Results of a Multicenter Patient Registry to Determine the Clinical Impact of Breast-Specific Gamma Imaging, a Molecular Breast Imaging Technique

Weigert, Jean; Bertrand, Margaret L.; Lanzkowsky, Leora; Stern, Lillian H.; Kieper, D.

doi:10.2214/ajr.10.6105

Cited by 60 publications

(34 citation statements)

References 11 publications

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“…This recall rate falls within the range of previously reported BSGI recall rates in women with benign mammograms (22,26). BSGI detected an additional 14 mammographically occult breast cancers (1.7%), or 16.5 cancers per 1,000 women screened.…”

Section: Discussionsupporting

confidence: 82%

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

et al. 2016

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Breast-specific γ-imaging (BSGI) is a physiologic imaging modality that can detect subcentimeter and mammographically occult breast cancer, with a sensitivity and specificity comparable to MRI. The purpose of this study was to determine the incremental increase in breast cancer detection when BSGI is used as an adjunct to mammography in women at increased risk for breast cancer. Methods: All patients undergoing BSGI from April 2010 through January 2014 were retrospectively reviewed. Eligible patients were identified as women at increased risk for breast cancer and whose most recent mammogram was benign. Examinations exhibiting focally increased radiotracer uptake were considered positive. Incremental increase in cancer detection was calculated as the percentage of mammographically occult BSGI-detected breast cancer and the number of mammographically occult breast cancers detected per 1,000 women screened. Results: Included in this study were 849 patients in whom 14 BSGI examinations detected mammographically occult breast cancer. Patients ranged in age from 26 to 83 y, with a mean age of 57 y. Eleven of 14 cancers were detected in women with dense breasts. The addition of BSGI to the annual breast screen of asymptomatic women at increased risk for breast cancer yields 16.5 cancers per 1,000 women screened. When high-risk lesions and cancers were combined, BSGI detected 33.0 high-risk lesions and cancers per 1,000 women screened. Conclusion: BSGI is a reliable adjunct modality to screening mammography that increases breast cancer detection by 1.7% (14/849) in women at increased risk for breast cancer, comparable to results reported for breast MRI. BSGI is beneficial in breast cancer detection in women at increased risk, particularly in those with dense breasts. Br east cancer is the second most common cancer in American women (1). X-ray mammography remains the standard of breast cancer screening and is an effective imaging tool that reduces mortality from breast cancer (2). However, it is an imperfect tool, with an overall reported sensitivity of 85%, which decreases to 68% in women with dense breasts (3,4). In prospective trials among women at high risk for breast cancer due to a familial or genetic predisposition, mammography demonstrated a 30%-40% sensitivity (5). Because of the limitations of mammography, supplemental imaging modalities, including MRI, whole-breast screening ultrasound, and breast-specific g-imaging (BSGI), are becoming increasingly important for women at increased risk, with the goal of detecting early-stage breast cancer.Breast MRI is a physiologic imaging modality recommended as a supplemental screening tool to mammography for high-risk women ($20%-25% lifetime risk) (6). MRI has demonstrated an incremental detection rate of 9.5 cancers per 1,000 high-risk women screened (7) and variable sensitivity and specificity ranging from 71% to 92% and 54% to 86%, respectively (8-10). However, MRI is costly, time-consuming for radiologists to interpret, poorly tolerated by some patients due to claus...

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Section: Discussionsupporting

confidence: 82%

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

et al. 2016

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“…Diagnostic breast imaging can include problem solving when vague abnormalities persist after additional mammographic views and ultrasound; but with current ultrasound equipment and tomosynthesis, it is rare to require further diagnostic imaging. Sensitivity is at least as high as ultrasound with BSGI, but specificity is higher with BSGI (17,18). In patients presenting with cancer of unknown primary cause (typically, a metastatic axillary node consistent with breast cancer), both 99m Tc-sestamibi-and 18 F-FDG-based imaging can identify the underlying breast cancer (Fig.…”

Section: The Evidencementioning

confidence: 99%

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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“…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 examination [8]. A total of 1,042 patients were evaluated.…”

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confidence: 90%

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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Results of a Multicenter Patient Registry to Determine the Clinical Impact of Breast-Specific Gamma Imaging, a Molecular Breast Imaging Technique

Abstract: Breast-specific gamma imaging significantly contributed to the detection of malignant or high-risk lesions in patients with negative or indeterminate mammographic findings, and it provided improved management when compared with ultrasound.

Cited by 60 publications

References 11 publications

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk

Nuclear Breast Imaging: Clinical Results and Future Directions

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

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