Objectives: The purpose of this study was to determine the sensitivity of breastspecific 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 (n5123) as well as all cancers grade 2 or higher (n5102), 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. Mammography has remained the modality of choice for breast cancer screening. Nevertheless, it is an imperfect examination with a sensitivity of 78-85% that declines to 68% in females with dense breasts [1][2][3][4][5][6]. The limitations of mammography have resulted in the development of adjunct imaging modalities to improve breast cancer detection. Most frequently, ultrasound is used in conjunction with mammography as an adjunct imaging modality for breast cancer diagnosis, particularly in females with dense breasts [2].Mammography and ultrasound are both anatomical approaches for the diagnosis of breast cancer. Nuclear medicine techniques that utilise physiological properties of tumours are increasingly being used. A meta-analysis of scintimammographic studies using a traditional, general purpose gamma camera demonstrated an average sensitivity of 84% for breast cancer detection, although many of the cancers included in these studies were palpable and larger [7]. However, scintimammography with a general purpose gamma camera is limited in the detection of non-palpable cancers and cancers less than 1 cm in size because of intrinsic resolution limitations [8][9][10][11]. Another limitation is the inability of a general purpose gamma camera to image in positions...

One of the risks of breast conservation surgery is local recurrence, which predominantly occurs as a result of inadequate surgical margins. The purpose of this study was to identify factors associated with close or positive surgical margins leading to reexcision (RE). The charts of 532 consecutive breast cancer patients treated at our center between September 2001 and June 2007 were reviewed to evaluate patients who opted for breast conservation surgery and needed reexcision. A total of 351 patients were treated with breast conservation, of which 118 (34%) had positive or close surgical margins and went on to RE. On univariate analysis, factors that significantly correlated with RE ( P < 0.05) were preoperative diagnosis, final pathology, size of tumor, and presentation with nipple discharge. RE was necessary in 53 per cent of patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS), 57 per cent of patients diagnosed by surgical excision, 86 per cent of patients presenting with nipple discharge, and 87 per cent of patients with DCIS or invasive carcinoma with extensive intraductal component in the final pathology. Additionally, 53 per cent of patients with T3 tumors required RE. Age, race, and grade of tumor had no effect on RE rates. Most (75%) patients were able to ultimately have breast conservation.

Mastectomy rates at this institution have not shown the recent sharp increase observed by some authors. The association of age, race, family history, and parity with CPM has been corroborated in multiple studies. However, there is disagreement between statistically significant findings among investigators evaluating factors associated with CPM, and there is limited data in the literature characterizing BCS-eligible patients who chose CM. Larger prospective studies are necessary to further evaluate CM and CPM rates.

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