George Peters Award: How does breast-specific gamma imaging affect the management of patients with newly diagnosed breast cancer?

Killelea, Brigid K.; Gillego, Alyssa; Kirstein, Laurie; Asad, Juhi; Shpilko, Marina; Shah, A.; Feldman, Sheldon; Boolbol, Susan K.

doi:10.1016/j.amjsurg.2009.06.016

Cited by 25 publications

(15 citation statements)

References 20 publications

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“…In one series (22), 9 of 159 (6%) women had additional unsuspected ipsilateral foci, and 5 (3%) had contralateral foci seen on BSGI, with a PPV of suggestive findings on BSGI of 14 of 40 (35%). The PPV of additional suggestive findings was 15 of 25 (60%) in a series of 138 women studied by Zhou et al (23), and 7 of 18 (39%) (including one ductal carcinoma in situ [DCIS] excised) in a series of 82 women reported by Killelea et al (24). The PPV of additional suspicious findings of only 35%-60% underscores the importance of percutaneous biopsy of additional suspicious findings before converting a patient to mastectomy.…”

Section: Extent Of Diseasementioning

confidence: 94%

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

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Interest in nuclear breast imaging is increasing because of technical improvements in dedicated devices that allow the use of relatively low doses of radiotracers with high sensitivity for even small breast cancers. For women with newly diagnosed cancer, primary chemotherapy is often recommended, and improved methods of assessing treatment response are of interest. With widespread breast density notification, functional rather than anatomic methods of screening are of increasing interest as well. For a cancer imaging technology to be adopted, several criteria must be met that will be discussed: evidence of clinical benefit with minimal harm, standardized interpretive criteria, direct biopsy guidance, and acceptable cost-effectiveness. Twor adiotracers have been used widely to depict breast cancer: the g-emitting 99m Tc-sestamibi ( 99m Tc-methoxyisobutylisonitrile), 140 keV, half-life of 6 h, originally developed as a myocardial perfusion agent; and the positron-emitting glucose analog 18 F-FDG, 511 keV, half-life of 2 h. Standard lead shielding as is used in a mammography suite is sufficient when using 99m Tc-sestamibi. Using 18 F-FDG requires much more extensive shielding and may not be feasible because of workspaces above or below the planned unit. State licensing requirements for nuclear medicine must be considered; typically, a hot lab with oversight by a trained nuclear medicine technologist and a physicist is required (1).Both 99m Tc-sestamibi and 18 F-FDG were initially studied for breast cancer using whole-body scanners. Low sensitivity to invasive cancers smaller than 1 cm was observed with whole-body g-camera imaging in a prospective multicenter series at 48.2%, compared with 74.2% for larger tumors (2); detection of small cancers, particularly small invasive cancers, is a major goal of breast imaging. Similar results were observed with whole-body PET, with sensitivity to invasive tumors 2 cm or smaller of only 30 of 44 (68%) compared with 57 of 62 (92%) for larger cancers (3).Dedicated breast g-camera imaging can be performed with singledetector scintillating-crystal systems such as breast-specific g-imaging (BSGI) (Dilon Technologies) with a 20 · 15 cm field of view, 3.3-mm pixel size; or using dual-head cadmium-zinc-telluride detector systems, often referred to as molecular breast imaging (MBI) (GE Healthcare, with a 24 · 16 cm field of view and 2.5-mm pixel size; or Gamma Medica, Inc., with a 20 · 16 cm field of view and 1.6 mm pixel size). Both approaches use positioning similar to that of mammography, with the breast gently stabilized between a compression paddle and the detector (BSGI) or between 2 detectors (MBI). It is important to include mammographic technologists in the positioning of the patients, at least for a minimum number of cases (e.g., 25), to ensure full inclusion of posterior tissues for both a craniocaudal and a mediolateral oblique (MLO) acquisition. Particularly with the dualhead systems, it can be difficult to prevent skin folds or to ensure that the nipple is in profile becau...

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Section: Extent Of Diseasementioning

confidence: 94%

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

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“…6,121,122 In a comparison of BSGI with MRI used in preoperative evaluation, the sensitivities of the two techniques were similar (89% and 92%) but BSGI demonstrated significantly better specificity of 90% compared to 39% for MRI (p < 0.0001). 123 A study performed using a dedicated CZT-based MBI system and 99m Tc-tetrofosmin in 264 patients showed gamma imaging to significantly improve detection of multifocal or multicentric disease compared to that detected with mammography (88% vs 48% of cases, p < 0.0005) and to correctly alter surgical management in 16% of patients.…”

Section: Ivb Preoperative Evaluationmentioning

confidence: 96%

Nuclear imaging of the breast: Translating achievements in instrumentation into clinical use

Hruska

O’Connor

2013

Medical Physics

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Approaches to imaging the breast with nuclear medicine and/or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed.

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“…Small, retrospective, single-site studies using BSGI report detection of additional malignancy in 9%-11% of patients, which included 3% with a contralateral occult cancer (13)(14)(15). One report that directly compared BSGI with MR imaging examined 66 patients and demonstrated comparable sensitivity (89% vs. 92%, respectively) with increased specificity of BSGI (90%) over MR imaging (39%) (16).…”

Section: Preoperative Evaluation Of Disease Extentmentioning

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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George Peters Award: How does breast-specific gamma imaging affect the management of patients with newly diagnosed breast cancer?

Cited by 25 publications

References 20 publications

Nuclear Breast Imaging: Clinical Results and Future Directions

Nuclear Breast Imaging: Clinical Results and Future Directions

Nuclear imaging of the breast: Translating achievements in instrumentation into clinical use

A Molecular Approach to Breast Imaging

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