99mTc-Sestamibi Using a Direct Conversion Molecular Breast Imaging System to Assess Tumor Response to Neoadjuvant Chemotherapy in Women With Locally Advanced Breast Cancer

Mitchell, David; Hruska, Carrie B.; Boughey, Judy C.; Wahner‐Roedler, Dietlind L.; Jones, Katie N.; Tortorelli, Cindy L.; Conners, Amy Lynn; O’Connor, Michael K.

doi:10.1097/rlu.0000000000000248

Cited by 25 publications

(20 citation statements)

References 28 publications

(32 reference statements)

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“…The result was even better after the second cycle of NCT, using a cut-off value of 46.4 %, ΔSPECT 2 T/N ratio demonstrated a sensitivity of 92.9 %, a specificity of 93.3 % and a negative predictive value of 93.3 %. Mitchell et al investigated the use of 99m Tc-MIBI imaging to evaluate tumor response to NCT in locally advanced breast cancer [12]. Using a threshold of 50 % reduction in tumor-to-background ratio at 3 to 5 weeks after NCT, 99m Tc-MIBI imaging predicted the presence of residual disease at surgery with a diagnostic accuracy of 89.5 %, a sensitivity of 92.3 %, and a specificity of 83.3 %.…”

Section: Discussionmentioning

confidence: 98%

“…Functional MRI techniques including dynamic contrast-enhanced MRI, diffusion-weighted imaging and magnetic resonance spectroscopy, provide surrogate markers of response to NCT [8][9][10]. Due to their low cost and wide availability, the use of single photon techniques using MIBI for the early detection of therapy response in breast cancer has also been investigated [11,12]. 99m Tc-3PRGD 2 SPECT is a newly developed imaging modality for evaluating tumor vascular status.…”

Section: Introductionmentioning

confidence: 99%

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99mTc-3PRGD2 SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer

Chen

Wang

et al. 2015

Eur J Nucl Med Mol Imaging

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

99mTc-3PRGD2 SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer

Chen

Wang

et al. 2015

Eur J Nucl Med Mol Imaging

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“…Previous studies have shown that quantitative assessment of tumor uptake of 99m Tc sestamibi demonstrated the ability to differentiate between pathological responders and non-responders as early as 3–5 weeks after initiation of NAC [36]. To date, there is little understanding of what these changes in tumor uptake represent.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Tc-99m maraciclatide and Tc-99m sestamibi molecular breast imaging in patients with suspected breast cancer

et al. 2017

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BackgroundMolecular breast imaging (MBI) performed with 99mTc sestamibi has been shown to be a valuable technique for the detection of breast cancer. Alternative radiotracers such as 99mTc maraciclatide may offer improved uptake in breast lesions. The purpose of this study was to compare relative performance of 99mTc sestamibi and 99mTc maraciclatide in patients with suspected breast cancer, using a high-resolution dedicated gamma camera for MBI. Women with breast lesions suspicious for malignancy were recruited to undergo two MBI examinations—one with 99mTc sestamibi and one with 99mTc maraciclatide. A radiologist interpreted MBI studies in a randomized, blinded fashion to assign an assessment score (1–5) and measured lesion size. Lesion-to-background (L/B) ratio was measured with region-of-interest analysis.ResultsAmong 39 analyzable patients, 21 malignant tumors were identified in 21 patients. Eighteen of 21 tumors (86%) were seen on 99mTc sestamibi MBI and 19 of 21 (90%) were seen on 99mTc maraciclatide MBI (p = 1). Tumor extent measured with both radiopharmaceuticals correlated strongly with pathologic size (99mTc sestamibi, r = 0.84; 99mTc maraciclatide, r = 0.81). The L/B ratio in detected breast cancers was similar for the two radiopharmaceuticals: 1.55 ± 0.36 (mean ± S.D.) for 99mTc sestamibi and 1.62 ± 0.37 (mean ± S.D.) for 99mTc maraciclatide (p = 0.53). No correlation was found between the L/B ratio and molecular subtype for 99mTc sestamibi (r s = 0.12, p = 0.63) or 99mTc maraciclatide (r s = −0.12, p = 0.64). Of 20 benign lesions, 10 (50%) were seen on 99mTc sestamibi and 9 of 20 (45%) were seen on 99mTc maraciclatide images (p = 0.1). The average L/B ratio for benign lesions was 1.34 ±0.40 (mean ±S.D.) for 99mTc sestamibi and 1.41 ±0.52 (mean ±S.D.) for 99mTc maraciclatide (p = 0.75). Overall diagnostic performance was similar for both radiopharmaceuticals. AUC from ROC analysis was 0.83 for 99mTc sestamibi and 0.87 for 99mTc maraciclatide (p = 0.64).Conclusions 99mTc maraciclatide offered comparable lesion uptake to 99mTc sestamibi, in both malignant and benign lesions. There was good correlation between lesion extent and uptake measured from both radiopharmaceuticals. 99mTc maraciclatide offered a marginal (but not significant) improvement in sensitivity over 99mTc sestamibi. Our findings did not support an association between the uptake of either radiopharmaceutical and tumor molecular subtype.Trial registrationClinicalTrials.gov, NCT00888589

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“…2 and 3). In a pilot study of 19 patients imaged sequentially with MBI, a decrease in the tumor-tobackground ratio 3-5 wk after the initial round of chemotherapy was shown to predict response to treatment; larger studies are in progress (69). Lack of a substantial decrease in 18 F-FDG uptake after 2 cycles of chemotherapy has been shown to predict residual tumor at the conclusion of chemotherapy and a high risk of recurrence for triple-negative breast cancer (70).…”

Section: Futurementioning

confidence: 99%

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

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Interest in nuclear breast imaging is increasing because of technical improvements in dedicated devices that allow the use of relatively low doses of radiotracers with high sensitivity for even small breast cancers. For women with newly diagnosed cancer, primary chemotherapy is often recommended, and improved methods of assessing treatment response are of interest. With widespread breast density notification, functional rather than anatomic methods of screening are of increasing interest as well. For a cancer imaging technology to be adopted, several criteria must be met that will be discussed: evidence of clinical benefit with minimal harm, standardized interpretive criteria, direct biopsy guidance, and acceptable cost-effectiveness. Twor adiotracers have been used widely to depict breast cancer: the g-emitting 99m Tc-sestamibi ( 99m Tc-methoxyisobutylisonitrile), 140 keV, half-life of 6 h, originally developed as a myocardial perfusion agent; and the positron-emitting glucose analog 18 F-FDG, 511 keV, half-life of 2 h. Standard lead shielding as is used in a mammography suite is sufficient when using 99m Tc-sestamibi. Using 18 F-FDG requires much more extensive shielding and may not be feasible because of workspaces above or below the planned unit. State licensing requirements for nuclear medicine must be considered; typically, a hot lab with oversight by a trained nuclear medicine technologist and a physicist is required (1).Both 99m Tc-sestamibi and 18 F-FDG were initially studied for breast cancer using whole-body scanners. Low sensitivity to invasive cancers smaller than 1 cm was observed with whole-body g-camera imaging in a prospective multicenter series at 48.2%, compared with 74.2% for larger tumors (2); detection of small cancers, particularly small invasive cancers, is a major goal of breast imaging. Similar results were observed with whole-body PET, with sensitivity to invasive tumors 2 cm or smaller of only 30 of 44 (68%) compared with 57 of 62 (92%) for larger cancers (3).Dedicated breast g-camera imaging can be performed with singledetector scintillating-crystal systems such as breast-specific g-imaging (BSGI) (Dilon Technologies) with a 20 · 15 cm field of view, 3.3-mm pixel size; or using dual-head cadmium-zinc-telluride detector systems, often referred to as molecular breast imaging (MBI) (GE Healthcare, with a 24 · 16 cm field of view and 2.5-mm pixel size; or Gamma Medica, Inc., with a 20 · 16 cm field of view and 1.6 mm pixel size). Both approaches use positioning similar to that of mammography, with the breast gently stabilized between a compression paddle and the detector (BSGI) or between 2 detectors (MBI). It is important to include mammographic technologists in the positioning of the patients, at least for a minimum number of cases (e.g., 25), to ensure full inclusion of posterior tissues for both a craniocaudal and a mediolateral oblique (MLO) acquisition. Particularly with the dualhead systems, it can be difficult to prevent skin folds or to ensure that the nipple is in profile becau...

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99mTc-Sestamibi Using a Direct Conversion Molecular Breast Imaging System to Assess Tumor Response to Neoadjuvant Chemotherapy in Women With Locally Advanced Breast Cancer

Cited by 25 publications

References 28 publications

99mTc-3PRGD2 SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer

99mTc-3PRGD2 SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer

Comparison of Tc-99m maraciclatide and Tc-99m sestamibi molecular breast imaging in patients with suspected breast cancer

Nuclear Breast Imaging: Clinical Results and Future Directions

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