Contribution of 99mTc-anti-carcinoembryonic antigen antibody and 99mTc-sestamibi scintimammography in the evaluation of high risk palpable breast lesions

Abstract

Mammography is the screening test of choice for breast cancer. Its low specificity leads to a large number of unnecessary biopsies. Scintimammography, with either Tc-sestamibi (MIBI) or Tc-anti-carcinoembryonic antigen (CEA) Fab', has been proposed as a non-invasive test to lower the high false positive rate of mammography in certain patients. The two agents have not been compared, nor has their combined application been evaluated. We performed a prospective, non-randomized, open-label, single-centre study of 32 women with clinically and mammographically suspected breast cancer [Breast Imaging Reporting and Data System (BI-RADS, American College of Radiology) 4 or 5]. All patients underwent Tc-MIBI and Tc-anti-CEA Fab' scintimammography, and the results were correlated with histopathology. Overall, the accuracies for MIBI and CEA scans were 90.3% (28/31) and 77.4% (24/31), respectively. The probability of disease after mammography was 0.939+/-0.081 (95% confidence interval, CI). The post-mammography probabilities after positive MIBI or CEA scan were 0.965 and 0.960, respectively, and after negative MIBI or CEA scan 0.750 and 0.875, respectively. None of the above differences is significant. The post-test probability when both scans were positive (irrespective of which was performed first) was 0.977. It can be concluded that there are indications that scintimammography with Tc-MIBI is superior to that with Tc-anti-CEA Fab' when these tests are used as screening tests for breast cancer. However, mammography remains the screening test of choice for highly suspicious clinically palpable breast lesions. In this group of patients, the application of scintimammography with either Tc-MIBI or Tc-anti-CEA Fab' (alone or in combination) offers no additional advantage.

99mTc-Sestamibi Scintimammography

“…In only four of the cited studies applied doses were below the recommended minimal dose of 740 MBq, in none of the studies, higher doses as recommended were applied (1,110 MBq). [47] Europe Turkey 740 Becherer [48] Europe Austria 630-740 Buscombe [49] Europe UK 740 Buscombe [50] Europe UK 740 Cwikla [51] Europe UK 740 Cwikla [52] Europe UK 740 Cwikla [53] Europe UK 740 Fondrinier [54] Europe France 740 Helbich [55] Europe Austria 629-740 Imbriaco [56] Europe Italy 555 Maffioli [57] Europe Italy 740 Marshall [58] Europe UK 750 Mathieu [59] Europe Belgium 740 Maublant [60] Europe France 740 Moretti [19] Europe France 500 Myslivecek [61] Europe Czech Republic 740 Palmedo [62] Europe Germany 740 Palmedo [63] Europe Germany 740 Papantoniou [64] Europe Greece 925-1,110 Prats [65] Europe Spain 740 Prats [66] Europe Spain 740 Sanidas [67] Europe Greece 740 Tiling [68] Europe Germany 740 Tiling [69] Europe Germany 740 Uriarte [70] Europe Spain 740 Chen [71] Asia China 740 Kao [72] Asia Taiwan 740 Kim [73] Asia South Korea 750 Kim [74] Asia South Korea 925 Kim [75] Asia South Korea 750 Tc-Sestamibi Scintimammography…”

Radionuclide-Based Cancer Imaging Targeting the Carcinoembryonic Antigen

“…2) (Erb and Nabi, 2000; Fuster et al 2003; Ghesani et al 2003; Goldenberg et al 1997; Hladik et al 2001; Moffat et al 1996; Sanidas et al 2003; Willkomm et al 2000). To assess the performance and potential clinical impact of this Fab’ fragment-based tracer, a study in 210 presurgical patients with advanced recurrent or metastatic colorectal carcinomas was conducted (Moffat et al 1996).…”

“…In 1996, a 99m Tc-labeled anti-CEA Fab’ fragment (arcitumomab; CEA-Scan; Immunomedics, Inc.) was approved by the United States Food and Drug Administration (FDA) for colorectal cancer imaging. Subsequently, CEA-Scan has also been applied for detecting other CEA-positive cancers such as breast cancer, medullary thyroid cancer and lung cancer (Goldenberg, 1997; Goldenberg et al 1997; Goldenberg and Nabi, 1999; Goldenberg and Wegener, 1997; Malamitsi et al 2002; Sanidas et al 2003). …”

Construction and Evaluation of the Tumor Imaging Properties of123I-Labeled Recombinant and Enzymatically Generated Fab Fragments of the TAG-72 Monoclonal Antibody CC49

“…Monoclonal antibodies (mAbs) directed against tumor-associated antigens overexpressed on the surface of tumor cells can deliver radionuclides to tumors for imaging. Small antibody fragments such as Fab or scFv are particularly suitable for this purpose because these fragments extravasate more efficiently, penetrate more deeply into tumor nodules, and clear more rapidly from the body compared with intact IgG, leading to higher tumor-to-normal tissue uptake ratios at early times ( − ). The utility of antibody fragments in tumor imaging is exemplified by anti-carcinoembryonic antigen (CEA) arcitumomab (CEA-Scan, Immunomedics Inc, Morris Plains NJ), which consists of Fab‘ of murine anti-CEA IgG labeled with 99m Tc ().…”