Detection of Occult Foci of Breast Cancer Using Breast-Specific Gamma Imaging in Women with One Mammographic or Clinically Suspicious Breast Lesion

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...

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

Section: Discussionsupporting

confidence: 81%

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

Tadwalkar

Rapelyea

Torrente

et al. 2012

BJR

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“…Small, retrospective, single-site studies using BSGI report detection of additional malignancy in 9%-11% of patients, which included 3% with a contralateral occult cancer (13)(14)(15). One report that directly compared BSGI with MR imaging examined 66 patients and demonstrated comparable sensitivity (89% vs. 92%, respectively) with increased specificity of BSGI (90%) over MR imaging (39%) (16).…”

Section: Preoperative Evaluation Of Disease Extentmentioning

confidence: 99%

A Molecular Approach to Breast Imaging

Fowler

2014

J Nucl Med

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Molecular imaging is a multimodality discipline for noninvasively visualizing biologic processes at the subcellular level. Clinical applications of radionuclide-based molecular imaging for breast cancer continue to evolve. Whole-body imaging, with scintimammography and PET, and newer dedicated breast imaging systems are reviewed. The potential clinical indications and the challenges of implementing these emerging technologies are presented.

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“…6,121,122 In a comparison of BSGI with MRI used in preoperative evaluation, the sensitivities of the two techniques were similar (89% and 92%) but BSGI demonstrated significantly better specificity of 90% compared to 39% for MRI (p < 0.0001). 123 A study performed using a dedicated CZT-based MBI system and 99m Tc-tetrofosmin in 264 patients showed gamma imaging to significantly improve detection of multifocal or multicentric disease compared to that detected with mammography (88% vs 48% of cases, p < 0.0005) and to correctly alter surgical management in 16% of patients.…”

Section: Ivb Preoperative Evaluationmentioning

confidence: 99%

“…Recent clinical studies have demonstrated potential roles of nuclear methods in detecting breast disease that is occult on mammography, 3 in providing a useful evaluation of both the ipsilateral and contralateral breast in the preoperative setting [4][5][6] and in monitoring the response to neoadjuvant (primary) chemotherapy. 7 These encouraging findings have led to a shift in thinking about nuclear medicine in breast imaging, and dedicated techniques are gradually becoming recognized as valid and beneficial tests for certain subsets of patients that are not served well by currently available modalities.…”

Section: Introductionmentioning

confidence: 99%

Nuclear imaging of the breast: Translating achievements in instrumentation into clinical use

Hruska

O’Connor

2013

Medical Physics

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Approaches to imaging the breast with nuclear medicine and/or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed.

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Detection of Occult Foci of Breast Cancer Using Breast-Specific Gamma Imaging in Women with One Mammographic or Clinically Suspicious Breast Lesion

Cited by 39 publications

References 28 publications

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

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

A Molecular Approach to Breast Imaging

Nuclear imaging of the breast: Translating achievements in instrumentation into clinical use

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