Usefulness of for BI-RAD Category 4 or Higher Lesions

PURPOSE: As an alternative to core-needle biopsy in confirming the diagnosis of breast cancer, the usefulness of (99m)Tc-sestamibi scintimammography (MIBI scan) has been rarely reported. Thus, we aimed to evaluate a direct comparison between general diagnostic modalities and breast MIBI scan, which may be revealed as a potential diagnostic alternative.METHODS: In a retrospective study, 301 patients with 801 lesions, who underwent breast MIBI scan, ultrasonography, and mammography simultaneously between January 2013 and February 2015, were reviewed. All data were analyzed by McNemar and Kappa test for statistical significance.RESULTS: Mean age was 49.2±9.37 years old (range from 26 to 85 years old). Results of Breast MIBI scan were divided into three categories: 236 positive intensity uptakes (29.5%), 565 negative intensity uptakes (70.5%), and 67 suspicious abnormal intensity uptakes (8.4%). Pathologic reports were also allocated into four subgroups: 122 invasive cancers (15.2%), 44 non-invasive cancers (5.5%), 194 proliferative benign lesions (24.2%), and 441 non-proliferative benign lesions (55.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of MIBI scan were 83.5%, 55.6%, 59.1%, and 95.2%, respectively. Specificity of MIBI scan plus general diagnostic modalities increased dramatically, up to 85.2%, compared to general modalities (6.8%).CONCLUSION: In general diagnostic modalities, such as mammography and ultrasound, BI-RAD category 4 or higher lesions were performed by needle biopsy rather than observation. The outstanding specificity and negative predictive value of MIBI scan provided confident results on non-proliferative benign lesions. MIBI scan may offer an alternative diagnostic tool for “invasive” biopsy procedures.

Utilidad de la gamagrafía con 99mTc-L-cisteína para la detección del cáncer de mama / Usefulness of 99mTc-L-cysteine in the detection of breast cancer

Para determinar la utilidad de los estudios gammagráficos con 99mTc-L-cisteína, en la detección del cáncer de mama, fueron estudiadas 100 pacientes mujeres mediante ultrasonido, mamografía y gamagrafía. Las imágenes gamagráficas fueron adquiridas a los 15 minutos y una hora después de la inyección del radiofármaco. Los resultados histopatológicos constituyeron la prueba de confirmación: 64 pacientes fueron concluidos como portadoras de carcinoma de mama y 36 con lesiones benignas. Los valores de sensibilidad, especificidad y exactitud diagnóstica de los estudios gamagráficos fueron: 98,4 por ciento, 94,4 por ciento y 97 por ciento, respectivamente. El valor predictivo positivo fue 96,9 por ciento y el valor predictivo negativo fue 97,1 por ciento. Existió infiltración metastásica de los ganglios axilares en 20 de las pacientes estudiadas; 70 por ciento fueron detectados por la gamagrafía con 99mTc-L cisteína. Conclusión: La gamagrafía con 99mTc-L-cisteína resultó útil para la detección del cáncer de mama.

To determine the usefulness of scintigraphic studies with 99mTc-L-cysteine in the detection of breast cancer, 100 female patients were studied by ultrasound, mammography and scintigraphy. The scintigraphic images were acquired at 15 minutes and one hour after injection of the radiopharmaceutical. Histopathologic results were the confirmation test: 64 patients were completed as having breast carcinoma and 36 benign lesions. The scintigraphic studies obtained value of sensitivity, specificity and diagnostic accuracy of: 98.4 percent, 94.4 percent and 97 percent respectively. The positive predictive value was 96.9 percent and the negative predictive value was 97.1 percent. There was infiltration of axillary lymph nodes in 20 of the patients studied, 70 percent were detected by 99mTc-L-cysteine. Conclusion: 99mTc-L-cysteine was useful for the detection of breast cancer.

The value of Dedicated Tc-99m MIBI Scintimammography in the Evaluation of Patients with Palpable Breast Lesions in Comparison with Mammography: Preliminary Result / 핵의학분자영상

PURPOSE: There are few studies evaluating the usefulness of dedicated high-resolution scintimammography and no studies using delayed washout with this dedicated high resolution scintimammography for the evaluation of breast lesions. We underwent this study to evaluate the clinical usefulness of Tc-99m MIBI in evaluating patients with palpable breast lesions using dedicated high-resolution scintimammography. MATERIALS AND METHODS: This study included 19 patients with 23 palpable breast lesions who underwent mammography. Tc-99m MIBI was taken to further characterize these lesions. Scintimammography images were acquired with standard craniocaudal and mediolateral oblique views and delayed images were additionally taken. Final conclusions were based on histopathology, either by biopsy or mastectomy results. RESULTS: Eighteen lesions were malignant and five were benign. Mammography was indeterminate for thirteen lesions, nine of those were malignant. Mammography also categorized one lesion as benign in a dense breast, but scintimammography and pathology results showed malignancy. Of the five benign lesions, two were visible on scintimammography, but delayed images showed washout. CONCLUSION: Based on our preliminary results, dedicated high resolution scintimammography seems to be very useful in characterizing palpable lesions that were indeterminate or negative on mammography.

Diagnostic Performance of Combined Single Photon Emission Computed Tomographic Scintimammography and Ultrasonography Based on Computer-Aided Diagnosis for Breast Cancer / 핵의학분자영상

PURPOSE: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). MATERIALS AND METHODS: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. RESULTS: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. CONCLUSION: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.

The Usefulness of Mammography and Scintimammography in Differential Diagnosis of Breast Tumor / 대한핵의학회잡지

PURPOSE: It is very important to differentiate breast cancer from benign mass. There are many reports to evaluate the differential diagnosis under the several diagnostic tools. We evaluated the usefulness of mammography and Tc-99m MIBI scintimammography in the differential diagnosis of breast mass and correlated with pathologic findings. MATERIALS AND METHODS: This study included 80 patients (age: 24-72, mean: 48.4) who underwent mammography and Tc-99m MIBI scintimammography for breast masses. Scintimammographies (anterior-posterior and lateral projections) were acquired in 10 minutes and 2 hours after intravenous injection of Tc-99m MIBI. Four specialists in diagnostic radiology and nuclear medicine evaluated the findings of breast masses under the mammography and Tc-99m MIBI scintimammography, and calculated the tumor to background (T/B) ratio. The pathologic results were obtained and we statistically analyzed the correlations between pathologic results and imaging findings under the mammography and Tc-99m MIBI scintimammography by chi-square and correlation test. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of mammography for detection of breast cancer were 87.5%, 56.3%, 75.0%, and 75.0% respectively. 45 cases of 80 patients were suspicious for breast cancer under the Tc-99m MIBI scintimammography. 41 cases of 45 patients were confirmed as breast cancer and the remaining 4 cases were confirmed as benign masses. The sensitivity, specificity, positive predictive value and negative predictive value of Tc-99m MIBI scintimammography for detection of breast cancer were 85.4%, 87.5%, 91.1%, and 80.8% respectively. The sensitivity of scintimammography was lower than that of mammography for detection of breast cancer, however the specificity, positive predictive value, and negative predictive value were higher. In the benign mass, the mean T/B ratio in 10 minutes was 1.409 +/- 0.30, and that in 2 hours was 1.267 +/- 0.42. The maximal T/B ratio of benign mass in 10 minutes was 1.604 +/- 0.42, and that in 2 hours was 1.476 +/- 0.50. In the malignant mass, the mean T/B ratio in 10 minutes was 2.220 +/- 1.07, and that in 2 hours was 1.842 +/- 0.75. The maximal T/B ratio of malignant mass was 2.993 +/- 1.94, and that in 2 hours was 2.480 +/- 1.34. And the T/B ratio under the early and delayed images were meaningful. CONCLUSION: The scintimammography is useful diagnostic tool to differentiate breast cancer from benign mass, although the sensitivity of mammography for detection of breast mass is high. Especially, the use of the T/B ratio is helpful to diagnose breast cancer.

Diagnostic Accuracy of Quantitative Scintimammography Using Tc-99m Tetrofosmin according to ROC Curve Analysis for Breast Cancer / 한국유방암학회지

PURPOSE: Tc-99m Tetrofosmin is a new alternative to Tc- 99m MIBI for nuclear breast imaging. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the feasibility of Tc-99m Tetrofosmin quantitative scintimammography (SMM) (qSMM) and to compare with previously reported Tc-99m MIBI qSMM data [J Kor Surg 1999;57(5):638-644)]. METHODS: Prone anterior, lateral planar and supine SPECT images were taken from 135 cases in 131 female patients (mean ages=44 yr) with breast mass (size> or =0.2 cm) after 30mCi intravenous injection of Tc-99m Tetrofosmin. 70 malignant and 65 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: the Lesion (L), the Normal breast opposite the lesion (NL) and the right Chest wall (CW). L/NL and L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that the planar L/NL ratio and the SPECT L/NL and L/CW ratios had higher diagnostic accuracy for detecting breast cancer than he planar L/CW ratio did (P<0.05). The qSMM (mean), which is an arithmetic mean of the planar L/NL ratio, the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, accuracy and area under curve (AUC) were 82.9%, 81.5%, 82.2% and 0.879 respectively. Presence of axillary lymph node metastasis showed a slightly higher qSMM (mean) value (2.79 {n=23} vs 2.75 {n=27} P=0.06). These are comparable with previously reported Tc-99m MIBI qSMM data of 84.4%, 76.6%, 81.0% and 0.847 respectively, and the presence of axillary lymph node metastasis showed a higher qSMM(mean) value (4.09 {n=17} vs 3.09 {n=28}, P=0.06) [J Kor Surg 1999; 57(5):638-644)]. CONCLUSION: Tc-99m Tetrofosmin qSMM (mean) is a useful and objective method for differentiating malignant from benign breast lesion and has the comparable diagnostic accuracies of Tc-99m MIBI qSMM.

Diagnostic Role of Tc-99m MIBI Scintimammography in Suspected Breast Cancer Patients: Results of Unicenter Trial / 대한핵의학회잡지

PURPOSE: Tc-99m MIBI scintimammography has been validated as an useful non-invasive diagnostic tool for the primary breast cancer. But most studies have included small population of patients. We have experienced a large study population and investigated the diagnostie usefulness of Tc-99m MIBI scintimammography in detection of primary breast cancer and axillary Iymph node metastasis. MATERIALS AND METHODS: This study included 30S patients who underwent scintimammography for palpable breast masses or abnormal radiologic findings. Tc-99m MIRI scintirnammography was performed 10 minutes after intravenous injection of 925 MBq of Tc-99m MIBI. If the early image revealed abnormal finding, 3 hour delayed image was also acquired. We calculated early and delayed lesion to non-lesion ratios (L/N). The pathologic diagnosis was obtained from surgical operation or F.4AB and compared with the results of Tc-99m MIBI scintimammography. RESULTS: Malignant breast diseases were 155 and benign ones were 150. Tc-99m MIBI scintimammography revealed 132 true positive, 23 false negative, 10 false positive, and 140 true negative cases. The sensitivity, specificity, positive predictive value and negative predictive value for the primary breast cancer detection were 85.2%, 93.4%, 92.9%, and 85.9%, respectively. The sensitivity, specificity, positive predictive and negative predictive values of Tc-99m MIBI scintimammography in detecting metastatic axillary lymph node involvement were 22%, 90.4%, 61.9% and 62.3%, respectively. Early L/N of malignant breast disease was significantly higher than that of benign one (2,44+/-0.97 vs 1.94+/-0.78, p=0.01). Delayed L/N had no significant difference between malignant an

Comparison of Tc-99m-Tetrofosmin and Tc-99m-MIBI Scintimammography in Differential Diagnosis of Breast Mass / 대한핵의학회잡지

PURPOSE: Tc-99m-MIBI (MIBI) and Tc-99m-Tetrofosmin (TF) are commonly used for scintimammography (SMM). We compared the diagnostic ability of SMM using Tc-99m-MIBI and Tc-99m-TF for the differential diagnosis of breast mass. MATERIALS AND METHODS: The study subjects were comprised of 123 breast lesions and 86 normal breasts of 114 patients who underwent SMM. Bilateral prone images and anterior supine images were obtained at 5 minutes and 1 or 3 hours after intravenous injection of 740 MBq of either MIBI or TF. Sizes of tumors were not significantly different between the MIBI and TF groups. First, two observers independently read the SMM without clinical information (1st interpretation), then read again with information about mass location (2nd interpretation). Sensitivity and specificity of each radiopharmaceutical for the diagnosis of breast cancer were evaluated in terms of image acquisition time, tumor size, and location. RESULTS: The SMM showed a good agreement between two observers for 1st and 2nd interpretation, except for TF SMM at 3 hr. For the first interpretation, the sensitivities at 5 min, 1 hr, and 3 hr were not significantly different between MIBI and TF SMM (81.6%, 80.0%, 60.9% in MIBI vs. 88.9%, 80.6%, 42.9% in TF), although the senstivities of 3 hr images were significantly lower than 5 min images in both MIBI and TF SMM. The specificity of TF at 5 min was superior to that of MIBI (81.5%, 90.0%, 82.9% in MIBI vs. 96.7%, 100%, 90.0% in TF, p<0.01 MIBI vs. TF at 5 min). For the second interpretation with information of mass location, the sensitivities at 3 hr images were significantly lower than 5 min images (86.8%, 86.7%, 78.3% in MIBI vs. 88.9%, 93.5%, 57.1% in TF) between MIBI and TF SMM. However, there was no significant difference in the specificity (60.0%, 53.8%, 75.0% for MIBI vs. 86.7%, 100%, 100% for TF). MIBI and TF SMM showed lower sensitivities for the tumors with less than 1 cm than tumors with more than 1 cm. However, the location of tumors did not influence the sensitivity and specificity between MIBI and TF SMM. CONCLUSION: The ability for the differential diagnosis of breast tumor is similar between MIBI and TF SMM, and delayed image is not necessary. TF may be better than MIBI considering the specificity of SMM without clinical information and labeling convenience.

99mTc-Tetrofosmin Scintimammography in Suspected Breast Cancer Patients: Comparison with 99mTc-MIBI / 대한핵의학회잡지

PURPOSE: The aim of this study was to investigate the diagnostic role of 99mTc-Tetrofosmin in detection of breast cancer and compared with that of 99mTc-MIBI. MATERAL AND METHODS: Forty-eight patients with a clinically palpable mass or abnormal mammographic or ultrasonographic findings had 99mTc-MIBI and 99mTc-Tetrofosmin scintimammographies after intravenous injection of 925 MBq of radiopharmaceuticals. The scintimammographs were correlated with histopathologic findings. RESULTS: Thirty-three patients were diagnosed with breast cancer and 15 patients with benign breast diseases. The numbers of true positive, true negative, false positive, and false negative cases of 99mTc-MIBI scintimammography were 29, 10, 5, and 4 respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of 99mTc-MIBI scintimammographies were 87.8%, 66.7%, 85.3%, and 71.4% respectively. The numbers of true positive, true negative, false positive, and false negative cases of 99mTc-Tetrofosmin were 31,10, 5, and 2 respectively. The sensitivity, specificity, positive predictive value, negative predictive value of 99mTc-Tetrofosmin were 93.9%, 66.7%, 86.1%, and 73.3% respectively. One patient was false negative in both 99mTc-MIBI and 99mTc-Tetrofosmin scintimammographies and its size was 0.5cm. CONCLUSION: 99mTc-Tetrofosmin and 99mTc-MIBI were non-invasive and useful in detection of breast cancer and 99mTc-Tetrofosmin was comparable to the 99mTc-MIBI in detection of primary breast cancer.

Diagnostic Accuracy of Quantitative Scintimammography Using Tc-99m MIBI According to ROC Curve Analysis for Breast Cancer

BACKGROUND: Technetium-99m sestamibi scintimammography (SMM) has been shown to be a useful diagnostic test in the detection of breast cancer, and the receiver operating characteristic (ROC) curve analysis provides detailed information about the diagnostic test. A ROC curve analysis was performed to evaluate the feasibility of Tc-99m sestamibi quantitative scintimammography (qSMM) for differentiating malignant from benign breast lesions. METHODS: Prone anterior, lateral planar, and supine SPECT imagings were performed on 75 female patients (mean age=43.4 yr) with breast masses (size> or =0.8 cm) after intravenous injection of 30 mCi of Tc-99m sestamibi. 45 malignant and 30 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: lesion (L), normal breast opposite to the lesion (NL), and right chest wall (CW). L/NL and the L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that planar L/NL ratio and the SPECT L/NL and L/CW ratios provide better diagnostic accuracies for detecting breast cancer than the planar L/CW ratio did (p<0.05). From the qSMM (mean), which was an arithmetic mean of the planar L/NL, ratio the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy were 84%, 77%, 84%, 77%, and 81%, respectively. Presence of axillary lymph-node metastasis showed a higher qSMM (mean) value (4.09 {n=17} vs 3.09 {n=28}, p=0.06). CONCLUSIONS: qSMM (mean) is a useful objective method for differentiating malignant from benign breast lesions.

Diagnostic Usefulness of Tc-99m Tetrofosmin Scintimammography in Patients with Primary Breast Cancer / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the diagnostic usefulness of scintimammography performed with Tc-99m tetrofosmin in the detection of primary breast cancer. MATERIALS AND METHODS: Sixty-one patients underwent Tc-99m tetrofosmin scintimammography, plain-filrn mammography and ultrasonography. After intravenous injection of Tc-99m tetrofosmin (740 MBq), prone lateral and anterior scintimammograms were obtained. Scintimammogram was visually interpreted as positive, probably positive, probably negative and negative for malignancy. The tumor to background count ratio (T/B) was measured at 5 minutes and 1 hour. Plain-film mammogram was interprcted as one of 5 categories. Final diagnosis was achieved by surgical histology (58/61) or fine needle aspiration (3/61). Of 61 patients, 44 had cancer and 17 had benign lesion. Tumor size of malignant and benign lesions on ultrasonogram were 2.51+/-1.30 cm (range 1-8 cm), 2.50+/-1.35 cm (range 0.96-6 cm), respectively. RESULTS: The sensitivity of plain-film mammography was 88.6%, specificity 58.8%, positive predictive value 84.7%, and negative predictive value 66.7%. The sensitivity of Tc-99m tetrofosmin scintimammography was 90.9%; specificity, 88.2%; positive predictive value, 94.9%; negative predictive value, 78.9%. Of 25 patients with indeterminate degree of suspicion for malignancy on plain-film mammogram, 23 were correctly diagnosed by scintimamography. The T/B at 5 minutes and 1 hour were 3.78+/-2.21, 3.25+/-1.80 respectively. The T/B was decreased significantly at 1 hour (p<0.001). CONCLUSION: Tc-99rn tetrofosrnin scintimammography was useful diagnostic procedure in the detection of primary breast cancer, especially in patients with indeterminate degree of suspicion for malignancy on plain-film mammogram.

Tc-99m MIBI scintimammography (SMM) in the evaluation of palpable breast masses.

Radionuclide breast imaging, also called scintimammography (SMM) was performed using Tc-99m MIBI in 37 patients with palpable breast masses. A total of 38 lesions were analyzed. Twenty cases subsequently underwent modified radical mastectomy while the remainder underwent only biopsy or fine needle aspiration for histologic proof. The average size of the masses were 3.03+1.61 x 4.10+2.89 cm in diameter. Twenty-six lesions were malignant and 12 were benign; 23 malignancies showed positive MIBI uptake but three did not. The false negative cases were all invasive ductal carcinomas. Nine benign lesions were true negatives and three were false positives. They were mastitis, foreign-body granuloma and fat necrosis which chronic inflammation. Of 14 cases which histologically proved to have axillary node metastasis, only 7 revealed positive MIBI uptake. The sensitivity and spectively. However, in the detection of axillary node metastasis, the sensitivity was only 50 percent. Thus, Tc-99m MIBI SMM is helpful in the diagnosis of routine mammography. However, the imaging is not accurate enough for the detection of axillary node metastasis. In addition, Tc-99m MIBUI SMM also plays an important role in terms of prognosis and therapeutic planning in patients with breast cancer.

Technetium-99m-methoxyisobutylisonitrile Scintigraphic Diagnosis ( Tc-99m MIBI SCAN ) of Breast Cancer

Patients with breast lesion suggestive of malignancy underwent Tc-99m MIBI scan in order to assess the value of this technique in the detection of breast carcinoma and axillary lymph node metastasis. One hundred five patients with breast lesion underwent 99m-MIBI scan before biopsy. 20mCi of Tc-99m MIBI was given intravenously in contralateral arm of the breast lesion and planar prone lateral and supine anterior views for 10 minutes each were taken. Pathological diagnoses were carcinoma in 77 breasts of 76 patients and benign in 29 patients. Pathologic types were DCIS in 4, IDC in 62, mucinous carcinoma in 3, medullary carcinoma in 2 and others in 6. The pathologic tumor status was DCIS in 4, T1 in 27 ,T2 in 30, T3 in 6, T4 in 4 and Tx is 6 cases. All patients with multiple lesions were positive. The sensitivity of Tc-99m-MIBI scan was 95%(73/77) and specificity was 69%(20/29). Sensitivity of mammography and ultrasonography were 85% and 82%. Axillary metastasis study showed 68% sensitivity and 92% specificity. The Tc-99m MIBI scan is a highly effective method in the diagnosis of breast cancer.

Scintigraphic Detection of Small Breast Carcinomas / 대한핵의학회잡지

No abstract available.