Can scintimammography with 99mTc-MIBI identify multifocal and multicentric primary breast cancer?

Abstract

Scintimammography with (99m)Tc-MIBI has been shown to be an effective adjunct to imaging of the breast with mammography. Uptake of (99m)Tc-MIBI is particularly high in sites of non-calcified cancer and ductal carcinoma in situ (DCIS), and as a consequence it may be possible to use this method of imaging in identifying multifocal or multicentric disease. The aim of this study was to evaluate the efficacy of preoperative scintimammography in the detection of multifocal and multicentric breast cancer and compare these results with mammography. A retrospective review was performed of 353 women imaged with (99m)Tc-MIBI as part of the clinical assessment of their suspected primary breast cancer. The results of the scintimammography and mammography were then compared with the final pathological diagnosis obtained after mastectomy in all patients. Histopathological assessments of breast tissue from mastectomy confirmed 40 women (12%) had multifocal (34) or multicentric (six) breast cancer. Scintimammography correctly identified 39 of these cancers and the multifocal or multicentric character of the cancer was identified in 22 (52%) of these patients. Anatomical imaging performed in all 40 patients including 25 with mammography alone, mammography and ultrasound in 11 cases and ultrasound alone in four patients. Anatomical imaging identified cancer to be present in 28 patients (70%) and the combination of mammography and ultrasound identified correctly that the cancer was multifocal or multicentric in eight patients (22%). In this study scintimammography was able to identify more cases of multifocal and multicentric cancer than mammography and/or ultrasound. In patients where pre-operative identification of multicentric or multifocal disease can alter treatment scintimammography may be a useful investigative tool.

Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade

“…This concurs with recent reports indicating that BSGI can detect additional foci of occult cancers in females with one known cancer [13,22,23].…”

“…The similarity in the detection of DCIS with both MRI and BSGI suggests that these two physiological-based approaches are comparable in sensitivity [21]. Similarly, this study demonstrated comparable sensitivity of BSGI to MRI for the diagnosis of invasive breast cancer [22]. It is important to note that MRI is performed without ionising radiation and BSGI uses a low-dose radiotracer that has safely been used in medical imaging for decades with ongoing studies aimed at further decreasing the dose.…”

Modern Breast Cancer Detection: A Technological Review

“…A comparison with sonography found that the negative aspects of SMM overshadowed its high detection accuracy, indicating that it probably will not replace sonography [48]. A study by Cwikla and colleagues [49] found that SMM detected more cases of multifocal and multicentric cancer than both mammography and ultrasonography. A study by Hillner [50] estimated that SMM usage in comparison to immediate surgery would decrease costs by 39% and result in 65% of women avoiding biopsy.…”

99mTc-Sestamibi Scintimammography

“…In only four of the cited studies applied doses were below the recommended minimal dose of 740 MBq, in none of the studies, higher doses as recommended were applied (1,110 MBq). [47] Europe Turkey 740 Becherer [48] Europe Austria 630-740 Buscombe [49] Europe UK 740 Buscombe [50] Europe UK 740 Cwikla [51] Europe UK 740 Cwikla [52] Europe UK 740 Cwikla [53] Europe UK 740 Fondrinier [54] Europe France 740 Helbich [55] Europe Austria 629-740 Imbriaco [56] Europe Italy 555 Maffioli [57] Europe Italy 740 Marshall [58] Europe UK 750 Mathieu [59] Europe Belgium 740 Maublant [60] Europe France 740 Moretti [19] Europe France 500 Myslivecek [61] Europe Czech Republic 740 Palmedo [62] Europe Germany 740 Palmedo [63] Europe Germany 740 Papantoniou [64] Europe Greece 925-1,110 Prats [65] Europe Spain 740 Prats [66] Europe Spain 740 Sanidas [67] Europe Greece 740 Tiling [68] Europe Germany 740 Tiling [69] Europe Germany 740 Uriarte [70] Europe Spain 740 Chen [71] Asia China 740 Kao [72] Asia Taiwan 740 Kim [73] Asia South Korea 750 Kim [74] Asia South Korea 925 Kim [75] Asia South Korea 750 Tc-Sestamibi Scintimammography…”