Comparison of 3 γ-probes for simultaneous iodine-125-seed and technetium-99m breast cancer surgery: NEMA standard characterisation with extended processing (original) (raw)
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Factors affecting cancer detectability in 99Tc MIBI scintimammography
Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 2003
Scintimammography shows strong potential in detecting and differentiating breast cancer. This scintigraphic technique, using a standard gamma camera, allows high sensitivity and specificity values (>95%) for detected tumors more than 1 cm size. However, the sensitivity of scintimammography using conventional gamma cameras is considerably less (40-50%) for tumors with smaller size. Recently, the authors demonstrated how the use of a small FOV dedicated gamma camera (Single Photon Emission Mammography, or SPEM camera), with very high intrinsic spatial resolution (1.7 mm FWHM), working with breast moderately compressed and positioned close to the breast tumor (i.e., analogously to X-ray mammography) increased sensitivity up to 80% for tumors sized between 0.5 and 1 cm (T1b). The aim of this paper is to demonstrate how the reduced breast thickness can play a primary role in small cancer detection. Five different methods were taken into account: clinical measurements, comparing tumor SNR values obtained from the same patients in prone scintimammography and in SPEM, comparing SNR values between compressed and uncompressed breast in craniocaudal projection, breast phantom measurements, Monte Carlo simulations and simplified theoretical model. Results confirm that the mechanism for the improvement in visualizing sub-centimeter lesions due to compression is a reduction of lesion-detector distance. As a result of this reduced distance there is a less reabsorption of signal by interposed breast tissue, and improved detector intrinsic spatial resolution.
Evaluation of surgical gamma probes for radioguided sentinel node localisation
European Journal of Nuclear Medicine and Molecular Imaging, 1998
By using a surgical gamma probe after peritumoral injection of a radioactive tracer, the surgeon can identify the sentinel, or first, nodal site of regional metastasis in clinically node-negative patients. In the near future, the pathological status of this node will have an important impact on the treatment strategy in breast cancer and melanoma patients. This article reviews the necessary requirements for the instrument, such as: absolute sensitivity, spectral resolution, angular sensitivity and response ratio to the radioactive source at depth. In addition, ergonomic characteristics are important. The surgeon must consider the above characteristics, as they influence operational handling. Four commercially available surgical gamma probes were subjected to laboratory tests to appraise the extent to which they fulfilled these criteria. The results for each gamma probe are summarised and discussed.
European Journal of Nuclear Medicine and Molecular Imaging, 2004
The aim of this study was to evaluate the feasibility of sentinel node (SN) biopsy in occult breast lesions with different radiopharmaceuticals and to establish the optimal lymphoscintigraphic method to detect both occult lesions and SNs (SNOLL: sentinel node and occult lesion localisation). Two hundred and twenty-seven consecutive patients suspected to have clinically occult breast carcinoma were enrolled in the study. In addition to the radioguided occult lesion localisation (ROLL) procedure, using macroaggregates of technetium-99m labelled human serum albumin (MAA) injected directly into the lesion, lymphoscintigraphy was performed with nanocolloids (NC) injected in a peritumoral (group I) or a subdermal site (group II). In group III, a sole injection of NC was done into the lesion in order to perform both ROLL and SNOLL. Overall, axillary SNs were identified in 205 of the 227 patients (90.3%). In 12/62 (19.4%) patients of group I and 9/79 (11.4%) patients of group III, radioactive nodes were not visualised, whereas SNs were successfully localised in 85 of 86 patients of group II (P<0.001). Pathological findings revealed breast carcinoma in 148/227 patients (65.2%) and benign lesions in 79 (34.8%). A total of 131 axillary SNs were removed in 118 patients with breast carcinoma; intraoperative examination of the SNs revealed metastatic involvement in 16 out of 96 cases of invasive carcinoma (16.7%). It is concluded that the combination of the ROLL procedure with direct injection of MAA into the lesion and lymphoscintigraphy performed with subdermal injection of radiocolloids represents the method of choice for accurate localisation of both non-palpable lesions and SNs.
Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment, 2006
High-resolution (HR) gray detector 99m Tc Bombesin (99m TcBN) and 99m Tc sestamibi (99m TcSM), have been used to drive Mammotome biopsy after fusion of scintigraphic with digital X-ray images. We studied eight patients with class V microcalcifications. An HR detector with spatial resolution of 3 mm was matched with Mammotome biopsy system provided with Fisher digital X-ray device: images were fused to use the pointer indifferently on X-ray, scintigraphic and fused images. Fusion between X-ray and HR image has previously been reported. The 12 Mammotome samples/patient were weighted and counted in a well counter. Tumour/bkg (T/B) ratio was measured on HR images as well as on biopsy samples. Axilla was also explored with the portable HR device in order to diagnose node invasion. Conventional histology assessment and immunohystochemical study with anti BN receptor antibody was blindly performed on samples. All the patients studied with 99m TcSM showed T1b cancer, 99m TcBN detected one T1a and two T1b cancers. HR scan of axilla detected node metastases in two patients, both studied with 99m TcBN. All the biopsies showed cancer on at least one of the 12 samples. Histology found node metastases in three patients: the two 99m TcBN positive and one studied with 99m TcSM whose axilla was negative at HR scan. Samples showed T/B ratio of 6.670.4 for 99m TcSM and 11.370.9 for 99m TcBN (po0.01). Note that also the patient with T1a cancer, showing 10.4 T/B ratio was included in the 99m TcBN series. Not only 99m TcBN HR is able to show breast cancer and to guide biopsy, but also detects node metastases. Our is the first ex vivo measurement of T/B ratio of 99m TcBN on humans.
Technetium-99m-MIBI scintimammography for suspicious breast lesions
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1996
The aim of this study was to evaluate the diagnostic accuracy of scintimammography with 99mTc-MIBI in patients with suspected primary breast cancer as monitored by SPECT or planar imaging. Patients with a suspect lesion detected by palpation or mammography were entered in the study. Excisional biopsy was performed on all patients and a mammography was performed within three weeks prior to scintigraphy. All patients received intravenously 740 MBq 99mTc-MIBI in the arm, contralateral to the suspicious breast, and were subsequently examined in a prone position. At 5-10 min postinjection, planar images were obtained in both the lateral and anterior views with an acquisition time of 10 min. After planar imaging, SPECT imaging was performed using a two-head high-resolution gamma camera. In the total patient group of 54 patients, 40 lesions were palpable and 14 were nonpalpable but were detected by mammography. Breast cancer was confirmed in 24 of the patients and 20 of the palpable masses...
99mTc-MIBI scintimammography using a dedicated nuclear mammograph
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1999
This study reports on a prototype single-photon emission mammograph (SPEM) dedicated to 99mTc-hexakis-2-methoxyisobutile isonitrile (MIBI) scintimammography. Main technical features are reported together with physical performance. Preliminary patient data are also reported. The SPEM detector head is composed of a CsI(T1) scintillating array coupled to a Hamamatsu R3292 position-sensitive photomultiplier tube with crossed-wire anode. The high-resolution collimator is 35-mm thick with a 1.7-mm hole diameter and a 0.2-mm septal thickness. The electronic acquisition system is composed of five integrated cards with computation based on high-speed programmable microprocessors. The readout electronics include correction maps for on-line energy correction and spatial uniformity. The small size of the detector head allows the use of mechanical breast compression to minimize detection distance and tissue scatter. After physical SPEM performance evaluation in vivo scintimammography was perform...
International prospective evaluation of scintimammography with 99mTechnetium sestamibi
The American Journal of Surgery, 2003
The purpose of this study is to evaluate the efficacy of scintimammography with 99m Technetium-Sestamibi for the diagnosis of breast cancer. Methods: This was a multicenter prospective cohort clinical trial. A total of 1,734 women were enrolled of whom 1,243 had complete data upon study completion. Results: The mean Ϯ standard error age of the patients is 56 Ϯ12 years (with a range of 19 to 94). Mammographic results were classified by the Breast Imaging Reporting and Data System (BIRADS) as 199 (16%) BIRADS 5, 149 (12%) BIRADS 4, 199 (16%) BIRADS 3, and 696 (56%) BIRADS 2 or 1. Scintimammography was positive for 322 (26%) of the patients and negative for 921 (76%). Histopathology showed malignancy for 201 (16%) of the patients. Sensitivity and specificity of scintimammography was estimated 93% and 87% respectively. A positive predictive value (PPV) of 58% with a negative predictive value of 98% were calculated. Conclusions: The present study suggests that scintimammography with 99m Technetium-Sestamibi is highly accurate for the detection of breast cancer.
We evaluated the clinical usefulness of single-photon emission tomography (SPET) with technetium-99m sestamibi and indium-ll 1 pentetreotide in breast cancer staging. Fifteen patients with clinical and/or mammographic findings suggesting T1-2N0-1 breast cancer were studied. SPET images were acquired 20 rain after 99mTc-sestamibi injection and 4 and 24 h after 111In-pentetreotide injection. Patients underwent surgery the day after the later l llIn-pentetreotide acquisition. Pathological examination showed 16 tumours in the 15 patients, with one bilateral carcinoma. The mean tumour diameter was 18.7 ram. Metastatic axillary involvement was found in 6/16 tumours, with a mean of five meta-static nodes per axilla. Both tracers correctly identified 15/16 primary tumours and five of the six cases of meta-static axillary node involvement. No difference between the tracers was observed in breast cancer staging. 99mTc-sestamibi seems to be the better tracer in terms of physical characteristics, execution time and cost-effectiveness. Our data suggest the future possibility of using nuclear medicine imaging to avoid axillary dissection in patients with T1 breast cancer.
Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine, 1998
was 85% (81% for planar SMM plus FBP-SPECT) with a specificity of 72%. Three carcinomas indeterminate on planar SMM were correctly identified by combined planar SMM plus ISA-SPECT. ISA-SPECT and FBP-SPECT provided additional information to planar SMM with respect to localization of sestamibi uptake, tumor extent, improved diagnostic certainty and detection of axillary nodes in 40 and 14 patients, respectively. Conclusion: ISA recon struction is the preferable approach to SPECT data. Combined with planar SMM, ISA-SPECT can improve sensitivity. SPECT is useful in cases of indeterminate and positive planar SMM.
Breast Care, 2016
Background: Sentinel lymph node (SLN) has become the gold standard for all cases with no axillary nodal metastasis. The combined radioisotope and blue dye technique is adopted in most centers. The lack of the technology for radioisotope in our institution encouraged us to study the feasibility of methylene blue (MB) for SLN detection in breast cancer patients admitted to Alexandria Surgical Oncology Unit. Methods: A total of 144 cases were subjected to SLN detection by injecting 2 ml of MB 1%. This was followed by standard axillary lymph node dissection. The safety and accuracy of MB as a tracer for detection of SLN were studied. Results: The identification rate was 93.15%. The number of SLN identified ranged from 1 to 8 nodes with a mean of 1.75 ± 1.17. The sensitivity of MB dye technique was 96.3%. The false negative rate was 3.7%. The negative predictive value was 97.6% and the accuracy was 98.5%. Conclusions: MB is a safe, reliable, cheap, and accurate alternative tracer for det...