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D’Onofrio A, Engelbrecht S, Läppchen T, Rominger A, Gourni E. GRPR-targeting radiotheranostics for breast cancer management. Front Med (Lausanne) 2023; 10:1250799. [PMID: 38020178 PMCID: PMC10657217 DOI: 10.3389/fmed.2023.1250799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Breast Cancer (BC) is the most common cancer worldwide and, despite the advancements made toward early diagnosis and novel treatments, there is an urgent need to reduce its mortality. The Gastrin-Releasing Peptide Receptor (GRPR) is a promising target for the development of theranostic radioligands for luminal BC with positive estrogen receptor (ER) expression, because GRPR is expressed not only in primary lesions but also in lymph nodes and distant metastasis. In the last decades, several GRPR-targeting molecules have been evaluated both at preclinical and clinical level, however, most of the studies have been focused on prostate cancer (PC). Nonetheless, given the relevance of non-invasive diagnosis and potential treatment of BC through Peptide Receptor Radioligand Therapy (PRRT), this review aims at collecting the available preclinical and clinical data on GRPR-targeting radiopeptides for the imaging and therapy of BC, to better understand the current state-of-the-art and identify future perspectives and possible limitations to their clinical translation. In fact, since luminal-like tumors account for approximately 80% of all BC, many BC patients are likely to benefit from the development of GRPR-radiotheranostics.
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Affiliation(s)
| | | | | | | | - Eleni Gourni
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Smith KA, Hunt KN, Rauch GM, Fowler AM. Molecular Breast Imaging in the Screening Setting. JOURNAL OF BREAST IMAGING 2023; 5:240-247. [PMID: 38416886 DOI: 10.1093/jbi/wbad011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 03/01/2024]
Abstract
Early detection of breast cancer through screening mammography saves lives. However, the sensitivity of mammography for breast cancer detection is reduced in women with dense breast tissue. Imaging modalities for supplemental breast cancer screening include MRI, whole breast US, contrast-enhanced mammography, and molecular breast imaging (MBI). Molecular breast imaging with 99mTc-sestamibi is a functional imaging test to identify metabolically active areas in the breast with positioning analogous to mammography. Since 2011, there have been six large, published studies of screening MBI as a supplement to mammography involving over 6000 women from four different institutions. A multicenter, prospective clinical trial of 3000 women comparing breast cancer detection using screening digital breast tomosynthesis alone or in combination with MBI recently completed enrollment. This review focuses on the current evidence of MBI use for supplemental breast cancer screening, the strengths and limitations of MBI, and recent technological advances.
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Affiliation(s)
| | - Katie N Hunt
- Mayo Clinic, Department of Radiology, Rochester, MN, USA
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX, USA
| | - Amy M Fowler
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
- University of Wisconsin School of Medicine and Public Health, Department of Medical Physics, Madison, WI, USA
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Hatazawa J. The Clinical Value of Breast Specific Gamma Imaging and Positron Imaging: An Update. Semin Nucl Med 2022; 52:619-627. [PMID: 35346487 DOI: 10.1053/j.semnuclmed.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/15/2023]
Abstract
In the management of patients with breast cancer (BC), a mammography contributed to screen an early-stage patient, to plan a therapy strategy, to evaluate a therapy outcome, to detect a recurrence, and to reduce a mortality. Currently, various imaging modalities, such as CT, MR, Ultrasound (US), SPECT/CT, PET/CT, PET/MR have been utilized for the management of BC patients. In order to overcome a limited spatial resolution and sensitivity of whole-body systems in nuclear medicine imaging, dedicated breast imaging modalities were developed. One is a gamma imaging system with single/dual head scintillation detectors or semiconductor detectors associated with light compression device for breast parenchyma. Radiopharmaceutical for the gamma imaging is 99mTc-sestamibi. Another is a positron imaging system with opposite-type panel detectors and ring-shaped type detectors. Radiopharmaceutical for positron imaging is 18F-fluorodeoxyglucose. The breast-specific gamma and positron imaging systems were utilized mainly to detect small lesions less than 1 cm in diameter especially in patients with dense breast, to evaluate an effect of preoperative neo-adjuvant therapy, to plan surgical procedures (conservative-surgery vs mastectomy), and to detect a recurrence. By combining higher sensitivity and spatial resolution scanners with new radiopharmaceuticals, an information on molecular-level pathology of BC is increasingly available in an individual patient. This article reviewed clinical impact and future perspective of this field.
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Affiliation(s)
- Jun Hatazawa
- Department of Quantum Cancer Therapy, Research Center for Nuclear Physics, Osaka University, Osaka, Japan; Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan; Institute for Radiation Sciences, Osaka University, Osaka, Japan; Immunology Frontier Research Center, Osaka University, Osaka, Japan.
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Radionuclide-Based Imaging of Breast Cancer: State of the Art. Cancers (Basel) 2021; 13:cancers13215459. [PMID: 34771622 PMCID: PMC8582396 DOI: 10.3390/cancers13215459] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Breast cancer is one of the most commonly diagnosed malignant tumors, possessing high incidence and mortality rates that threaten women’s health. Thus, early and effective breast cancer diagnosis is crucial for enhancing the survival rate. Radionuclide molecular imaging displays its advantages for detecting breast cancer from a functional perspective. Noninvasive visualization of biological processes with radionuclide-labeled small metabolic compounds helps elucidate the metabolic state of breast cancer, while radionuclide-labeled ligands/antibodies for receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer. This review focuses on the most recent developments of novel radiotracers as promising tools for early breast cancer diagnosis. Abstract Breast cancer is a malignant tumor that can affect women worldwide and endanger their health and wellbeing. Early detection of breast cancer can significantly improve the prognosis and survival rate of patients, but with traditional anatomical imagine methods, it is difficult to detect lesions before morphological changes occur. Radionuclide-based molecular imaging based on positron emission tomography (PET) and single-photon emission computed tomography (SPECT) displays its advantages for detecting breast cancer from a functional perspective. Radionuclide labeling of small metabolic compounds can be used for imaging biological processes, while radionuclide labeling of ligands/antibodies can be used for imaging receptors. Noninvasive visualization of biological processes helps elucidate the metabolic state of breast cancer, while receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer, contributing to early diagnosis and better management of cancer patients. The rapid development of radionuclide probes aids the diagnosis of breast cancer in various aspects. These probes target metabolism, amino acid transporters, cell proliferation, hypoxia, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), gastrin-releasing peptide receptor (GRPR) and so on. This article provides an overview of the development of radionuclide molecular imaging techniques present in preclinical or clinical studies, which are used as tools for early breast cancer diagnosis.
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Urbano N, Scimeca M, Bonfiglio R, Mauriello A, Bonanno E, Schillaci O. [99mTc]Tc-Sestamibi Bioaccumulation Can Induce Apoptosis in Breast Cancer Cells: Molecular and Clinical Perspectives. APPLIED SCIENCES 2021; 11:2733. [DOI: 10.3390/app11062733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The aim of this study was to investigate the possible role of [99mTc]Tc-Sestamibi in the regulation of cancer cell proliferation and apoptosis. To this end, the in vivo values of [99mTc]Tc-Sestamibi uptake have been associated with the in-situ expression of both Ki67 and caspase-3. For in vitro investigations, BT-474 cells were incubated with three different concentrations of [99mTc]Tc-Sestamibi: 10 µg/mL, 1 µg/mL, and 0.1 µg/mL. Expression of caspase-3 and Ki67, as well as the ultrastructure of cancer cells, was evaluated at T0 and after 24, 48, 72, and 120 h after [99mTc]Tc-Sestamibi incubation. Ex vivo data strengthened the known association between sestamibi uptake and Ki67 expression. Linear regression analysis showed a significant association between sestamibi uptake and the number of apoptotic cells evaluated as caspase-3-positive breast cancer cells. As concerning the in vitro data, a significant decrease of the proliferation index was observed in breast cancer cells incubated with a high concentration of [99mTc]Tc-Sestamibi (10 µg/mL). Amazingly, a significant increase in caspase-3-positive cells in cultures incubated with 10 µg/mL [99mTc]Tc-Sestamibi was observed. This study suggested the possible role of sestamibi in the regulation of pathophysiological processes involved in breast cancer.
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Abstract
Screening for breast cancer reduces breast cancer-related mortality and earlier detection facilitates less aggressive treatment. Unfortunately, current screening modalities are imperfect, suffering from limited sensitivity and high false-positive rates. Novel techniques in the field of breast imaging may soon play a role in breast cancer screening: digital breast tomosynthesis, contrast material-enhanced spectral mammography, US (automated three-dimensional breast US, transmission tomography, elastography, optoacoustic imaging), MRI (abbreviated and ultrafast, diffusion-weighted imaging), and molecular breast imaging. Artificial intelligence and radiomics have the potential to further improve screening strategies. Furthermore, nonimaging-based screening tests such as liquid biopsy and breathing tests may transform the screening landscape. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Ritse M Mann
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Regina Hooley
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Richard G Barr
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
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Urbano N, Scimeca M, Tancredi V, Bonanno E, Schillaci O. 99mTC-sestamibi breast imaging: Current status, new ideas and future perspectives. Semin Cancer Biol 2020; 84:302-309. [PMID: 31982511 DOI: 10.1016/j.semcancer.2020.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
Here we proposed the most recent innovations in the use of Breast Specific Gamma Imaging with 99mTc-sestamibi for the management of breast cancer patients. To this end, we reported the recent discoveries concerning: a) the implementation of both instrumental devices and software, b) the biological mechanisms involved in the 99mTc-sestamibi uptake in breast cancer cells, c) the evaluation of Breast Specific Gamma Imaging with 99mTc-sestamibi as predictive markers of metastatic diseases. In this last case, we also reported preliminary data about the capability of Breast Specific Gamma Imaging with 99mTc-sestamibi to identify breast cancer lesions with high propensity to form bone metastatic lesions due to the presence of Breast Osteoblast-Like Cells.
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Affiliation(s)
- Nicoletta Urbano
- Nuclear Medicine, Policlinico "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; University of San Raffaele, Via di Val Cannuta 247, 00166, Rome, Italy; Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122, Milano (Mi), Italy; UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Virginia Tancredi
- Department of Systems Medicine, School of Sport and Exercise Sciences, University of Rome Tor Vergata, Rome, Italy; Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena Bonanno
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier, 1, 00133, Rome, Italy; Diagnostica Medica' & 'Villa dei Platani', Neuromed Group, Avellino, 83100, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; IRCCS Neuromed, Pozzilli (Is), 86077, Italy.
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Breast-Specific Gamma Imaging Versus MRI: Comparing the Diagnostic Performance in Assessing Treatment Response After Neoadjuvant Chemotherapy in Patients With Breast Cancer. AJR Am J Roentgenol 2019; 212:696-705. [PMID: 30620672 DOI: 10.2214/ajr.17.18930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to evaluate the diagnostic performance of breast-specific gamma imaging (BSGI) and breast MRI in assessing for residual tumor after neoadjuvant chemotherapy (NAC) in patients with breast cancer. MATERIALS AND METHODS A total of 114 patients underwent BSGI and MRI for initial staging as well as after undergoing NAC. Of those, 112 underwent subsequent definitive breast surgery. Thirty of the 114 patients had a complete pathologic response to NAC. RESULTS BSGI and MRI had comparable sensitivities in detecting residual tumor after NAC (70% vs 83%). BSGI had a higher specificity than MRI in accurately determining complete response after NAC (90% vs 60%). CONCLUSION BSGI may be a useful adjunctive tool for predicting a complete pathologic response to NAC.
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Rauch GM, Adrada BE. Comparison of Breast MR Imaging with Molecular Breast Imaging in Breast Cancer Screening, Diagnosis, Staging, and Treatment Response Evaluation. Magn Reson Imaging Clin N Am 2018; 26:273-280. [PMID: 29622132 DOI: 10.1016/j.mric.2017.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Breast MR imaging and molecular breast imaging (MBI) are functional imaging modalities that can be used to noninvasively evaluate the pathophysiology and biology of breast cancer. In the era of personalized medicine, these imaging techniques give clinicians insight into cancer pathobiology and allows them to individualize treatment regimens. Breast MR imaging has gained acceptance for breast cancer evaluation; work is ongoing on validation of MBI for breast cancer evaluation. This article discusses clinical applications of breast MR imaging and MBI, and compares the performance of these techniques in breast cancer screening, diagnosis, staging, and treatment response evaluation.
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Affiliation(s)
- Gaiane M Rauch
- Department of Diagnostic Radiology, Abdominal Imaging Section, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1473, Houston, TX 77030, USA.
| | - Beatriz E Adrada
- Department of Diagnostic Radiology, Breast Imaging Section, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1350, Houston, TX 77030-3721, USA
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Adrada BE, Moseley T, Rauch GM. Molecular Breast Imaging: Role as a Screening Modality. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0225-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alternative screening for women with dense breasts: breast-specific gamma imaging (molecular breast imaging). AJR Am J Roentgenol 2015; 204:252-6. [PMID: 25615745 DOI: 10.2214/ajr.14.13525] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Given mammography's limitations in evaluating dense breasts, examination with breast-specific gamma imaging (BSGI)-also called molecular breast imaging (MBI)-has been proposed. We review the literature pertinent to the performance of BSGI in patients with dense breasts. CONCLUSION. Many studies have reported the sensitivity of BSGI in finding cancers even in dense breasts. However, BSGI has not yet been validated as an effective screening tool in large prospective studies. In addition, whole-body dose remains a significant concern.
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Greene LR, Wilkinson D. The role of general nuclear medicine in breast cancer. J Med Radiat Sci 2015; 62:54-65. [PMID: 26229668 PMCID: PMC4364807 DOI: 10.1002/jmrs.97] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/08/2015] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.
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Affiliation(s)
- Lacey R Greene
- Faculty of Science, Charles Sturt University Wagga Wagga, New South Wales, Australia
| | - Deborah Wilkinson
- Faculty of Health, Wheeling Jesuit University Wheeling, West Virginia
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Pinker K, Helbich TH, Magometschnigg H, Fueger B, Baltzer P. [Molecular breast imaging. An update]. Radiologe 2014; 54:241-53. [PMID: 24557495 DOI: 10.1007/s00117-013-2580-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CLINICAL/METHODICAL ISSUE The aim of molecular imaging is to visualize and quantify biological, physiological and pathological processes at cellular and molecular levels. Molecular imaging using various techniques has recently become established in breast imaging. STANDARD RADIOLOGICAL METHODS Currently molecular imaging techniques comprise multiparametric magnetic resonance imaging (MRI) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), proton MR spectroscopy ((1)H-MRSI), nuclear imaging by breast-specific gamma imaging (BSGI), positron emission tomography (PET) and positron emission mammography (PEM) and combinations of techniques (e.g. PET-CT and multiparametric PET-MRI). METHODICAL INNOVATIONS Recently, novel techniques for molecular imaging of breast tumors, such as sodium imaging ((23)Na-MRI), phosphorus spectroscopy ((31)P-MRSI) and hyperpolarized MRI as well as specific radiotracers have been developed and are currently under investigation. PRACTICAL RECOMMENDATIONS It can be expected that molecular imaging of breast tumors will enable a simultaneous assessment of the multiple metabolic and molecular processes involved in cancer development and thus an improved detection, characterization, staging and monitoring of response to treatment will become possible.
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Affiliation(s)
- K Pinker
- Abteilung für Molekulare Bildgebung, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Novikov SN, Krzhivitskii PI, Kanaev SV, Krivorotko PV, Ilin ND, Jukova LA, Ponomareva OI. Axillary lymph node staging in breast cancer: clinical value of single photon emission computed tomography-computed tomography (SPECT-CT) with 99mTc-methoxyisobutylisonitrile. Ann Nucl Med 2014; 29:177-83. [PMID: 25398309 DOI: 10.1007/s12149-014-0926-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine diagnostic accuracy of SPECT, CT and SPECT-CT in axillary lymph node (LN) staging in breast cancer (BC). METHODS Sixty consecutive patients with primary operable T1-3NxM0 BC were included in this study. All patients underwent SPECT-CT examination on Symbia-T16 scanner which consists of dual-head gamma camera combined with 16 slices diagnostic CT. SPECT-CT acquisition started 10-15 min after i/v injection of 740-1,000 MBq of 99mTc-MIBI. On CT images of axillary LN we analyzed following diagnostic signs: size (short axis more or less than 10 mm), shape (round or oval), cortical thickness and fat content (solid or with fat gate). Intensity of tracer uptake in axillary LN was classified as follows: grade (Gr) I-background, Gr II-slightly above background, Gr III-intense but below uptake in muscles, Gr IV-as high as in muscles. Histological examination of dissected LN was used as gold standard. RESULTS Various combinations of CT signs of axillary LN involvement demonstrated moderate diagnostic value with best results characterized by low (55 %) sensitivity (SEN), 97 % specificity (SP) and 83 % accuracy (AC). Intensive (Gr IV) uptake of 99mTc-MIBI in axillary LN characterized by low (55 %) SEN, high (100 %) SP and moderate (84 %) AC. Combination of CT and SPECT signs looks most promising especially when LN metastases were diagnosed in patients with enlarged solid LN or normal sized LN with Gr III-IV 99Tc-MIBI uptake. In these cases, SEN was equal to 75 %, SP-90 %, AC-85 %, only one of 5 patients with false negative results had metastases in more than 2 LN. CONCLUSIONS By combination of SPECT and CT data we can more accurately diagnose axillary LN invasion by breast cancer.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology and Nuclear Medicine, N.N. Petrov Institute Oncology, Leningradskaya 68, St Petersburg, 197758, Russia,
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Magometschnigg HF, Helbich T, Brader P, Abeyakoon O, Baltzer P, Füger B, Wengert G, Polanec S, Bickel H, Pinker K. Molecular imaging for the characterization of breast tumors. Expert Rev Anticancer Ther 2014; 14:711-22. [DOI: 10.1586/14737140.2014.885383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Ribeiro MP, Souza SALD, Lopes FPPL, Rosado-de-Castro PH, Fonseca LMBD, Gutfilen B. 99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer. Clinics (Sao Paulo) 2013; 68:283-9. [PMID: 23644845 PMCID: PMC3611895 DOI: 10.6061/clinics/2013(03)oa01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/19/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Mammography has been established as the gold standard for the detection of breast cancer, and imaging techniques such as ultrasonography, magnetic resonance imaging, scintigraphy and positron emission tomography may be useful to improve its sensitivity and specificity. The objective of this study with breast scintigraphy was to evaluate the uptake of 99mTc-thymine in mammary lesions. METHODS A total of 45 patients were included in this study. Thirty-three patients (73%) were subjected to surgery or percutaneous biopsy, providing histopathological data. The other 12 patients who remained under surveillance received clinical examinations and biannual mammography with a normal follow-up of at least three years, the data from which were used for comparison with the scintimammography results. RESULTS The majority of patients (64.4%) had clinically impalpable lesions with a mammogram diagnosis of microcalcifications, impalpable nodules, or focal asymmetry. Of the studied lesions, 87% were smaller or equal to 20 mm in diameter, and 22% had malignant histopathological findings. Scintigraphy with 99mTc-thymine had a sensitivity of 70%, a specificity of 85.7%, positive and negative predictive values of 58.3% and 90.9%, respectively, and an accuracy of 82.2%. CONCLUSIONS The results of this study are consistent with those previously reported by other authors. The good specificity and high negative predictive value of this technique and the absence of uptake in the heart indicate that it may be a promising complementary method in clinical practice and that it may contribute to reducing unnecessary benign biopsies.
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Affiliation(s)
- Monica Pires Ribeiro
- Departamento de Radiologia, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Kim BS, Moon BI, Cha ES. A comparative study of breast-specific gamma imaging with the conventional imaging modality in breast cancer patients with dense breasts. Ann Nucl Med 2012; 26:823-9. [DOI: 10.1007/s12149-012-0649-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 08/07/2012] [Indexed: 11/30/2022]
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18
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Jacobsson H. Single-photon-emission computed tomography (SPECT) with 99 technetium sestamibi in the diagnosis of small breast cancer and axillary node involvement. World J Surg 2012; 35:2673-4. [PMID: 21913133 DOI: 10.1007/s00268-011-1271-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hans Jacobsson
- Department of Radiology and Nuclear Medicine, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden.
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Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast: a comparative study with MRI. Ann Nucl Med 2011; 26:131-7. [DOI: 10.1007/s12149-011-0544-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 09/29/2011] [Indexed: 10/16/2022]
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Tadwalkar RV, Rapelyea JA, Torrente J, Rechtman LR, Teal CB, McSwain AP, Donnelly C, Kidwell AB, Coffey CM, Brem RF. Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade. Br J Radiol 2011; 85:e212-6. [PMID: 21712429 DOI: 10.1259/bjr/34392802] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the sensitivity of breast-specific gamma imaging (BSGI) in the detection of invasive breast cancers and to characterise the sensitivity of BSGI based on tumour size and pathological grade. METHODS 139 females with invasive carcinoma who underwent BSGI were retrospectively reviewed. Patients were injected in the antecubital vein with 20-30 mCi (925-1110 MBq) of (99m)Tc-sestamibi. Images were obtained with a high-resolution, breast-specific gamma camera (Dilon 6800; Dilon Technologies, Newport News, VA) and were categorised based on radiotracer uptake as normal, normal with heterogeneous uptake, probably abnormal and abnormal. For a positive examination, the region of the area of increased uptake had to correlate with the laterality and location of the biopsy-proven cancer. RESULTS 149 invasive cancers in 139 patients with a mean size of 1.8 cm (0.2-8.5 cm) were included. 146 were identified with BSGI (98.0%). All cancers which measured ≥ 0.7 cm (n = 123) as well as all cancers grade 2 or higher (n = 102), regardless of tumour size, were identified with BSGI (100%). There were 6 cancers that were pathological grade 1 and measured <7 mm, of which 50% (3/6) were identified with BSGI. The overall sensitivity of BSGI for the detection of invasive breast cancer is 98.0%. The sensitivity for subcentimetre cancers is 88.5% (23/26). CONCLUSION BSGI has a high sensitivity for the detection of invasive breast cancer. Our results demonstrate that BSGI detected all invasive breast cancers pathological grade 2 and higher regardless of size and all cancers which measured ≥ 7 mm regardless of grade. BSGI can reliably detect invasive breast cancers and is a useful adjunct imaging modality for the diagnosis of breast cancer.
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Affiliation(s)
- R V Tadwalkar
- Breast Imaging and Interventional Center, Department of Radiology, The George Washington University, Washington, DC, USA
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Pinker K, Bogner W, Gruber S, Brader P, Trattnig S, Karanikas G, Helbich TH. Molecular Imaging in Breast Cancer - Potential Future Aspects. Breast Care (Basel) 2011; 6:110-119. [PMID: 21673821 PMCID: PMC3104901 DOI: 10.1159/000328275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
SUMMARY: Molecular imaging aims to visualize and quantify biological, physiological, and pathological processes at cellular and molecular levels. Recently, molecular imaging has been introduced into breast cancer imaging. In this review, we will present a survey of the molecular imaging techniques that are either clinically available or are being introduced into clinical imaging. We will discuss nuclear imaging and multiparametric magnetic resonance imaging as well as the combined application of molecular imaging in the assessment of breast lesions. In addition, we will briefly discuss other evolving molecular imaging techniques, such as phosphorus magnetic resonance spectroscopic imaging and sodium imaging.
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Affiliation(s)
- Katja Pinker
- Universitätsklinik für Radiodiagnostik, Division für Molekulare und Gender Bildgebung, Austria
| | - Wolfgang Bogner
- Universitätsklinik für Radiodiagnostik, Division für Molekulare und Gender Bildgebung, Austria
- MR Exzellenzzentrum, Universitätsklinik für Radiodiagnostik, Austria
| | - Stephan Gruber
- Universitätsklinik für Radiodiagnostik, Division für Molekulare und Gender Bildgebung, Austria
- MR Exzellenzzentrum, Universitätsklinik für Radiodiagnostik, Austria
| | - Peter Brader
- Universitätsklinik für Radiodiagnostik, Division für Molekulare und Gender Bildgebung, Austria
| | - Siegfried Trattnig
- Universitätsklinik für Radiodiagnostik, Division für Molekulare und Gender Bildgebung, Austria
- MR Exzellenzzentrum, Universitätsklinik für Radiodiagnostik, Austria
| | - Georgios Karanikas
- Universitätsklinik für Nuklearmedizin, Medizinische Universität Wien, Austria
| | - Thomas H. Helbich
- Universitätsklinik für Radiodiagnostik, Division für Molekulare und Gender Bildgebung, Austria
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Nguyen BD, Roarke MC, Karstaedt PJ, Ingui CJ, Ram PC. Practical applications of nuclear medicine in imaging breast cancer. Curr Probl Diagn Radiol 2009; 38:68-83. [PMID: 19179194 DOI: 10.1067/j.cpradiol.2007.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rise in incidence, morbidity, and mortality of breast cancer has triggered multiple imaging efforts to detect this malignancy early, stage it accurately, and monitor it with precision in the posttherapeutic course. Among different imaging modalities, nuclear medicine provides an important contribution to the clinical management of breast cancer. This article discusses four practical applications based on the use of radionuclides in the evaluation of breast malignancy, focusing on scintimammography, preoperative tumor localization procedure using radioactive seeds, sentinel nodal scintigraphy, and F-18 fluorodeoxyglucose positron emission tomography/computed tomography.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V. Breast-specific Gamma Imaging as an Adjunct Imaging Modality for the Diagnosis of Breast Cancer. Radiology 2008; 247:651-7. [PMID: 18487533 DOI: 10.1148/radiol.2473061678] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rachel F Brem
- Departments of Radiology and Surgery, George Washington University, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA.
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Schillaci O, Spanu A, Madeddu G. Breast Scintigraphy. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Brem RF, Fishman M, Rapelyea JA. Detection of ductal carcinoma in situ with mammography, breast specific gamma imaging, and magnetic resonance imaging: a comparative study. Acad Radiol 2007; 14:945-50. [PMID: 17659240 DOI: 10.1016/j.acra.2007.04.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/09/2007] [Accepted: 04/08/2007] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the sensitivity of high-resolution breast-specific gamma imaging (BSGI) for the detection of ductal carcinoma in situ (DCIS) based on histopathology and to compare the sensitivity of BSGI with mammography and magnetic resonance imaging (MRI) for the detection of DCIS. MATERIALS AND METHODS Twenty women, mean 55 years (range 34-76 years), with 22 biopsy-proven DCIS were retrospectively reviewed. After injection of 25-30 mCi (925-1,110 MBq) technetium 99m-sestamibi, patients had BSGI with a high-resolution, small-field-of-view gamma camera in craniocaudal and mediolateral oblique projections. BSGI studies were prospectively classified according to focal radiotracer uptake using a 1 to 5 scale, as normal 1), with no focal or diffuse uptake; benign 2), with minimal patchy uptake; probably benign 3), with scattered patchy uptake; probably abnormal 4), with mild focal radiotracer uptake; and abnormal 5), with marked focal radiotracer uptake. Imaging findings were compared to findings at biopsy or surgical excision. The sensitivity of BSGI, mammography, and when performed, MRI were determined for the detection of DCIS. Breast MRI was performed on seven patients with eight biopsy-proven foci. The sensitivities were compared using a two-tailed t-test and confidence intervals were determined. RESULTS Pathologic tumor size of the DCIS ranged from 2 to 21 mm (mean 9.9 mm). Of 22 cases of biopsy-proven DCIS in 20 women, 91% were detected with BSGI, 82% were detected with mammography, and 88% were detected with magnetic resonance imaging. BSGI had the highest sensitivity for the detection of DCIS, although this small sample size did not demonstrate a statistically significant difference. Two cases of DCIS (9%) were diagnosed only after BSGI demonstrated an occult focus of radiotracer uptake in the contralateral breast, previously undetected by mammography. There were two false-negative BSGI studies CONCLUSIONS BSGI has higher sensitivity for the detection of DCIS than mammography or MRI and can reliably detect small, subcentimeter lesions.
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Affiliation(s)
- Rachel F Brem
- Breast Imaging and Intervention, The George Washington University, Washington, DC 20037, USA.
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Accuracy of ultrasonography and 99mTc-sestamibi scintimammography for assessing axillary lymph node status in breast cancer patients. A prospective study. Eur J Surg Oncol 2006; 32:933-6. [PMID: 16797155 DOI: 10.1016/j.ejso.2006.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 05/10/2006] [Indexed: 02/05/2023] Open
Abstract
AIMS The aim of this study was to evaluate the sensitivity, specificity and accuracy of axillary ultrasonography (US) and (99m)Tc-sestamibi scintimammography (SSM) in patients with breast cancer (BC) undergoing curative surgery. METHODS A series of 77 consecutive women (median age 54 years, range 36-70) with primary BC underwent both US and SSM from 2 to 15 (median 4) days prior to curative surgery. The results of imaging studies were compared against the final pathology. Breast-conserving surgery with axillary node (AN) dissection was performed in 49 (63.6%) patients, and modified radical mastectomy in 28 (36.4%) patients, according to the tumour staging. RESULTS Final pathology showed 5 pT1bN0, 1 pT1bN1, 28 pT1cN0, 19 pT1cN1, 7 pT2N0, and 17 pT2N1 BC. Overall, 719 AN were removed of which 106 (14.7%) were metastatized nodes (median 3, range 1-5 per patient). The sensitivity, specificity and accuracy were 67.6%, 80.0%, and 74.0% for US, 78.4%, 85.0%, and 81.8% for SSM, and 91.9%, 92.5%, and 92.2% for US and SSM together, respectively. There was a significant difference (p<0.05) in the number of metastatized AN between patients with metastases correctly detected and undetected by both US (3.1+/-1.3 vs. 2.0+/-0.7) and SSM (3.2+/-1.3 vs. 1.7+/-0.7). CONCLUSIONS Although the results of each diagnostic tests are strictly dependent on the number of the metastatized AN, the combination of axillary US and SSM is a sensitive low-cost procedure that should be suggested in all patients with BC, when a preoperative evaluation of the AN status is required.
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Brem RF, Rapelyea JA, Zisman G, Mohtashemi K, Raub J, Teal CB, Majewski S, Welch BL. Occult breast cancer: scintimammography with high-resolution breast-specific gamma camera in women at high risk for breast cancer. Radiology 2005; 237:274-80. [PMID: 16126919 DOI: 10.1148/radiol.2371040758] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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.
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Affiliation(s)
- Rachel F Brem
- Department of Radiology, Breast Imaging and Intervention Center, George Washington University Medical Center, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA.
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Massardo T, Alonso O, Llamas-Ollier A, Kabasakal L, Ravishankar U, Morales R, Delgado L, Padhy AK. Planar Tc99m--sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: results of an international multicenter trial. BMC NUCLEAR MEDICINE 2005; 5:4. [PMID: 16048648 PMCID: PMC1199526 DOI: 10.1186/1471-2385-5-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 07/27/2005] [Indexed: 02/05/2023]
Abstract
Background Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was performed. Methods One hundred and forty-nine female patients were included prospectively from different regions. Their mean age was 55.1 ± 11.9 years. Histological report was obtained from 2.987 excised lymph nodes from 150 axillas. An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients, all images performed with 740–925 MBq dose of Tc99m sestamibi. Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla. Diagnostic values, 95% confidence intervals [CI] and also likelihood ratios (LR) were calculated. Results Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes. Sestamibi was positive in 30 axillas (25 true-positive) and negative in 120 (only 55 true-negative). The sensitivity corresponded to 27.8% [CI = 18.9–38.2] and specificity to 91.7% [81.6–97.2]. The positive and negative LR were 3.33 and 0.79, respectively. There was no difference between early and delayed images. Sensitivity was higher in patients with palpable lesions. Conclusion This work confirmed that non tomographic Tc99m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer.
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Affiliation(s)
- Teresa Massardo
- Nuclear Medicine, University of Chile Clinical Hospital, Santiago, Chile
| | - Omar Alonso
- Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo, Uruguay
| | | | - Levin Kabasakal
- Nuclear Medicine Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey
| | - Uma Ravishankar
- Nuclear Medicine Department, Indraprastha Apollo Hospitals, New Delhi, India
| | - Rossana Morales
- Department of Nuclear Medicine, Neoplastic Disease Institute and Peruvian Institute of Nuclear Energy, Lima, Peru
| | - Lucía Delgado
- Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo, Uruguay
| | - Ajit K Padhy
- Medicine Section, Department of Human Health, International Atomic Energy Agency, Vienna, Austria
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