Breast-Specific Gamma Imaging Influences Surgical Management in Patients with Breast Cancer

Abstract

Breast-specific gamma imaging (BSGI) is a physiologic breast imaging modality that provides more sensitive detection of breast lesions than mammography or ultrasound, and appears to have greater specificity than breast MRI. The purpose of this study was to evaluate how often BSGI changed surgical management in patients with breast cancer. Charts were reviewed from 218 consecutive eligible patients who had preoperative evaluation with BSGI or MRI before surgery for breast cancer from January 2008 to May 2010. Patients who were initially considered eligible for breast-conserving therapy (BCT) were evaluated to determine how many ultimately had mastectomies. Patients who underwent mastectomy because of personal choice or ineligibility for BCT were excluded. Management was changed to mastectomy in 11.9% of those who had BSGI and 28.9% of those who had MRI. Review of pathology demonstrated that all patients who underwent mastectomies were not candidates for breast conservation. 15.4% of patients who underwent BCT based on BSGI findings required a single re-excision due to positive surgical margins. 14.4% required mastectomy. In the MRI group, 18.8% required a single re-excision, and 6.3% required mastectomy. Evaluation with BSGI changed management to mastectomy in a substantial proportion of patients believed to be eligible for BCT following standard imaging. BSGI is effective in evaluation of extent of disease in patients with breast cancer, and is comparable to MRI in terms of its influence on surgical management.

The role of digital mammography, scintimammography with ^99mTc-methoxyisobutylisonitrile (MIBI) and ultrasound in the diagnosis of multicentric breast cancer

“…Значительное расстояние между опухолевыми очагами (>4 см) при МЦ РМЖ также способствует повышению информативности МСГ при визуализации каждого опухолевого образования. Следует отметить, что у части больных (36 %), вошедших в исследование, выполнялось органосохраняющее хирургическое лечение, и это позволяет предположить возможность [25] отметили, что среди 218 женщин, которым выполнялась МСГ с 99m Tc-MIBI (препарат, аналогичный 99m Tc-технетрилу), тактика лечения была изменена в 11,9 % случаев -вместо органосохраняющей операции выполнялась мастэктомия. Интересно, что авторы не указывают на случаи гипердиагностики, когда степень распространенности РМЖ была завышена по данным радионуклидного исследования.…”

Nuclear Breast Imaging: Clinical Results and Future Directions

“…In a series of 118 women anticipating breast-conserving therapy, 14 (11.9%) were appropriately converted to mastectomy on the basis of BSGI; another 15 of the 104 (14.4%) remaining women thought to be candidates for breast-conserving therapy required mastectomy (underestimated extent on BSGI), with more than half of those being underestimated because of a greater extent of DCIS than seen on BSGI (26). In a series of 286 patients with 390 invasive tumor foci imaged by MBI (6), 341 (87.4%) foci were seen on MBI, although ascertainment of missed cancers depends on detailed pathologic analysis exceeding that in routine practice.…”

Usefulness of for BI-RAD category 4 or Higher Lesions

“…Since then, technological advancements and progress have been made in high-resolution breast-specific gamma imaging with 99m Tc-sestamibi scintimammography (MIBI scan). The sensitivity and specificity of breast-specific gamma imaging have been reported as 89%-96%, 60%-90%, respectively [10][11][12][13][14].…”