Accuracy of technetium-99m sestamibi scintimammography and X-ray mammography in premenopausal women with suspected breast cancer

Abstract

The aim of this study was to evaluate the usefulness of technetium-99m sestamibi scintimammography (SSM) and combined use of SSM and X-ray mammography (MG) in premenopausal patients with small (< or =2 cm) suspicious breast lesions. Eighty-seven premenopausal women (median age 47 years, range 32-52) with breast lesions ranging from 4 to 20 mm in greatest diameter (median 12 mm) and detected by MG, underwent SSM prior to open breast biopsy. A planar camera and single-photon emission tomography (SPET) technique were used in 23 (26.4%) and 64 (73.6%) patients, respectively. At histological examination, 72 (82.8%) breast cancers (pT1a=3, pT1b=27, pT1c=42) and 15 (17.2%) benign masses were found. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MG and SSM were 80.6% vs 80.6%, 60.0% vs 93.3% (P<0.05), 90.6% vs 98.3%, 39.1% vs 50.0% and 77.0% vs 82.8%, respectively. MG + SSM together had a sensitivity of 94.4% (P<0.05 vs SSM alone) and an accuracy of 82.8% for the detection of breast cancer. Tumours undetected by both MG and SSM were significantly (P<0.05) smaller than those correctly diagnosed. Patients with false-negative MG were younger (P<0.05) than those with tumours correctly detected, while SSM sensitivity was independent (P=NS) of age. In conclusion, in premenopausal patients with small breast lesions, the sensitivity of SSM and MG is similar (P=NS), whereas the specificity of SSM is significantly higher (P<0.05) than that of MG. Furthermore, the combination of MG and SSM offers significantly improved sensitivity and accuracy in comparison with the individual techniques, suggesting a complementary role of SSM in the detection of breast cancer in younger patients.

Breast-specific Gamma Imaging as an Adjunct Imaging Modality for the Diagnosis of Breast Cancer

“…These techniques have yielded an average sensitivity of 84% and specificity of 86% as reported by Taillefer (5) in a meta-analysis of 5660 patients. In comparison with mammography, the sensitivity of 99m Tcsestamibi scintimammography is independent of breast density (6)(7)(8). In addition, scintimammography has not shown increased uptake in women with architectural distortion or scarring from a prior procedure (9).…”

Integrin scintimammography using a dedicated breast imaging, solid‐state γ‐camera and 99mTc‐labelled NC100692

“…SMM with 99m Tc‐sestamibi has been demonstrated as a valuable tool for lesions >1 cm in diameter (Khalkhali et al. , 1995, 2000; Lumachi et al. , 2001 ; Liberman et al.…”

“…, 2003; Schillaci & Buscombe, 2004). However, the sensitivity of 99m Tc‐sestamibi SMM is substantially lower for sub‐centimetre lesions, and published data suggest that when lesion size falls below 9 mm, the detection rate becomes extremely low using conventional γ‐cameras (Lumachi et al. , 2001).…”

Radionuclide-Based Imaging of Breast Cancer: State of the Art

“…Khalkhali et al [ 125 ] reported a multicenter study performed in 558 women that prospectively enrolled 580 abnormal breasts, including 276 dense breasts, and concluded that the diagnostic accuracy of 99m Tc-MIBI breast scintigraphy is not affected by breast density. Lumachi et al [ 126 ] evaluated the effectiveness of 99m Tc-MIBI scintimammography and mammography in 87 premenopausal patients with suspicious breast lesions smaller than 2 cm. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic rate were 81% vs. 81%, 93% vs. 60%, 98% vs. 91%, 50% vs. 39%, and 83% vs. 77%, respectively.…”