[Combined use of 99mTc-MIBI scintigraphy and ultrasonography (US) in the diagnosis of axillary lymphatic metastasis in patients with breast cancer].

We aimed to evaluate different imaging strategies for diagnosis of axillary LNMs in patients with primary breast cancer (BC). 168 consecutive patients with primary BC were included in the study. Functional imaging by scintigraphy (AxSc) with 99mTc-MIBI was performed in static and tomography modes 15 min after i/v injection. Focal areas of tracer accumulation in axial region were considered as sings of LNMs. Ultrasound (US) examination of axillary region was performed on 7.5 kH scanner. Nodes with diameter more than 1 cm were considered abnormal. All patients were operated with axial LN dissection and subsequent histological evaluation. Scintigraphic signs of LNMs revealed in 65 patients: 48--true positive, 17--false positive. Among 103 women with normal AxSc results 27 had LNMs and 76--uninvolved nodes. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of AxSc were as follows: 64%, 82% and 74%. Sonography diagnosed LNMs in 74 women: 56 were metastatic on histology while other 18--uninvolved. On the contrary, 19 of 94 US normal sized nodes were metastatic on histology. US had following values when used for diagnosis of axillary LNMs: Sen--75%, Sp--81%, Ac--78%. When LNMs were diagnosed as the combination of concordantly abnormal US and AxSc examinations Sp reached 95%, Sen dropped down to 56% and Ac--to 77%. Another model was based on the assumption that LNMs must be diagnosed in all patients with abnormal US or AxSc examinations. According to this strategy Sen reached 83%, Sp--68% and Ac--74%. Thus, we found comparative accuracy of US and AxSc in diagnosis of axillary LNMs in patients with primary BC. Combination of both modalities can significantly improve sensitivity (83%) or specificity (95%) of final conclusion which is determined by established diagnostic strategy and criteria's that are used for BC diagnosis.

[Methodologic aspects of radionuclide diagnosis of breast cancer with 99mTc-MIBI].

The aim was to study the diagnostic possibilities of breast scintigraphy with help of domestic RFP tehnetril labeled 99mTc. Breast scintigraphy was performed in 132 women at age between 32 and 68 years. Visualization of both breasts in planned mode was performed in the lateral and anterior projections in 10-15 minutes after intravenous injection of 740-860 MBq of 99mTc-tehnetril. After this, a study was conducted in the mode emission computed tomography. Morphological verification of changes in the breast was performed in all cases. Sensitivity, specificity and overall accuracy of planar breast scintigraphy was 96% (105/112), 94% (245/252) and 95% respectively. Upon planar study of 132 breasts suspicious on cancer presence breast scintigraphy showed not high specificity 68% (7/21), sensitivity reached 94% (105/112), overall accuracy--90%. SPECT did not show visible benefits: sensitivity-92% (100/112), specificity--75% (5/21), and overall accuracy--89%. Usage of a semi-quantitative accrual rate of RFP in tumor allowed distinguishing four groups of patients with different, to breast scintigraphy data, likelihood of breast cancer (from 2-10% to 96%). As a result current methods of breast scintigraphy provide high sensitivity (88-96%) and accuracy in breast cancer detecting of any size as far as the use of additional diagnostic criteria, semi-quantitative ratio RFP accumulation in tumor in particular, can significantly increase (up 94%), specificity of diagnostic conclusions.