Dedicated Dual-Head Gamma Imaging for Breast Cancer Screening in Women with Mammographically Dense Breasts

Rhodes, Deborah J.; Hruska, Carrie B.; Phillips, Stephen W.; Whaley, Dana H.; O’Connor, Michael K.

doi:10.1148/radiol.10100625

Cited by 145 publications

(95 citation statements)

References 47 publications

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“…without mammography, with a mean kappa of 0.8, and the agreement of observers with expert consensus (kappa 0.83). This interobserver agreement is higher than that reported in validation studies of other breast imaging modalities [10], including PEM [15], and also when compared to a previous BSGI report evaluating BC screening in women with mammographically dense breasts [16]. In this latter study, two observers retrospectively examined images obtained with a dedicated dual-head gamma camera for the presence of abnormal radiopharmaceutical uptake, using a five-point score (10no abnormality, 50 highly suspicious for malignancy).…”

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confidence: 78%

The importance of standardized interpretation of molecular breast imaging with dedicated gamma cameras

Schillaci

2012

Eur J Nucl Med Mol Imaging

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Breast cancer (BC) is the most common malignancy and the second leading cause of cancer death in females, accounting in the USA for 29% of the total new cancer cases and 14% of the total cancer deaths in 2012 [1]. Early diagnosis and treatment are of the utmost importance to improve prognosis.For detection and characterization of primary breast lesions, anatomical imaging including mammography, ultrasonography, and MRI are commonly employed. Scintimammography is a molecular nuclear medicine technique for breast imaging which uses single-photon radiopharmaceuticals such as 99m Tc sestamibi and 99m Tc tetrofosmin. It is a functional imaging modality so some of the main drawbacks of mammography are resolved [2]. It was developed almost 20 years ago with standard large field-of-view (FOV) gamma cameras. Certainly, the principal limiting factor in the clinical acceptance of scintimammography has been its low sensitivity for cancers of ≤1 cm in size, mainly because of the lack of suitable equipment specifically designed for breast imaging.Dedicated gamma cameras specifically built for breast imaging are now available. The use of these breast-optimized, small FOV, high-resolution cameras allows both greater flexibility in patient positioning (improving breast imaging by limiting the FOV and reducing image contamination from other organs, i.e. liver and heart) and breast compression, with an important increase in the target-to-background ratio [3]. In fact, the detector can be placed directly against the chest and a mild compression is possible, to reduce breast thickness and improve the camera's sensitivity. Moreover, by design, these specific cameras are also able to provide better intrinsic and extrinsic spatial resolution than standard ones, with an enhancement in contrast resolution for small lesions [4], and to acquire projections similar to those of mammography (craniocaudal, mediolateral oblique and true lateral).Studies comparing standard and breast-specific cameras have provided clinical evidence that the dedicated ones show better accuracy in molecular breast imaging, especially in increasing the sensitivity for subcentimetre lesions [4][5][6]. It is worth noting that a recent retrospective review of one institution's experience with breast-specific gamma imaging (BSGI) has indicated that this test is not only both sensitive (93%) and specific (79%) for the identification of BC, but it is also helpful as an adjunct to standard breast imaging modalities for problem solving in indeterminate cases [7]. Moreover, in this study including 416 cases, BSGI was demonstrated to be useful in evaluating lesions difficult to biopsy and in patients who desired further testing rather than biopsy or short term follow-up of their breast abnormality. These interesting data have been then confirmed in a multicentre clinical patient registry analysis, which aimed to quantify the impact of BSGI on the management of patients with BC in clinical practice, and to identify the subgroups benefiting more from the use of this examinatio...

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confidence: 78%

The importance of standardized interpretation of molecular breast imaging with dedicated gamma cameras

Schillaci

2012

Eur J Nucl Med Mol Imaging

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“…For comparison, the effective dose equivalent of digital mammography is approximately 0.44 mSv and 1.2 mSv for digital mammography combined with tomosynthesis (19). Technologic improvements in instrumentation design combined with optimized patient preparation to increase radiopharmaceutical uptake have been pursued to reduce the radiation exposure to levels feasible to consider for breast cancer screening programs (20)(21)(22)(23). Continued research into dose reduction methods or consideration of less frequent screening intervals will facilitate broader acceptance of radionuclidebased supplemental screening approaches in clinical practice.…”

Section: See Page 678mentioning

confidence: 99%

Molecular Imaging Approaches for Supplemental Screening in Women at Increased Breast Cancer Risk

Fowler¹

2016

J Nucl Med

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Mammography is an effective screening method that reduces breast cancer mortality (1). However, mammography is not a perfect test and its sensitivity is diminished in women with dense breast tissue (2). For women at increased breast cancer risk, the use of imaging modalities in addition to mammography, termed supplemental screening, can improve the overall cancer detection rate. Current guidelines recommend MRI for supplemental screening in women with greater than 20% lifetime risk of breast cancer (3). For women who cannot tolerate MRI, have mammographically dense breast tissue, or have an intermediate lifetime risk of breast cancer, screening ultrasound can be considered (3). However, these techniques have some drawbacks, which have fueled interest in alternative functional imaging-based methods for supplemental screening in high-risk women. In this issue of The Journal of Nuclear Medicine, Brem et al. investigate the diagnostic performance of a molecular imaging approach for supplemental breast cancer screening (4). See page 678Breast-specific g-imaging (BSGI) is a Food and Drug Administrationapproved radionuclide-based technique that can be used to detect breast cancer (5,6). A high-spatial-resolution, small-field-of-view g-camera detects and localizes g-ray energy emitted by the radiopharmaceutical 99m Tc-methoxyisobutylisonitrile (sestamibi), which preferentially accumulates in malignant breast cells with increased vascular supply and concentration of mitochondria compared with surrounding normal breast tissue. Images are acquired immediately after intravenous injection of the radiopharmaceutical, with the patient seated in standard mammographic views (craniocaudal and mediolateral oblique views) with the breast in mild compression for a total of approximately 40 min. Interpretation of breast-specific g-images follows a standardized lexicon and results in assessment categories and recommendations that parallel those of other imaging modalities outlined by the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) (7-9).Although several studies have evaluated the performance of BSGI for diagnosing breast cancer in a heterogeneous mix of clinical indications (10), data regarding the application of BSGI for supplemental screening for women at increased breast cancer risk are sparse. The study by Brem et al. is a single-institution, retrospective review of asymptomatic, increased-risk women undergoing BSGI from 2010 to 2014 whose most recent screening mammogram showed no suspicious abnormalities (4). The study population consisted of 849 women ranging in age from 26 to 83 y with a personal history of treated breast cancer, a family history of breast cancer, a personal history of an atypical or high-risk breast biopsy result, or a known genetic predisposition to breast cancer development. BSGI detected 14 mammographically occult cancers in 849 women, resulting in a supplemental cancer detection rate of 16.5 per 1,000 women screened. Furthermore, mammographic breast density did not affe...

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“…It is approved as a diagnostic tool after mammography and is not indicated for screening or as an alternative to biopsy. Typical protocols specify an injection of 740-1,100 MBq (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) into the arm contralateral to the suspected abnormality. Imaging begins 5-10 min after injection, with 10 min per view.…”

Section: Single-photon G Imaging Systems For Dedicated Breast Imagingmentioning

confidence: 99%

“…The largest prospective study of BSGI involved 936 women with dense breasts and at least one risk factor (22). They found that the addition of BSGI increased the sensitivity from 27% to 91% and increased the cancer detection rate by 7.5 per 1,000 women screened.…”

Section: Screening Of Women With Dense Breastsmentioning

confidence: 99%

A Molecular Approach to Breast Imaging

Fowler

2014

J Nucl Med

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Molecular imaging is a multimodality discipline for noninvasively visualizing biologic processes at the subcellular level. Clinical applications of radionuclide-based molecular imaging for breast cancer continue to evolve. Whole-body imaging, with scintimammography and PET, and newer dedicated breast imaging systems are reviewed. The potential clinical indications and the challenges of implementing these emerging technologies are presented.

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Dedicated Dual-Head Gamma Imaging for Breast Cancer Screening in Women with Mammographically Dense Breasts

Abstract: Addition of gamma imaging to mammography significantly increased detection of node-negative breast cancer in dense breasts by 7.5 per 1000 women screened (95% CI: 3.6, 15.4). To be clinically important, gamma imaging will need to show equivalent performance at decreased radiation doses.

Cited by 145 publications

References 47 publications

The importance of standardized interpretation of molecular breast imaging with dedicated gamma cameras

The importance of standardized interpretation of molecular breast imaging with dedicated gamma cameras

Molecular Imaging Approaches for Supplemental Screening in Women at Increased Breast Cancer Risk

A Molecular Approach to Breast Imaging

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