Abstract
PURPOSE: To prospectively evaluate a high-resolution breast-specific gamma camera for depicting occult breast cancer in women at high risk for breast cancer but with normal mammographic and physical examination findings.
MATERIALS AND METHODS: Institutional Review Board approval and informed consent were obtained. The study was HIPAA compliant. Ninety-four high-risk women (age range, 36–78 years; mean, 55 years) with normal mammographic (Breast Imaging Reporting and Data System [BI-RADS] 1 or 2) and physical examination findings were evaluated with scintimammography. After injection with 25–30 mCi (925–1110 MBq) of technetium 99m sestamibi, patients were imaged with a high-resolution small-field-of-view breast-specific gamma camera in craniocaudal and mediolateral oblique projections. Scintimammograms were prospectively classified according to focal radiotracer uptake as normal (score of 1), with no focal or diffuse uptake; benign (score of 2), with minimal patchy uptake; probably benign (score of 3), with scattered patchy uptake; probably abnormal (score of 4), with mild focal radiotracer uptake; and abnormal (score of 5), with marked focal radiotracer uptake. Mammographic breast density was categorized according to BI-RADS criteria. Patients with normal scintimammograms (scores of 1, 2, or 3) were followed up for 1 year with an annual mammogram, physical examination, and repeat scintimammography. Patients with abnormal scintimammograms (scores of 4 or 5) underwent ultrasonography (US), and those with focal hypoechoic lesions underwent biopsy. If no lesion was found during US, patients were followed up with scintimammography. Specific pathologic findings were compared with scintimammographic findings.
RESULTS: Of 94 women, 78 (83%) had normal scintimammograms (score of 1, 2, or 3) at initial examination and 16 (17%) had abnormal scintimammograms (score of 4 or 5). Fourteen (88%) of the 16 patients had either benign findings at biopsy or no focal abnormality at US; in two (12%) patients, invasive carcinoma was diagnosed at US-guided biopsy (9 mm each at pathologic examination).
CONCLUSION: High-resolution breast-specific scintimammography can depict small (<1-cm), mammographically occult, nonpalpable lesions in women at increased risk for breast cancer not otherwise identified at mammography or physical examination.
© RSNA, 2005
References
- 1
. Mammographic features of early breast cancer. AJR Am J Roentgenol 1984;143:461–464.Sickles EA - 2
, Sheiner NM. False-negative mammograms in patients with breast cancer. Can J Surg 1981;24:50–52.Niloff PH - 3
, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002;225(1):165–175.Kolb TM - 4
, Mena I, Jouanne E. Prone scintimammography in patients with suspicion of carcinoma of the breast. J Am Coll Surg 1994;178:491–497.Khalkhali I - 5
, Cutrone JA, Mena I. Scintimammography: the complementary role of Tc-99m sestamibi prone breast imaging for the diagnosis of breast carcinoma. Radiology 1995;196:421–426.Khalkhali I - 6
, Schoonjans JM, Kieper DA, Majewski S. High-resolution scintimammography: a pilot study. J Nucl Med 2002;43:909–915.Brem RF - 7
, Villanueva-Meyer J, Edell S. Diagnostic accuracy of Tc-99m sestamibi breast imaging: multi-center trial results. J Nucl Med 2000;41(12):1973–1979.Khalkhali I - 8
, Argon M, Memis A. Evaluation of palpable breast masses with Tc-99m-MIBI: a comparative study with mammography and ultrasonography. Nucl Med Commun 1994;15:604–612.Burak Z - 9
, Becherer A, Trattnig S. Differentiation of benign and malignant breast lesions: MR Imaging versus Tc-99m sestamibi scintimammography. Radiology 1997;202:421–429.Helbich TH - 10
, Sandbank J, Cohen M, Lelcuk S, Lubin E. Technetium 99-m MIBI scintimammography in palpable and nonpalpable breast lesions. J Nucl Med 1998;39:86–91.Mekhmandarov S - 11
, Robidoux A, Lambert R. Technetium 99-m sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement. J Nucl Med 1995;36:1758–1765.Taillefer R - 12
, Lugo-Zamudio C. Scintimammography in the diagnosis of breast cancer. Am J Surg 1996;172:483–486.Clifford EJ - 13
, Wang SJ, Liu TJ. The use of technetium-99m methoxyisobutylisonitrile breast scintigraphy to evaluate palpable breast masses. Eur J Nucl Med 1994;21:432–436.Kao CH - 14
, Biersak HJ, Lastoria S. Scintimammography with technitium-99m methoxyisobutylisonitrile: results of a prospective European multi-center trial. Eur J Nucl Med 1998;25:375–385.Palmedo H - 15
, Khalkhali I, Sommer H. The role of Tc-99m sestamibi scintimammography and contrast enhanced magnetic resonance imaging for the evaluation of indeterminate mammograms. Eur J Nucl Med 1997;24:1221–1229.Tiling R - 16
, Pappo I, Cohenpour M. Tc-99m MIBI scintimammography for the detection of breast malignancies: the contribution of the count ratio to specificity. Nucl Med Commun 1999;20:511–516.Horne T - 17
, Ozturk E, Ilgan S. Tc-99m MIBI scintimammography in the evaluation of breast lesions and axillary involvement: a comparison with mammography and histopathological diagnosis. Nucl Med Commun 1999;20:317–325.Arslan N - 18
, Agresti R, Chiti A, Crippa F. Prone scintimammography in patients with nonpalpable breast lesions. Anticancer Res 1996;16:1269–1274.Maffioli L - 19
, Ierardi M, Porfiri LM, et al. Tc-99m MIBI prone scintimammography in patients with high and intermediate risk mammography. Anticancer Res 1997;17:1635–1638.Scopinaro F - 20
, Schillaci O, Ussof W, et al. A three center trial on the diagnostic accuracy of Tc-99m MIBI scintimammography. Anticancer Res 1997;17:1631–1634.Scopinaro F - 21
, Cutrone JA, Wang B. Scintimammographic analysis of nonpalpable breast lesions previously identified by conventional mammography. J Natl Cancer Inst 1998;90:846–849.Tolmos J - 22
, Grunwald F, Bender H. Scintimammography with technetium-99m methoxyisobutylionitrile: comparison with mammography and magnetic resonance imaging. Eur J Nucl Med 1996;23:940–946.Palmedo H - 23
, Kieper D, Keppel C. Optimization of dedicated scintimammography procedure using small detector prototypes and compressible breast phantoms (abstr). Presented at the IEEE Medical Imaging Conference, Lyon, France, October 2000.Majewski S - 24
, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 1999;353(9169):1993–2000.Fisher B - 25
, Brem RF. Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 2001;20(9):967–972.Schoonjans JM - 26
. The role of (99m)Tc methoxyisobutylisonitrile in imaging breast cancer. Semin Nucl Med 1997;27:40–54.Waxman AD - 27
, Khalkhali I, Yosper LS. Tc-99m sestamibi scintimammography for the evaluation of breast masses in patients with radiographically dense breasts. Breast J 1999;5:383–388.Cutrone JA - 28
, Waxman A, Nguyen K. Correlation of Tc-99m sestamibi uptake with histopathologic characteristics in patients with benign breast disease (abstr). J Nucl Med 1996;37:250.Gupta P - 29
, Lester S. The female breast. Pathologic basis of disease. 6th ed. Philadelphia, Pa: Saunders, 1999; 1100–1102.Cotran S - 30
, Khalkhali I, Diggles L. The role of radionuclide imaging in the evaluation of suspected breast abnormalities. Breast Dis 1998;10:177–187.Rice SJ - 31
. Clinical applications of 99mTc-sestamibi scintimammography. Semin Nucl Med 2005;35:100–115.Taillefer R - 32
, Klingensmith WC 3rd, Parker SH, Stavros AT, Sutherland JD, Aldrete KD. Comparative value of Tc-99m sestamibi scintimammography and sonography in the diagnostic workup of breast masses. AJR Am J Roentgenol 2000;174:1779–1783.Klaus AJ - 33
, Pisano ED, Schnall MD, Fajardo LL. Future directions in imaging of breast disease. Radiology 1998;206:297–300.Williams MB - 34
, Mielcarek P, Klaschik S. Dynamic breast MR imaging: are the signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 1999;211:101–110.Kuhl CK