalence and radiographic detectability

    Radiology

    (1987)
  • L.W. Bassett et al.

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

    AJR Am J Roentgenol

    (1991)
  • L. Tabar et al.

    The Swedish two county trial of mammographic screening for breast cancerRecent results and calculation of benefit

    J Epidemiol Community Health

    (1989)
  • E.A. Sickles

    Mammographic features of early breast cancer

    AJR Am J Roentgenol

    (1984)
  • P.H. Niloff et al.

    False-negative mammograms in patients with breast cancer

    Can J Surg

    (1981)
  • J.E. Meyer et al.

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

    Radiology

    (1988)
  • B.D. Mann et al.

    Delayed diagnosis of breast cancer as a result of normal mammograms

    Arch Surg

    (1983)
  • D.D. Addler et al.

    New methods for imaging the breastTechniques, Findings and potential

    AJR Am J Roentgenol

    (1995)
  • K.P. Ryan et al.

    Breast cancer imaging with In-111 human IgM monoclonal antibodiesPreliminary studies

    Radiology

    (1988)
  • H.P. Kalofonos et al.

    Kinetics, quantitative analysis and radioimmunolocalisation using indium-111-HMFG1 monoclonal antibody in patients with breast cancer

    Br J Cancer

    (1989)
  • P. Major et al.

    Breast cancer imaging with mouse monoclonal antibodies

    Eur J Nucl Med

    (1989)
  • L.M. Lamki et al.

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

    J Nucl Med

    (1991)
  • D.M. Goldenberg et al.

    Radioimmunodetection in cancer identification

    J Nucl Med

    (1992)
  • D. Rosner et al.

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

    Cancer Invest

    (1995)
  • M. Granowska et al.

    Breast cancer 99mTc SM3 radioimmunoscintigraphy

    Acta Oncol

    (1996)
  • H.M. Abdel-Dayem et al.

    Role of 201Tl chloride and 99mTc sestamibi in tumor imaging

  • A.M. Sehweil et al.

    Mechanism of 201Tl uptake in tumours

    Eur J Nucl Med

    (1989)
  • A.D. Waxman et al.

    Thallium scintigraphy in the evaluation of mass abnormalities of the breast

    J Nucl Med

    (1993)
  • R. Taillefer

    Clinical applications of 99mTc-sestamibi scintimammography

    Semin Breast Dis

    (2002)
  • M. DeJong et al.

    Comparison of uptake of 99mTc-MIBI, 99mTc-Tetrofosmin and 99mTc-Q12 into human breast cancer line

    Eur J Nucl Med

    (1996)
  • L. Mansi et al.

    Breast imaging with 99mTc-tetrofosmin

  • S. Piccolo et al.

    Technetium-99m-methylene diphosphonate scintimammography to image primary breast cancer

    J Nucl Med

    (1995)
  • S. Piccolo et al.

    Scintimammography (SNM) with 99mTc-MDPAn overview of the experience at the National Cancer Institute of Napoli

    Tumori

    (1997)
  • S. Lastoria et al.

    Breast imaging with 99mTc-methylene-diphosphonate

  • S.T. Muller et al.

    Imaging of malignant tumors with Tc-99m MIBI SPECT

    Eur J Nucl Med

    (1987)
  • I.M. Hassan et al.

    Uptake and kinetics of Tc-99m hexakis 2-methoxy isobutyl isonitrile in benign and malignant lesions in the lungs

    Clin Nucl Med

    (1989)
  • C. Aktolun et al.

    Clinical experience with Tc-99m MIBI imaging in patients with malignant tumorsPreliminary results and comparison with T1-201

    Clin Nucl Med

    (1992)
  • M.L. Chiu et al.

    Effect of mitochondrial and plasma membrane potentials on accumulation of hexakis (2 methoxyisobutyl isonitrile) technetium in cultured mouse fibroblasts

    J Nucl Med

    (1990)
  • L.I. Delmon-Moingeon et al.

    Uptake of the cation hexakis (2-methoxy isobutylisonitrile)-technetium-99m by human carcinoma cell lines in vitro

    Cancer Res

    (1990)
  • D. Piwnica-Worms et al.

    Functional imaging of multidrug resistant P-glycoprotein with an organotechnetium complex

    Cancer Res

    (1993)
  • M.D. Cordobes et al.

    Technetium-99m-sestamibi uptake by human benign and malignant breast tumor cellsCorrelation with mdr gene expression

    J Nucl Med

    (1996)
  • J.L. Moretti et al.

    Primary breast cancer imaging with technetium-99m sestamibi and its relation with P-glycoprotein overexpression

    Eur J Nucl Med

    (1996)
  • P.D. Crane et al.

    Autoradiography and radioscintigraphy of technetium-99m-sestamibi in c-neu transgenic mice

    J Nucl Med

    (1995)
  • J. Maublant et al.

    In vitro uptake of Tc-99m teboroxime in carcinoma cell lines and normal cell linesComparison with Tc99m sestamibi and Tl-201

    J Nucl Med

    (1993)
  • V. Papantoniou et al.

    Uptake and washout of 99mTcV-dimercaptosuccinic acid and 99mTc-sestamibi in the assessment of histological type and grade in breast cancer

    Nuc Med Commun

    (2002)
  • I. Khalkhali et al.

    Prone scintimammography in patients with suspicion of carcinoma of the breast

    J Am Coll Surg

    (1994)
  • G. Lu et al.

    99mTc-MIBI mammoscintigraphy of breast massesEarly and delayed imaging

    Nucl Med Commun

    (1995)
  • Z. Burak et al.

    Evaluation of palpable breast masses with Tc99m MIBIa comparative study with mammography and ultrasonography

    Nucl Med Commun

    (1994)
  • R. Taillefer et al.

    Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement

    J Nucl Med

    (1995)
  • Cited by (0)

    View full text