Scintimammography - Molecular Imaging: Value and New Perspectives with 99mTc(V)-DMSA (original) (raw)
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Role of scintimammography in the diagnosis of breast cancer
The Malaysian journal of medical sciences : MJMS, 2006
X-ray mammography has been the backbone of early detection of breast cancer. Several large scale systematic studies have shown that judicious use of X-ray mammography can indeed save life. However, though reasonably sensitive, X-ray mammography lacks in specificity leading to many unnecessary biopsies. Scintimammography is a relatively new imaging method to demonstrate cancer tissue in the breast. A radiopharmaceutical agent (Tc-99m Sestamibi) is administered intravenously and images of the breast are taken under a Gamma Camera. There is no need for any manipulation like compression of the breast as required to be done during mammography. The radiopharmaceutical accumulates in the breast in the presence of cancer tissue which can easily be seen in the images. The affinity of the cancer tissue to this radiopharmaceutical is up to 9 times in comparison to normal breast tissue. Several multi centric studies with blinded image interpretation have established the sensitivity and specific...
The Breast, 2001
The aim of this work has been to evaluate the clinical usefulness of 99m Tc-MIBI scintimammography, used as a complement to mammography, in the study of patients with suspected breast cancer. We performed prone breast scintigraphy in 253 patients (268 lesions) with suspected breast cancer. The size and degree of the suspected breast cancer was evaluated by mammography. Diagnosis was established by biopsy. Malignancy was diagnosed in 155 lesions and benign diseases in 113. The results of the scintimammography were a sensitivity of 91%, a specificity of 71%, PPV=81% and NPV=85%. In lesions smaller than 1 cm, sensitivity and specificity were 57% and 100%; in lesions with a diameter of between 1 and 2 cm, these figures were 90% and 72% respectively, and in lesions of more than 2 cm the sensitivity was 99% and the specificity 50%. On mammography, 155 lesions were considered as having a high suspicion of malignancy, whilst 72 were indeterminate and 41 had a low probability. In lesions with a low or indeterminate suspicion of malignancy on mammography, the sensitivity and NPV of the scintimammography were 97% and 98%. Scintimammography is a useful technique in the study of lesions where breast cancer is suspected. Scintimammography results are closely related to tumour size and the degree of mammographic suspicion. Scintimammography can be useful where mammography identifies lesions with a low or indeterminate suspicion of malignancy.
European Journal of Nuclear Medicine, 1996
The aim of the trial was to determine the diagnostic accuracy of scintimmammography with technetium-99m methoxyisobutylisonitrile ( 99m Tc-MIBI) in the detection of primary breast cancer and to verify its clinical usefulness. A total of 246 patients with a suspicious breast mass or positive mammogram were included in this prospective European multicentre trial. At 5 min and 60 min (optional) p.i. two lateral prone images were acquired for 10 min each; 30 min p.i. one anterior image was acquired for 10 min. There were 253 lesions (195 palpable and 58 non-palpable), in respect of which histology revealed 165 cancers and 88 benign lesions. Institutional and blinded read results were correlated to core laboratory histopathology results obtained during excisional biopsy. Diagnostic accuracy for the detection of breast cancer was calculated per lesion. The overall sensitivity and specificity of blinded read scintimammography were 71% and 69%, respectively. For palpable lesions, the sensitivity of blinded read and institutional read scintimammography was 83% and 91%, respectively. Sensitivity was not dependent on the density of the breast tissue. Invasive ductal and invasive lobular cancers showed similar sensitivity. The sensitivity and specificity of mammography were 91% and 42%, respectively, and did not depend on the tumour size. In 60% of false-negative mammograms, 99m Tc-MIBI was able to diagnose malignancy (true-positive). High-quality imaging with 99m Tc-MIBI has a high diagnostic accuracy for the detection of primary breast cancer. Used as a complementary method, scintimammography with 99m Tc-MIBI can help to diagnose breast cancer at an earlier stage in patients with dense breasts.
Initial evaluation of breast cancer using Tc-99m sestamibi scintimammography
European Journal of Radiology, 2005
Aim: Aim of the study was to elaborate on the diagnostic role of Tc-99m sestamibi scintimammography (SMM) in the initial diagnosis of breast cancer, partially in comparison to MRI. The study presents an update of previously published data. Materials and methods: Out of a total of 464 scintimammograms findings of 252 studies were correlated with the histopathologic outcome. A subgroup of 68 patients with indeterminate preliminary diagnosis underwent additional MRI. SMM and MRI findings were correlated to the final hisopathological outcome. Results: Overall sensitivity and specificity for SMM were 84 and 85%, respectively. Depending on tumor size sensitivity ranged from 60% for stage pT1a,b carcinomas to 94% stage pT1c or higher. In the subgroup with indeterminate preliminary diagnosis sensitivity of SMM decreased to 76% which was lower as compared to MRI (84%). Specificity of SMM was 86% in this subgroup which was evidently higher as compared to MRI (51%). Conclusion: SMM has severe limitations in the diagnosis of small carcinoma and therefore should not be used for breast cancer screening. SMM can be used to further evaluate indeterminate or probably benign mammographic findings, especially when conventional mammography is inconclusive due to dense breast tissue.
International Journal of Oncology, 2002
The aim of this study was to evaluate the usefulness of supine 99m Tc-tetrofosmin SPECT in the detection of small size breast carcinomas (BC), for which planar scintimammo graphy has showed a low sensitivity. We studied 93 patients with breast lesions <10 mm, 69 with BC (14 Tla and 55 Tib, 39 palpable and 30 non-palpable) and 24 with benign lesions (16 palpable and 8 non-palpable). All patients had previously undergone clinical examination and mammography. Ten min after 740 MBq 99m Tc-tetrofosmin i.v. injection, both planar and SPECT (360°; angular step: 3°; acquisition time/frame: 30 sec) scintimammography were performed in all patients using a rectangular dual head gamma camera equipped with HR parallel-hole collimators. In all patients the scintigraphic data were related to histology. In the 69 BC patients, SPECT showed a significantly higher overall sensitivity than planar (89.8% vs. 46.4%; p<0.0005). SPECT gave a higher sensitivity than planar in both Tla (71.4% vs. 35.7%) and Tib (94.5% vs. 49.1%) carcinomas, and in the latter the difference was statistically significant (p<0.0005). SPECT sensitivity was also significantly higher in palpable (94.9% vs. 48.7%; p<0.0005) and non-palpable (83.3% vs. 43.3%; p<0.005) carcinomas. SPECT and planar imaging showed the same specificity (95.8%). SPECT showed a significantly higher overall negative predictive value and accuracy than planar (76.7% vs. 38.3% and 91.4% vs. 59.1%, respectively; p<0.0005). In our series mammography sensitivity, specificity and accuracy were 94, 36.8 and 81.4%, respectively. 99m Tc-tetrofosmin SPECT is a
Mayo Clinic Proceedings, 2005
2 4 MOLECULAR BREAST IMAGING ORIGINAL ARTICLE Fro m the De partme nt o f Inte rnal Me dic ine and Divis io n o f Pre ve ntive and Oc c upatio nal Me dic ine (D.J.R.), De partme nt o f Radio lo gy (M.K.O., S.W.P., D.A.C.), and De partme nt o f Inte rnal Me dic ine and Divis io n o f Ge ne ral Inte rnal Me dic ine (R.L.S.), Mayo Clinic Co lle ge o f Me dic ine , Ro c he s te r, Minn. This wo rk was funde d in part by a grant fro m Ge ne ral Ele c tric Me dic al Sys te ms , Wauke s ha, Wis . No ne o f the autho rs have a financ ial invo lve me nt with any o rganizatio n o r e ntity that has a financ ial inte re s t in the s ubje c t matte r dis c us s e d in this artic le . Addre s s re print re que s ts and c o rre s po nde nc e to De bo rah J. Rho de s , MD, Divis io n o f Pre ve ntive and Oc c upatio nal Me dic ine , Mayo Clinic Co lle ge o f Me dic ine , 2 0 0 Firs t St SW, Ro c he s te r, MN 5 5 9 0 5 (e -mail: rho de s .de bo rah @ mayo .e du). OBJECTIVE: To determine the sensitivity of molecular breast imaging (M BI) to detect small cancers of the breast. PATIENTS AND METHODS: A cadmium-zinc-telluride gamma cam-
Accuracy of 99mTc-sestamibi scintimammography for breast cancer diagnosis
Experimental and Therapeutic Medicine, 2009
Scintimammography using 99m tc-sestamibi is a noninvasive and painless diagnostic imaging method that is used to detect breast cancer when mammography is inconclusive. Because of the advantages of labeling with 99m Tc-sestamibi and its high efficiency in detecting carcinomas, it is the most widespread agent for this purpose. its accumulation in the tumor has multifactorial causes and does not depend on the presence of architectural distortion or local or diffuse density variation in the breast. the objective of this study was to evaluate the accuracy of scintimammography for detecting breast cancer. One hundred and fifty-seven patients presenting 158 palpable and non-palpable breast nodules were evaluated. three patients were male and 154 were female, aged between 14 and 81 years. all patients underwent scintimammography, and the nodule was subjected to cytological or histological study, i.e., the gold standard for diagnosing cancer. One hundred and eleven malignant and 47 benign nodules were detected, with predominance of ductal carcinomas (n=94) and fibroadenoma/fibrocystic condition (n=11/n=11), respectively. The mean size was 3.11 cm (7-10 cm) among the malignant nodules and 2.07 cm among the benign nodules (0.5-10 cm). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 89, 89, 95, 78 and 89%, respectively. analysis on the histological types showed that the technique was more effective on tumors that were more aggressive, such as ductal carcinoma. in this study, 99m tc-sestamibi scintimammography was shown to be an important tool for diagnosing breast cancer when mammography was inconclusive.
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...
Scintimammography with 99mTc-MIBI and magnetic resonance imaging in the evaluation of breast cancer
European Journal of Nuclear Medicine and Molecular Imaging, 2003
This study was performed to evaluate the sensitivity and specificity of technetium-99m methoxyisobutylisonitrile (99m Tc-MIBI) scintimammography (SMM) and contrast-enhanced magnetic resonance imaging (MRI) in patients with breast masses, using the histological findings as the gold standard. Forty-five consecutive patients with a breast lesion, detected by self-examination, physical examination or screening mammography, underwent SMM and MRI. In 38 cases (84.5%), the histopathology was malignant; the breast cancers ranged from 3 to 100 mm in diameter (mean 22 mm). In the overall patient group, MRI showed a slightly higher sensitivity than SMM (92% vs 84%), but SMM showed a better specificity: 71% vs 42%. The accuracy was 82% and 84% for SMM and MRI respectively. To evaluate the influence of lesion size on the results, patients with lesions ≤20 mm and ≤15 mm were examined. In patients with lesions ≤20 mm, the sensitivity of SMM and MRI decreased to 64% and 82% respectively, while SMM again displayed considerably better specificity: 83% vs 50% for MRI. The accuracy of SMM and MRI was 64% and 82% respectively. In patients with lesions ≤15 mm, SMM again showed better specificity (75% vs 50%), while MRI displayed better sensitivity and accuracy (sensitivity, 81% vs 62%; accuracy, 75% vs 65%). In this study the specificity of SMM in patients with breast lesions was thus superior to that of MRI. The combination of SMM and MRI may be used in those patients with equivocal findings at mammography and ultrasound to reduce the number of unnecessary surgical biopsies.