Breast Cancer: Monitoring Response to Neoadjuvant Chemotherapy Using Tc-99m Sestamibi Scintimammography

Abstract

Background: Aim of the study was to assess the value of scintimammography using Tc-99m sestamibi in the evaluation of tumor response to neoadjuvant chemotherapy. Material and Methods: Results were calculated for 9 patients undergoing neoadjuvant chemotherapy. Scintimammography using 740 MBq Tc-99m sestamibi was performed before, during and after chemotherapy, and sestamibi uptake was scored visually and semiquantitatively to evaluate tumor response. Results: In the case of complete response (n = 3) sestamibi uptake decreased 8 days after beginning neoadjuvant chemotherapy and normalized in the following course. Focal uptake decreased more slowly in patients with partial response (n = 3), who showed clear, persisting tracer accumulation after therapy. The patients without response (n = 3) showed a persisting high tumor activity even after chemotherapy was completed. Conclusions: The preliminary data suggest that in contrast to other imaging modalities scintimammography appears to yield early information regarding tumor response to neoadjuvant chemotherapy.

Role of Tc99m-Sestamibi scintimammography in assessing response to neoadjuvant chemotherapy in patients with locally advanced breast cancer

“…Many studies have been published emphasizing the role of Tc-99m-sestamibi in response assessment to NACT in patients with breast cancer. [82021222324]…”

Different methods for the detection of small changes in uptake between single-photon emission computed tomography (SPECT) examinations: 99mTc-sestamibi in chemotherapy for breast tumours

“…One study has evaluated different digital methods for the assessment of the uptake of 99m Tc-sestamibi in order to distinguish benign from malignant breast lesions when using planar scintigraphy [20]. In a few studies using planar and SPECT examinations to evaluate neoadjuvant chemotherapy in breast cancer with 99m Tc-sestamibi, digital and visual evaluations were performed, but these were not compared [13,14,21]. In a SPECT study using 99m Tc-sestamibi in head and neck cancer, the choice of reference region for the calculation of relative tumour uptake was studied [22].…”

Imaging breast cancer response during neoadjuvant systemic therapy

“…69 43 [36] Correlates well with pathology if lobular or inflammatory carcinomas are excluded (r = 0.537) 57 [37] Scintimammography Early changes in sestamibi uptake show good correlation with response 9 [43] MRI Correlates well with pathologic response (r = 0.89) 52 [47] Better agreement with histopathology than conventional imaging (81 vs. 68%) 67 [48] DCE-MRI Early changes in K trans predict for response. Sensitivity of 100%, specificity of 72% in identifying nonresponders after two cycles of chemotherapy 28 [57] MRS Change in TCho within 24 h predicts for response (r = 0.79) 13 [63] PET Changes in FDG uptake after one cycle of chemotherapy can predict for eventual pathologic response.…”

“…In a small study by Tiling and colleagues, scintimammography was performed using 740 MBq sestamibi before, during and after neoadjuvant chemotherapy in nine patients with breast cancer [43]. Sestamibi uptake was scored visually and compared with eventual response.…”