Comparative evaluation of 99mTc-MIBI and 99mTc-HMDP scintimammography for the diagnosis of breast cancer and its axillary metastases

Abstract

The purpose of the present study was to compare scintimammography using technetium-99m hexakis 2-methoxyisobutylisonitrile (MIBI) with that using 99mTc-hydroxymethylene diphosphonate (HMDP) in the detection of breast cancer and its axillary lesions. The study population comprised 50 consecutive females with breast cancer who were scheduled for surgery. All patients underwent scintimammography with 99mTc-MIBI and 99mTc-HMDP. The images were acquired 5 min (early) and 2 h (delayed) after injection of each radiopharmaceutical. Regions of interest were placed over the breast tumour (T), the axillary lesion (A) and the normal ipsilateral breast tissue (N). The two count ratios were calculated, i.e. the tumour to normal breast tissue ratio (T/N) and the axillary lymph node to normal breast tissue ratio (A/N). For the breast tumours, using 99mTc-MIBI the positive rate was 86% (43/50) for the early and 72% (36/50) for the delayed images. The corresponding values using 99mTc-HMDP were 72% (36/50) and 40% (20/50), respectively. Histopathological examination revealed metastatic lymph node involvement in 22 patients. For the axillary lesions, using 99mTc-MIBI the positive rate was 72.7% (16/22) for the early and 54.5% (12/22) for the delayed images. Using 99mTc-HMDP, the positive rate was only 18.2% (4/22) for the early and 4.5% (1/22) for the delayed images. Using 99mTc-MIBI, the mean T/N (+/- SD) ratios on early and delayed images were 2.69 +/- 1.64 and 2.03 +/- 1.16, respectively, and the mean A/N (+/- SD) ratios on early and delayed images were 2.20 +/- 1.23 and 1.80 +/- 1.20, respectively. The corresponding values using 99mTc-HMDP were 1.77 +/- 0.91, 1.42 +/- 0.72, 1.27 +/- 0.63 and 1.08 +/- 0.25, respectively. The T/N and A/N ratios on the early and delayed 99mTc-MIBI images were both significantly higher than those obtained using 99mTc-HMDP. 99mTc-MIBI scintimammography is more sensitive than 99mTc-HMDP scintimammography for the detection of breast cancer and its axillary lymph node metastases.

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management

“…However, at the same time, this poses new questions, such as the adequacy of diagnostic preoperative staging of the axillary lymph nodes (LN) in order to adopt specific therapeutic decisions. Besides clinical examination, different sophisticated imaging techniques have been proposed as alternative methods in the staging of axillary LN in breast cancer (Kvistad et al, 2000;Shimizu et al, 2000;Nishiyama et al, 2001). However, none of these procedures has been successful enough to replace histological examination.…”

Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial

“…The experience with SPECT is significantly better including small primary breast tumours [32]. Tc99m diphosphonates (MDP) proposed as an interesting alternative as well as pentavalent DMSA, have less diagnostic value than sestamibi for breast primary lesions and also for axillary node evaluation, according to our group results and others [13,26]. …”

Técnicas de imagen para la valoración del estado ganglionar axilar en el cáncer de mama

“…El propio autor y sobre su experiencia en 201 casos de CM, describe una sensibilidad del 82,3% con una especificidad del 94,1%, advirtiendo no obstante, que esa sensibilidad descendió al 69,7% en el grupo de pacientes con una afectación metastásica de < 3 ganglios axilares. Resultados similares son descritos por Nishiyama 33 , que encuentra una sensibilidad del 72,7%, advirtiendo que los casos falso negativo correspondieron a ganglios menores de 10 mm.…”