Uptake and washout of 99mTcV-dimercaptosuccinic acid and 99mTc-sestamibi in the assessment of histological type and grade in breast cancer

Abstract

This study was performed to investigate the relationship between histological type and grade, with the uptake and washout of 99mTc-hexakis-2-methoxyisobutylisonitrile (99mTc-sestamibi, 99mTc-MIBI) and 99mTcV-dimercaptosuccinic acid (99mTcV-DMSA) in breast cancer. Forty-five patients with histologically proven breast cancer had previously been referred for 99mTcV-DMSA and/or 99mTc-MIBI scintimammography. Twenty-five of them underwent both 99mTcV-DMSA and 99mTc-MIBI scintigraphy in a double phase study. Lateral prone and anterior supine images were acquired at 15 and 60 min after administration of 740-925 MBq of each radiotracer. Uptake ratios and retention index were calculated and correlated with histology and grade of malignancy. Histology showed eight different histotypes: 77.7% were infiltrating ductal or lobular carcinomas. Mammography was definitely positive in 32/45, indeterminate in 10 and negative in three cases (sensitivity 71%). 99mTcV-DMSA was true positive in 37/40 (sensitivity 92.5%) and 99mTc-MIBI in 28/30 (sensitivity 93.3%) breast cancers. Uptake ratios were significantly higher in ductal than in lobular carcinomas on 99mTcV-DMSA and 99mTc-MIBI scintigrams at early and delayed phases. Grade II carcinomas had significantly lower values of retention index (rapid washout) than grade III carcinomas. This finding was statistically significant only on 99mTc-MIBI scans and was observed in ductal and lobular carcinomas. The retention index did not show any significant difference between ductal and lobular carcinomas. Uptake ratios were also not statistically different between grade II and III cancers. It is concluded that 99mTc-MIBI and 99mTcV-DMSA uptake in breast cancer is probably related to histological type and may distinguish ductal from lobular carcinomas. To a certain degree, the washout rate may reflect the histological grade, but since grade is not the only factor influencing this phenomenon it should be explored further in conjunction with other parameters by multivariate analysis in order to clarify eventual indirect correlations.

Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography

“…Denoyer and colleagues recently reported that the radiotracer uptake is specifically mediated by NaPi cotransporter type III in cancer cells, similar to phosphate ions, which enter cells via NaPi cotransporters [13], while other reports suggest that its uptake in tumors is related to glucose metabolism-mediated acidosis [14]. 99m Tc-(V)DMSA has been tried out in identifying invasive and preinvasive breast cancer [15-17]. …”

Scintimammography - Molecular Imaging: Value and New Perspectives with 99mTc(V)-DMSA

“…99m Tc(V)-DMSA is a well-known tumor-seeking radiotracer with affinity for neuroendocrine and soft tissue tumors, such as medullary thyroid carcinoma and lung, breast, brain, and metastatic bone lesions [Ohta et al, 1984, Babbar et al, 1991, Kashyap et al, 1992, Hirano et al, 1995, Atasever et al, 1997, Lam et al, 1997, Kiratli et al, 1998, Papantoniou et al, 2002, 2010, Denoyer et al, 2004, Tsiouris et al, 2007, Al-Saeedi, 2007. These tumor-seeking properties have lead to the use of 99m Tc(V)-DMSA in scintimammographic studies.…”

“…Regarding lymph node involvement, the tracers have been reported to show 78.9% sensitivity and 86.3% specificity. Pre-invasive lesions, like DCIS and lobular carcinoma in situ (LCIS) are detected with high sensitivity by 99m Tc(V)-DMSA, whereas with high specificity by 99m Tc-sestamibi [Papantoniou et al, 2001[Papantoniou et al, , 2002.…”

“…Moreover, in breast cancer we have determined tumor size and Ki-67 as independent parameters of 99m Tc-sestamibi and 99m Tc(V)-DMSA uptake, respectively; hence tumors which accumulate 99m Tc(V)-DMSA sustain increased cell proliferation and are in fact more aggressive [Papantoniou et al 2002].…”

99mTc-Sestamibi Scintimammography

“…Papantoniou et al evaluated the relationship between the histological type and grade of the tumor and the uptake and washout of 99m Tc-sestamibi. They found that the 99m Tc-sestamibi uptake ratios were significantly higher in ductal than in lobular carcinomas [20]. Furthermore, grade II carcinomas also showed a significantly faster washout (i. e., lower retention index values) than that observed in grade III tumors [20].…”