Technetium-99m-MIBI scintimammography by planar and SPECT imaging in the diagnosis of breast carcinoma and axillary lymph node involvement.

BACKGROUND: We compared SPECT and planar (99m)Tc-MIBI scintimammography (SMM) in the detection of primary breast cancer and metastatic axillary lymph node involvement, and the scintigraphic results with the histopathological/cytological findings. MATERIAL AND METHODS: 303 consecutive patients with 308 suspicious or indeterminate lesions observed in mammographies were entered in this study. After an intravenous injection of 740 MBq of (99m)Tc-MIBI, anterior supine, right and left lateral planar images in a prone position and a SPECT study were acquired. RESULTS: 85 malignant and 223 benign breast lesions were confirmed by histopathology/cytology. The overall sensitivity in the detection of breast cancer was 92% (78/85) for SPECT and 82% (70/85) for planar imaging (p = NS), respectively; overall specificity was 91% (204/223) for SPECT and 91% (202/223) for planar scans (p = NS), respectively. Metastatic axillary lymph node involvement was seen in 35 patients; per-axilla overall sensitivity was 66% (23/35) for SPECT and 54% (19/35) for planar images (NS), respectively; overall specificity was 76% (38/50) and 86% (43/50), respectively (NS). CONCLUSIONS: Our results confirm the high diagnostic accuracy of (99m)Tc-MIBI scintimammography in the diagnosis of breast cancer, and show SPECT to be slightly more sensitive than planar imaging, especially in detecting malignant breast lesions. We found the sensitivity of both imaging modalities to be quite low in the detection of metastatic axillary lymph node involvement. SPECT provides additional information to planar SMM with respect to the localization of (99m)Tc-MIBI uptake and tumour extent and improves diagnostic certainty. Our experience suggests that SPECT combined with planar SMM should be used more widely.

Changes in mammographic and ultrasound image of the breast of women undergoing estrogen replacement therapy.

OBJECTIVE: Evaluation of changes in mammographic and ultrasound image of the breast in female patients undergoing estrogen hormonal replacement therapy (ERT). MATERIAL AND METHODS: 126 women with surgical menopause in case of benign disease using ERT and a control group of 100 women in menopause with no hormonal replacement therapy were selected for the study. Changes in the mammographic image were monitored in relation to individual types of breast according to Tabár's typology and with regard to the type of ERT application. In 38 women, changes in ultrasound image were also monitored together with ERT. RESULTS: In 17 women (13 %) undergoing ERT, an increase in mammographic image density was found. This data was statistically significant in comparison with the control group without ERT (chi2 = 21.566, p < 0.0001). In 103 (82 %) women there was no change in mammographic density and in 6 women (5 %) decreased density despite using of ERT was found. In the group of patients undergoing ERT in peroral form, we found a greater percentage of women with an increased mammographic density (17 %) in comparison with the group of women with intradermally applied ERT (9 %). Increased density of mammographic image was more frequent in women with a prevalence of adipose tissue in their breasts (type II according to Tabár). In 8 patients (21 %) of 38 women with ultrasound examination an enlargement or development of new benign formations in the breast was found; this data was statistically insignificant in comparison with the control group. CONCLUSION: In women with surgical menopause undergoing ERT, a statistically significant increase in the density of mammographic image was found (chi2 = 21.566, p < 0.0001). Increase in density of mammographic image was most frequent in women with a predominance of adipose tissue in breasts (a type II according to Tabár) and in women undergoing ERT in the peroral form. These data were statistically insignificant in 21 % of women with supplementary ultrasound examination enlargement and development of new benign lesions in the breasts were found.