Comparison of BSGI, MRI, mammography, and ultrasound for the diagnosis of breast lesions and their correlations with specific molecular subtypes in Chinese women

Abstract

Background Breast cancer is a leading cause of cancer in females, and is the second leading cancer-related cause of death in this group. Early diagnosis is essential to breast cancer to be effectively treated, and ultrasound, mammography, and magnetic resonance imaging (MRI) represent three key technologies that are utilized for the diagnosis of breast lesions. Breast-specific gamma imaging (BSGI) is an approach to molecular breast imaging that allows for high-resolution radio-imaging that is not adversely impacted by breast tissue density. This study was therefore designed to assess the relative diagnostic efficacy of BSGI, MRI, mammography, and ultrasound in different molecular subtypes of breast cancer among Chinese women. Methods Diagnostic findings from 390 patients that had undergone diagnosis and treatment in our breast surgery department were retrospectively reviewed. Patients had been diagnosed via BSGI, mammography, ultrasound, and MRI. The diagnostic efficacy of these different imaging modalities and their associated biological characteristics were compared in the present study. Results A total of 229 of these 390 patients (58.7%) were diagnosed with malignant breast cancer, with the remaining 161 (41.3%) cases having been found to be benign. BSGI, MRI, mammography, and ultrasound yielded respective sensitivity values of 91.7, 92.5, 77.3, and 82.1%, while the respective specificity values for these imaging modalities were 80.7, 69.7, 74.5, and 70.8%. For lesions > 1 cm, BSGI offered a sensitivity of 92.5%. For mammographic breast density A, B, C, and D, BSGI offered a sensitivity of 93.3, 94.0, 91.5, and 89.3%, respectively. BSGI also yielded a significantly higher lesion-to-normal lesion ratio (LNR) for malignant lesions relative to benign lesions (2.76 ± 1.32 vs 1.46 ± 0.49). Conclusions These findings confirm that BSGI is highly sensitive and is superior to mammography in the detection and diagnosis of ductal carcinomas in situ (DCIS). Such diagnostic efficacy can be further improved by using BSGI as an auxiliary modality to mammography and ultrasound, potentially improving the reliability of breast lesion diagnosis, thereby ensuring that patients receive rapid and effective treatment without the risk of misdiagnosis or unnecessary surgical treatment.

Comparison of BSGI and MRI as Approaches to Evaluating Residual Tumor Status after Neoadjuvant Chemotherapy in Chinese Women with Breast Cancer

“…Therapeutic efficacy must therefore be evaluated as quickly and accurately as possible so that appropriate interventional strategies can be formulated while minimizing the risk of toxicity. Breast MRI scans are one of the primary approaches used to gauge patient responses to NAC; however, breast MRI analyses can nonetheless yield high false-positive rates and can overestimate tumor size, whereas BSGI is a more recently developed imaging approach that has been leveraged for both tumor staging and NAC response evaluation [9,13,16]. BSGI is a functional imaging approach that utilizes the positively-charged, fat-soluble 99m Tc-sestamibi radiotracer to estimate mitochondrial metabolic activity.…”

“…High-resolution bilateral craniocaudal (CC) and mediolateral oblique (MLO) images. Individual image acquisition was conducted for approximately 5 min, with a minimal range of 100 Kcounts/image [9,10]. Two nuclear medicine specialists evaluated BSGI results as per the Society of Nuclear Medicine guidelines [11] for interpreting BSGI results while also considering available baseline ultrasound and mammography images.…”

“…Immunohistochemical staining following diagnostic biopsy prior to NAC treatment was used to evaluate tumor hormone receptor and HER2 status. Tumors were separated into four subtypes based upon HER2, Ki-67, progesterone receptor (PR), and estrogen receptor (ER) status as follows: Luminal A, Luminal B, Her-2 positive, and triple-negative [9,14].…”

“…However, non-mass enhancement at pre-treatment MRI negatively affected the diagnostic performance of MRI in assessing treatment response after NAC. MRI can also not be used regularly owing to its high costs [8,9]. In addition, patients with claustrophobia or magnetic resonance contraindications such as pacemaker installation cannot undergo magnetic resonance examination.…”

Comparison of diagnostic efficacy of ultrasound, ultrasound elastography and magnetic resonance imaging for breast lesions

“…In some studies carried out among asymptomatic women, this rate has been reported to be as low as 1.6% to 10.4% [17][18] . However, studies conducted among women with suspected breast lesions/masses have reported a higher malignancy rate ranging from 30% to 69.8% [19][20][21][22][23][24] . Although, some studies conducted among suspected women have reported this incidence to be less than 30%.…”