Varices of inferior epigastric veins caused by chronic inferior vena cava obstruction: Mimicking normal venous flow pattern on radionuclide venography

A 21-year-old patient with long-standing inferior vena cava obstruction secondary to idiopathic thrombosis extending from the external iliac veins underwent a radionuclide venography with Tc-99m pertechnetate labeled erythrocytes. The blood pool phase of the study revealed bilaterally distorted inferior epigastric veins mimicking normal venous flow pattern. The authors present this case to discuss the possible alternative routes and the underlying physiopathologic mechanism of this unusual flow pattern in chronic inferior vena cava obstruction.

Unusual patterns of I-131 contamination

Whole body imaging with radioiodine can detect functioning metastases, which can often be effectively treated with appropriate amounts of radioiodine. Non-physiologic I-131 uptake detected on images is usually interpreted as suggesting functioning thyroid metastases. However, extra-thyroidal I-131 accumulation does not always imply thyroid cancer metastases and has been reported on many occasions, including various non-thyroidal neoplasms, and contamination by body secretions. In order to avoid unnecessary therapeutic interventions it is extremely important to properly distinguish false-positive sites of I-131 localization. Three patients with unusual radioiodine contamination patterns, either presented for the first time or rarely presented in the existing literature, were reported. Reported cases consist of contamination in hair (due to styling hair with sputum), contamination in neck (due to drooling during sleep) and, contaminated chewing gum. False positive contamination sources were clarified by careful examination of patients and further images when necessary.

Iodine-131 treatment and high-resolution CT: results in patients with lung metastases from differentiated thyroid carcinoma

Between 1984 and 2002, pulmonary metastases were detected in 42 (4%) out of 1,023 patients with differentiated thyroid carcinoma (DTC) in our department. The age at diagnosis ranged from 6 to 77 years. Lung metastases were diagnosed by both increased thyroglobulin (Tg) levels and positive uptake of iodine-131 on scans, and/or positive radiological findings. The primary tumours were histologically classified as papillary (30 patients), follicular (nine patients) and poorly differentiated (two tall cell, one insular carcinoma). The duration of follow-up ranged from 24 to 228 months. The end-results of the (131)I therapy were evaluated. The treatment of choice was (131)I therapy of metastases after total thyroidectomy plus lymph node dissection (if lymph node metastases were present). Applied single and total (131)I activities were 1.8-10.4 GBq and 5.5-43.7 GBq, respectively. Lung metastases were present at the time of diagnosis in 30 patients and developed during the follow-up period in the remaining 12. Twelve patients with extensive metastases died of thyroid carcinoma and another died due to secondary malignancy (malignant mesothelioma). Ten patients with lung metastases remain completely free of disease and are probably cured, while another seven were stable at the time of study. Three- and five-year survival rates were 86% (36/42) and 76% (32/42), respectively. To define the diagnostic value of high-resolution computed tomography (HRCT) and identify the distinctive features of lung metastases from DTC, 22 patients were further examined with HRCT within 2 weeks of the initial diagnosis of lung metastases and the results were compared with chest X-ray findings. HRCT detected metastases in 10 out of 14 patients with a normal chest X-ray and confirmed metastases in all patients with positive (n=5) and suspicious (n=3) chest X-ray. HRCT did not show any abnormalities in four patients with positive lung uptake on (131)I whole-body images. Stage of disease, existence of distance metastases other than to the lung, and HRCT characteristics were significant prognostic variables. Lung metastases from DTC can be cured with (131)I therapy in a considerable number of patients, especially when they are not associated with other distant metastases; they should therefore be treated at an early stage. HRCT clearly improved diagnostic ability in the evaluation of lung metastases compared with chest X-ray and should be the primary method when radiological correlation is needed. The main, and new, finding of the study is that HRCT not only improves diagnostic ability but is also of prognostic value.

Uterine doughnut in early proliferating phase: potential pitfall in gastrointestinal bleeding studies

A 41-year-old woman with rectal bleeding was referred to our department for gastrointestinal (GI) bleeding study. She was in early post-menstrual period and had stable vital signs. A GI bleeding study with Tc-99m SC revealed uterine blush in the pelvis. The shape of activity and quick fading excluded a GI bleeding. To rule out an intermittent bleeding, patient underwent a second bleeding study with Tc-99m RBC. Serial images showed uterine "doughnut" in the pelvis. The activity neither changed in shape nor showed distal movement with time excluding a GI hemorrhage. Uterus in early proliferating phase could be a potential pitfall in GI bleeding studies.

A new, practical, low-dose 14C-urea breath test for the diagnosis of Helicobacter pylori infection: clinical validation and comparison with the standard method

The carbon-14 urea breath test (UBT) is a reliable and non-invasive technique for the diagnosis of Helicobacter pylori (HP) infection. In this study we evaluated the diagnostic performance of a new, practical and low-dose (14)C-UBT system for the diagnosis of HP and compared the results with those obtained using the standard method. Seventy-five patients (56 female, 19 male) with dyspepsia underwent (14)C-UBT and endoscopy with antral biopsies for histological analysis. The rapid urease test (CLO test) was applied to 50 of these patients. After a 6-h fasting period, a 37-kBq (14)C-urea capsule was swallowed for UBT. Breath samples were collected and counted using two different methods, the Heliprobe method and the standard method. In the Heliprobe method, patients exhaled into a special dry cartridge system (Heliprobe BreathCard) at 10 min. The activities of the cartridges were counted using a designated small GM counter system (Heliprobe analyser). Results were expressed both as counts per minute (HCPM) and as grade (0, not infected; 1, equivocal; 2, infected) according to the counts. In the standard method, breath samples were collected by trapping in a liquid CO(2) absorber. Radioactivity was counted as disintegrations per minute (SDPM) using a liquid scintillation counter after addition of a liquid scintillation cocktail. Histological examination was used as a gold standard. Two patients were excluded from the study because of inadequate biopsy sampling. Forty-eight patients (65%) were found to be HP positive on histology. The Heliprobe method correctly classified 48 of 48 HP-positive patients and 19 of 25 HP-negative patients (sensitivity 100%, specificity 76%, PPV 88%, NPV 100%, accuracy 91%). The standard method correctly classified 48 of 48 HP-positive patients and 20 of 25 HP-negative patients (sensitivity 100%, specificity 80%, PPV 90%, NPV 100%, accuracy 93%). On the other hand, the CLO test identified 26 of 32 HP-positive and 12 of 16 HP-negative patients (sensitivity 81%, specificity 75%, PPV 86%, NPV 66%, accuracy 79%). With the Heliprobe method, all of the positive results were grade 2, and all of the negative results were grade 0. No patients were defined as having grade 1 results. Counts allowed clear discrimination of HP-positive and -negative patients with both methods, the difference being statistically significant in each case ( P<0.001). A significant correlation was found between HCPM and SDPM ( r 0.863, P<0.001). According to the ROC analysis, the area under the curve was nearly the same with HCPM (AUC, 0.888; 95% CI, 0.785-0.992) and SDPM (AUC, 0.898; 95% CI, 0.802-0.994). In conclusion, the new (14)C-UBT system is a highly accurate method for the diagnosis of HP infection. It is rapid and practical, and therefore suitable for clinical and office practice.

Diagnostic approach to prostate cancer using total prostate specific antigen-based parameters together

This prospective study investigated the value of serum total prostate specific antigen (tPSA)-based parameters in the diagnosis of prostate cancer (PCa). Serum tPSA, free to tPSA ratio (f/tPSA), PSA density (PSAD), and PSA transition zone (PSAT) were evaluated in 110 patients with histologically confirmed benign prostate hyperplasia (BPH) and 98 patients with PCa. Once the serum tPSA was elevated (greater than 4 ng/ml) or digital rectal examination (DRE) was suspicious, transrectal ultrasound-guided biopsies were recommended. The tPSA, f/tPSA, PSAD, and PSAT levels were significantly different between the BPH and PCa groups. In patients with a tPSA level of 4.1-9.9 ng/ml or an abnormal DRE finding, only PSAT was found to have discriminating power. The cut-off values were 0.15 for f/tPSA, 0.30 for PSAT, and 0.15 for PSAD. The diagnostic sensitivity of a positive result for one of these parameters in the whole group was 84%, but 75% in patients with a tPSA of 4.1-9.9 ng/ml or an abnormal DRE finding. The diagnostic specificity of positive results for 3 parameters was 92% in the whole group and 93% in patients with a tPSA of 4.1-9.9 ng/ml or an abnormal DRE finding. All parameters were influenced by the histological grades. Histological grades showed a negative correlation (r = -0.56) with f/t PSA and a positive correlation (r = 0.44) with PSAT. No diagnostic marker investigated heretofore was able to rule out or detect early PCa in patients with a PSA level of 4.1-9.9 ng/ml. Using the PSA-based parameters together can be helpful in management of these patients. If all of the PSA-based parameters are negative, biopsy might be postponed; patients who have three positive PSA-based parameters should be biopsied. In case of one or two of the parameters, the patient's age and race should be considered in clinical decision-making.

Post-surgical ablation of thyroid remnants with high-dose (131)I in patients with differentiated thyroid carcinoma

The aims of this study were to evaluate the efficacy of an empirically determined "fixed" high ablative dose of radioiodine ((131)I) therapy and to determine the utility of ultrasonography (US) in dose determination. A retrospective analysis was performed of 242 thyroid cancer cases treated with "fixed" high-dose (131)I for ablation of thyroid remnants without a pre-ablative (131)I diagnostic scintigraphy or radioiodine uptake study. Treatment doses ranged from 1850 MBq (50 mCi) to 7.4 GBq (200 mCi). The selection of the treatment dose was based on the surgical and pathological findings as well as the remnant thyroid volume calculated by US. A successful ablation was defined as the absence of activity in the thyroid bed on subsequent imaging studies. Successful ablation was obtained in 218 of the 242 patients (90%). In 162 of the 218 patients (74.3%), successful ablation was achieved after a single (131)I treatment. The remnant thyroid volume calculated by US was significantly different (P=0.04) between those who were successfully ablated and those who were not. The total (131)I dose needed for successful ablation was significantly higher in males (P=0.003). Patients with higher post-operative thyroglobulin (Tgb) levels and patients with a higher stage of disease required higher doses (P=0.036 and P=0.021 respectively). Serum Tgb levels were under 10 ng.ml(-1) in 220 of the 242 patients (90%) following radioiodine ablation while not receiving L-thyroxine suppression. Nineteen patients (7.8%) showed metastases on post-therapy scan and successful treatment was achieved in 11 of 19 (57.8%). Four of the 19 patients with distant metastases (revealed on post-treatment scan) were found to have been given a treatment dose of less than 200 mCi based on the proposed empirical approach. These results indicate that "fixed" high-dose (131)I treatment is clinically feasible with an acceptable dose underestimation rate, and the utilization of US in the determination of the thyroid remnant volume provides more accurate and reproducible results.

Comparison of In-111 octreotide and Tc-99m (V) DMSA scintigraphy in the detection of medullary thyroid tumor foci in patients with elevated levels of tumor markers after surgery

PURPOSE

In this retrospective study, the authors evaluated the utility of In-111 octreotide (OctreoScan) and Tc-99m (V) DMSA scintigraphy for the localization of recurrent metastatic tumor foci in patients with medullary thyroid cancer (MTC) and compared the findings with those of conventional radiologic imaging methods.

METHODS

The scintigraphic images were compared with computed tomography (CT) and magnetic resonance imaging (MRI) and ultrasonography (US) in 14 patients (8 men, 6 women; age range, 22 to 74 years) with elevated calcitonin and carcinoembryonic antigen levels after total thyroidectomy. All scintigraphic image findings were evaluated qualitatively as mild uptake (+) and moderate to marked uptake (++).

RESULTS

In-111 octreotide may be superior to Tc-99m (V) DMSA for the detection of tumor foci of patients with MTC on a patient basis (78.5% versus 57.1%) and on a lesion basis (44.1% versus 30.2%). The sensitivity rate for In-111 octreotide (78.5%) was also similar to that of CT and MRI on a patient basis. Conversely, the combined use of Tc-99m (V) DMSA and In-111 octreotide revealed the best sensitivity rate (85.7%) on a patient basis, whereas the combined use of CT and MRI showed the best sensitivity rate (81.3%) on a lesion basis.

CONCLUSIONS

These findings suggest that In-111 octreotide is superior to Tc-99m (V) DMSA and has a similar sensitivity rate to CT and MRI for the diagnosis of recurrent or metastatic MTC. Although the combined use of In-111 octreotide and Tc-99m (V) DMSA was most sensitive, the combined use of CT and MRI with radionuclide imaging methods may better detect more metastatic tumor foci.

A practical approach to glomerular filtration rate measurements: creatinine clearance estimation using cimetidine

Determination of creatinine clearance (Ccr) is not a reliable indicator of glomerular filtration rate (GFR), owing to tubular secretion of creatinine. It has been reported that Ccr measurements can approximate true GFR after cimetidine (Ci) administration. In this study, GFR was estimated by Cockcroft and Gault's equation (C(C-G)) based on measurement of plasma creatinine, and Ccr was determined by the standard clearance equation using 4- and 24-hr urine samples (Ccr4 and Ccr24, respectively) in 17 patients and 10 healthy controls. After cimetidine administration (800 mg, 3 times daily), GFR values were recalculated at the same time periods (C(CiC-G), CcrCi4 and CcrCi24, respectively). The results were all compared to those obtained by the 99mTc-DTPA protein-free double-sample method (C(DTPA)), which is a reference method for GFR determination. The coefficient of variation (CV%) for Ccr24/C(DTPA) was high before cimetidine administration; Ccr24 and CcrCi24 values were significantly different from C(DTPA) (CV 23.1%, Ccr24/C(DTPA) = 1.17, p 0.005; and CV 14.1%, CcrCi24/C(DTPA) = 0.92, p 0.006, respectively). Ccr4 values obtained before cimetidine ingestion showed large variation and were significantly different from C(DTPA) (CV 15.5%, Ccr4/C(DTPA) = 1.11, p 0.001). CcrCi4 values after cimetidine were similar to CDTPA (CV 6.9%, CcrCi4/C(DTPA) = 1.01, p 0.28). C(C-G) estimates were higher before cimetidine intake (CV 12.4%, C(C-G)/C(DTPA) = 1.21, p <0.001), whereas C(CiC-G) values were not significantly different from C(DTPA) values (CV 7.0%, C(CiC-G)/C(DTPA) = 1.01, p 0.67). This study shows that GFR estimations by C(C-G), Ccr4, Ccr24, or CcrCi24 are insufficiently reliable. On the other hand, C(CiC-G) and CcrCi4 results are acceptable for true GFR estimations.

Utility of ventilation and perfusion scan in the diagnosis of young military recruits with an incidental finding of hyperlucent lung

Swyer-James-MacLeod syndrome (SJMS) is considered to be a relatively uncommon disease presenting with unilateral hyperlucent lung due to hypoplasia of a pulmonary artery and bronchiectasis of the affected lung. In this report, we describe the ventilation-perfusion (V/Q) scan findings of nine male recruits (aged 20-29 years, mean 24.4+/-2.96 years) with SJMS in whom the diagnosis was first established in adulthood. V/Q scan findings of all patients were compared with those on planar radiographs, pulmonary function studies, high resolution computed tomography (HRCT) and digital subtraction angiography (DSA). The ventilation (133Xe) and perfusion (99Tcm-macro-aggregated albumin) scans showed the characteristic pattern of a matched V/Q defect and marked air trapping on the washout phase on 133Xe scintigraphy. HRCT displayed hypodense lung with integrity of main airways, and markedly diminished vasculature on the affected side in all patients. A smaller pulmonary artery on the affected side with poor peripheral vasculature was observed with DSA in all patients. All patients had features of obstructive airway disease in varying degrees on pulmonary function studies. In contrast to other imaging methods, bronchiectasis as an etiological factor was displayed on HRCT. Some pulmonary areas, which were normal on HRCT and planar radiographs, showed air trapping on V/Q scan. Although a V/Q scan was more helpful in determining the extent of the disease and correlates well with conventional imaging methods, HRCT was the most valuable imaging method for the evaluation of aetiology in unilateral hyperlucent lung.

Use of CA15-3, CEA and prolactin for the primary diagnosis of breast cancer and correlation with the prognostic factors at the time of initial diagnosis

The main goals of the clinical use of tumor markers are to evaluate the adequacy of the treatment, monitor recurrence and follow up response to the treatment applied. For this purpose a baseline level for the commonly used tumor marker must be known at the time of initial diagnosis, before any therapy, in order to compare with the tumor marker levels which will be obtained after the treatment and during the clinical follow-up. The aim of this study was to investigate the correlation, if there is any, of the baseline levels of CA15-3, CEA and prolactin (PRL) in patients with breast cancer with the most commonly used prognostic factors, i) the presence of distant metastasis, ii) the presence of axillary lymphatic invasion, iii) the number of invaded axillary lymph nodes, iv) tumor size and v) stage of the disease, for breast cancer. Baseline serum CA15-3, CEA and PRL levels of 172 patients with breast masses were determined prior to biopsy. The sensitivity and specificity of baseline CA15-3, CEA and PRL were; 23.2% and 95.3%, 17.41% and 83.7%, 5.8% and 97.6%, respectively. At least one of the three tumor markers was high in 36% (31/86) of the breast cancer patients. Baseline CA15-3 levels were frequently higher than CEA in patients with bone metastasis (60% vs. 20%) and axillary lymphatic invasion (31.8% vs. 25%), and showed a better correlation with the stage of disease. Baseline tumor marker levels showed no statistically significant correlation with either the number of invaded axillary lymph nodes or tumor size. In conclusion, sensitivities and negative predictive values for baseline CA15-3, CEA and PRL were not satisfactory for primary diagnosis of breast cancer. Correlation of baseline CA15-3 was found superior to CEA and PRL in terms of stage of disease, presence of axillary invasion and distant metastasis.

The role of Tc-99m (V) DMSA scintigraphy in the evaluation of superscan on bone scintigraphy

PURPOSE

This study evaluated the biodistribution of Tc-99m (V) DMSA in patients with superscans on bone imaging and defined its role in differentiating the underlying cause.

METHODS

Nine patients (five with metastatic and four with metabolic bone disease) with classical superscans were entered into the study. All patients had the necessary radiologic and biochemical studies and a final diagnosis was reached accordingly. Tc-99m (V) DMSA scintigraphy was performed 1 week after Tc-99m MDP whole-body bone imaging.

RESULTS

In four of five patients with widespread skeletal metastases, Tc-99m (V) DMSA scan showed diffusely increased bone uptake. In the remaining patient, the Tc-99m (V) DMSA scan showed a normal distribution pattern. All patients with metabolic bone disease had increased bone uptake on Tc-99m (V) DMSA scans.

CONCLUSION

Tc-99m (V) DMSA shows increased bone uptake in patients having a superscan appearance in metastatic or metabolic bone disease. Tc-99m (V) DMSA imaging may play a role in the evaluation of patients with equivocal bone scan findings for a superscan.

The comparison of dual phase Tc-99m MIBI and tc-99m MDP scintimammography in the evaluation of breast masses: preliminary report

The aim of this prospective study was to determine the diagnostic value of Tc-99m MDP scintimammography (SMG) for the detection of breast cancer in patients with breast masses and to compare the results with Tc-99m MIBI scintimammography. Twenty patients, categorized as suspicious, positive or benign for breast cancer according to the mammographic findings were included in the study. Dual phase Tc-99m MIBI and Tc-99m MDP SMG were performed in the prone lateral position within 5 days of each other. Although early and late Tc-99m MIBI SMG showed equal (90.4%) sensitivity, the specificity of late Tc-99m MIBI (87.5%) was found superior to early (62.5%) imaging. The overall sensitivity and specificity of early Tc-99m MDP SMG were 71.4% and 62.5%, respectively. Although late Tc-99m MDP imaging showed 100% specificity, its sensitivity was only 23.8%. In the patients with palpable masses, both early Tc-99m MDP and Tc-99m MIBI showed equal sensitivity (100%), but the sensitivity of early Tc-99m MIBI (37.5%) was found slightly higher than Tc-99m MDP (25.0%) for nonpalpable breast lesions. The sensitivity of Tc-99m MIBI and Tc-99m MDP SMG in detecting metastatic axillary involvement was 66.6% and 50%, respectively. High sensitivity and specificity together with its low cost, easy availability and the possibility of detecting bone metastases seems to make Tc-99m MDP a contributive agent in the evaluation of breast lesions as an alternative to Tc-99m MIBI.

Synthesis of [99mTc]ethylenedicysteine-colchicine for evaluation of antiangiogenic effect

Angiogenesis is in part responsible for tumor growth and the development of metastasis. Radiolabeled angiongenesis inhibitors would be useful to assess tumor microvasculature density. Colchicine (COL), a potent antiangiogenic agent, is known to inhibit microtubule polymerization and cell arrest at metaphase. This study aimed to develop 99mTc-labeled COL (EC-COL) using ethylenedicysteine (EC) as a chelator to assess tumor microvascular density. EC was conjugated to trimethylcolchicinic acid using N-hydroxysuccinimide and 1-ethyl-3-dimethylaminopropyl carbodiimide as coupling agents with a yield of 50-60%. In vivo stability was analyzed in rabbit serum at 0.5-4 h. Tissue distribution and planar imaging studies of [99mTc]EC-COL were evaluated in breast tumor-bearing rats at 0.5, 2 and 4 h. The data was compared to that using [99mTc]EC (control). The radiochemical yield of [99mTc]EC-COL was greater than 95%. [99mTc]EC-COL was stable in rabbit serum. In vivo biodistribution of [99mTc]EC-COL in breast tumor-bearing rats showed increased tumor-to-blood (0.52+/-0.12 to 0.72+/-0.07) and tumor-to-muscle (3.47+/-0.40 to 7.97+/-0.93) ratios as a function of time. Conversely, tumor-to-blood values showed a time-dependent decrease with [99mTc]EC over the same time period. Planar images confirmed that the tumors could be visualized clearly with [99mTc]EC-COL from 0.5 to 4 h. [99mTc]EC-COL may be useful to assess antiangiogenic and therapeutic effects during chemotherapy.

Noninvasive assessment of tumor hypoxia with 99mTc labeled metronidazole

PURPOSE

The assessment of tumor hypoxia by imaging modality prior to radiation therapy would provide a rational means of selecting patients for treatment with radiosensitizers or bioreductive drugs. This study aimed to develop a 99mTc-labeled metronidazole (MN) using ethylene-dicysteine (EC) as a chelator and evaluate its potential use to image tumor hypoxia.

METHODS

EC was conjugated to amino analogue of MN using Sulfo-N-hydroxysuccinimide and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide-HCl as coupling agents, the yield was 55%. Tissue distribution of 99mTc-EC-MN was determined in breast tumor-bearing rats at 0.5, 2, and 4 hrs. Planar imaging and whole-body autoradiograms were performed. The data was compared to that using 99mTc-EC (control), [18F]fluoromisonidazole (FMISO) and [(131)I] iodomisonidazole (IMISO).

RESULTS

In vivo biodistribution of 9mTc-EC-MN in breast tumor-bearing rats showed increased tumor-to-blood and tumor-to-muscle ratios as a function of time. Conversely, tumor-to-blood values showed time-dependent decrease with 9mTc-EC in the same time period. Planar images and autoradiograms confirmed that the tumors could be visualized clearly with 99mTc-EC-MN from 0.5 to 4 hrs. There was no significant difference of tumor-to-blood count ratios between 99mTc-EC-MN and [(131)I]IMISO at 2 and 4 hrs postinjection. From 0.5 to 4 hrs, both 9mTc-EC-MN and [(131)I]MISO have higher tumor-to-muscle ratios compared to [18]FMISO.

CONCLUSIONS

It is feasible to use 9mTc-EC-MN to image tumor hypoxia.

99Tcm-MIBI scintimammography in the evaluation of breast lesions and axillary involvement: a comparison with mammography and histopathological diagnosis

The aim of this prospective study was to determine the diagnostic value of prone lateral 99Tcm-MIBI scintimammography in the detection of primary breast cancer and axillary lymph node involvement in patients with breast lesions. We evaluated 83 palpable and 22 non-palpable lesions in 77 consecutive patients with a clinically palpable mass and/or suspicious mammographic finding. Early and late scintimammograms were performed after the intravenous injection of 740 MBq 99Tcm-MIBI. The overall sensitivity of both scintimammography and mammography in the detection of primary breast cancer was 94%. The overall specificity was 84% and 56% for scintimammography and mammography respectively. In the patients with palpable masses, the sensitivity of scintimammography was 97% and the specificity was 84%; in those with non-palpable masses, the sensitivity was 35% and the specificity 100%. For the detection of axillary lymph node involvement, the sensitivity and specificity of scintimammography were 68% and 93% respectively. However, conventional mammography showed 37% sensitivity and 86% specificity. In conclusion, scintimammography is an accurate and clinically valuable tool for evaluating palpable and non-palpable breast abnormalities. In addition to its high sensitivity, it improves the specificity of mammography both in the evaluation of breast masses and in the detection of axillary involvement.