Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

Abstract

Ductal carcinoma in situ (DCIS) is a subtype of breast cancer encountered increasingly in clinical practice because of the widespread use of screening mammography. In the present study, we evaluated the usefulness of breast-specific g-camera (BSGC) scintigraphy in DCIS identification, describing the scintigraphic findings and their correlation with mammography and histologic subtype. Methods: Thirty-three women, aged 41-81 y, with surgically proven DCIS were retrospectively reviewed. Before surgery, all patients underwent breast scintigraphy using a high-resolution semiconductor-based BSGC, starting 10 min after intravenous injection of 740 MBq of 99m Tc-tetrofosmin. All patients had previously undergone mammography. A definitive histologic diagnosis was obtained in all cases after scintigraphy, and the scintigraphic findings were correlated with mammography and histologic subtype. Results: Mammography was positive in 30 of 33 patients (sensitivity, 90.9%), showing calcifications in 22 of 30 (73.3%), masses in 3 of 30 (10%), and masses plus calcifications in the remaining 5 of 30 (16.7%). Scintigraphy was positive in 31 of 33 patients (sensitivity, 93.9%), showing patchy irregular uptake in patients with calcifications and focal uptake in masses; sensitivity was higher in low-to intermediate-grade DCIS than in intermediate/high-and high-grade DCIS (100% vs. 91.3%), but the difference was not statistically significant. Two comedo-type DCIS (one 20-mm intermediate/high-grade and one 15-mm high-grade) with heterogeneously or highly dense breasts at mammography and one papillary low/intermediate-grade DCIS associated with Paget disease were true positive only at scintigraphy. Moreover, scintigraphy better assessed disease extent than did mammography in 5 additional patients. Two comedo-type DCIS (one 6-mm intermediate/highgrade and one 15-mm high-grade) were true positive only at mammography. The difference in sensitivity between scintigraphy and mammography was not statistically significant. The combined use of mammography and scintigraphy achieved 100% sensitivity. Conclusion: BSGC scintigraphy proved to be a highly sensitive diagnostic tool in the detection of DCIS, irrespective of histologic subtype, and with a scintigraphic pattern of uptake that correlated well with mammography findings. In our series, BSGC scintigraphy demonstrated a slightly higher sensitivity than mammography and a better assessment of local disease extent. Thus, BSGC scintigraphy should represent a useful adjunctive tool in breast cancer diagnosis.Key Words: DCIS; breast-specific g-camera scintigraphy; mammography Duct al carcinoma in situ (DCIS) of the breast is a noninvasive subtype of primary breast cancer characterized by a malignant proliferation of ductal epithelium with no histologic evidence of invasion through the ductal basement membrane (1). The mortality associated with a pure DCIS without invasion is thus extremely low, generally lower than 1%-2% (2).However, different behaviors have been observed after the initial treatment; ...

Comparative Diagnostic Utility of Low‐Dose Breast‐Specific Gamma Imaging to Current Clinical Standard

“…In addition, the specificity for both groups was tempered by a relatively high number of false-positive results with 32.7% (50 of 153 lesions) and 35.9% (52 of 145 lesions) of findings representing false-positive outcomes in the low-dose and high-dose groups, respectively. The most common benign pathology resulting in a false-positive BSGI was fibrocystic change, which is consistent with prior studies reporting on false-positive lesions with BSGI (9,(22)(23)(24).…”

“…Breast-specific gamma imaging has also shown utility in the diagnosis of DCIS with a sensitivity ranging from 67.0% to 94.0% (9,(23)(24)(25)(26). The reported sensitivity of mammography in the detection of DCIS ranges from 27% to 82% (26)(27)(28), while the sensitivity of MRI has been reported as 91.4% (29).…”

“…The purpose of our study was to retrospectively compare the diagnostic utility of low-dose BSGI (7-10 mCi) to the previously utilized high-dose (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) protocol in the detection of breast cancer.…”

Breast-Specific Gamma Imaging: Correlations With Mammographic and Clinicopathologic Characteristics of Breast Cancer

“…We could not compare pathologic subtypes and visibility on BSGI because our study included only a limited number of them, except IDC. Spanu et al [10] had reported a higher sensitivity to low-to-intermediate grade DCIS than to intermediate-to-high or high-grade DCIS (100% vs 91.3%), though the difference was not statistically significant. According to our results, 100% (12/12) of high-nuclear-grade cancers and 81% (34/42) of low-nuclear-grade were visible on BSGI, but without statistical significance.…”

New possibilities for molecular imaging and interventions in breast cancer and other female malignancies

“…The indocyanine green (ICG) added to 53 Furthermore, the incorporation of co-registered SPECT/CT to 3D navigation probe may be used during the operation offering a 3D roadmap to the surgeon and facilitating the anatomical localisation of SLN(s). In the current literature on radioguided surgery, this approach has been reported in penile cancer by Brower et al 54 In conclusion, the SLN procedure has widely been validated in vulvar cancer and cervical cancer.…”