Occult breast cancer: prevalence and radiographic detectability.

Pollei, S R; Fa, Mettler; Bartow, Sue A.; Moradian, G P; Moskowitz, Myron

doi:10.1148/radiology.163.2.3562827

Cited by 49 publications

(11 citation statements)

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“…However, the smallest breast cancer in this study, which was 7 mm in diameter and located in the superficial outer quadrant, was detected on early 99m Tc-MIBI scintimammography as an area of focal accumulation. In women with dense breasts, mammography has a false-negative rate of 25%-45% [40]. In the present study, all four patients with indeterminate findings on mammography because of dense breast tissue showed abnormal accumulation on scintimammography using 99m Tc-MIBI and 99m Tc-HMDP.…”

Section: Discussionsupporting

confidence: 41%

Comparative evaluation of 99mTc-MIBI and 99mTc-HMDP scintimammography for the diagnosis of breast cancer and its axillary metastases

et al. 2001

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The purpose of the present study was to compare scintimammography using technetium-99m hexakis 2-methoxyisobutylisonitrile (MIBI) with that using 99mTc-hydroxymethylene diphosphonate (HMDP) in the detection of breast cancer and its axillary lesions. The study population comprised 50 consecutive females with breast cancer who were scheduled for surgery. All patients underwent scintimammography with 99mTc-MIBI and 99mTc-HMDP. The images were acquired 5 min (early) and 2 h (delayed) after injection of each radiopharmaceutical. Regions of interest were placed over the breast tumour (T), the axillary lesion (A) and the normal ipsilateral breast tissue (N). The two count ratios were calculated, i.e. the tumour to normal breast tissue ratio (T/N) and the axillary lymph node to normal breast tissue ratio (A/N). For the breast tumours, using 99mTc-MIBI the positive rate was 86% (43/50) for the early and 72% (36/50) for the delayed images. The corresponding values using 99mTc-HMDP were 72% (36/50) and 40% (20/50), respectively. Histopathological examination revealed metastatic lymph node involvement in 22 patients. For the axillary lesions, using 99mTc-MIBI the positive rate was 72.7% (16/22) for the early and 54.5% (12/22) for the delayed images. Using 99mTc-HMDP, the positive rate was only 18.2% (4/22) for the early and 4.5% (1/22) for the delayed images. Using 99mTc-MIBI, the mean T/N (+/- SD) ratios on early and delayed images were 2.69 +/- 1.64 and 2.03 +/- 1.16, respectively, and the mean A/N (+/- SD) ratios on early and delayed images were 2.20 +/- 1.23 and 1.80 +/- 1.20, respectively. The corresponding values using 99mTc-HMDP were 1.77 +/- 0.91, 1.42 +/- 0.72, 1.27 +/- 0.63 and 1.08 +/- 0.25, respectively. The T/N and A/N ratios on the early and delayed 99mTc-MIBI images were both significantly higher than those obtained using 99mTc-HMDP. 99mTc-MIBI scintimammography is more sensitive than 99mTc-HMDP scintimammography for the detection of breast cancer and its axillary lymph node metastases.

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Section: Discussionsupporting

confidence: 41%

Comparative evaluation of 99mTc-MIBI and 99mTc-HMDP scintimammography for the diagnosis of breast cancer and its axillary metastases

et al. 2001

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“…13,14 A few other autopsy studies have found undetected DCIS and invasive carcinomas in the breast tissues of women who died accidentally. [15][16][17][18] Certainly, among older women who were diagnosed incidentally with breast carcinoma at autopsy (the disease never altered their lives), it may be argued that, because they died of other diseases, the detection of these innocuous tumors when the individual was alive would have led only to "harms" through unnecessary psychological trauma and totally unnecessary treatment. The autopsy studies that have evaluated women who died accidentally, however, represent a very different group.…”

Section: Ductal Carcinoma In Situmentioning

confidence: 99%

A simple model of breast carcinoma growth may provide explanations for observations of apparently complex phenomena

Kopans

Rafferty

Georgian-Smith

et al. 2003

Cancer

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BACKGROUNDThere has been great debate regarding the importance of ductal carcinoma in situ (DCIS) in the breast. Autopsy results that demonstrate a much greater number of these lesions compared with the number of invasive carcinomas, and the numbers of deaths from breast carcinoma each year have been cited as evidence that DCIS rarely leads to invasion and death. These analyses have overlooked the fact that, to sustain a rate of detection each year, there would have to be a reservoir of undetected breast carcinomas growing in the population. The authors developed a simple model that makes this clear. In addition, complex phenomena have been suggested to explain why invasive breast disease may grow more rapidly among very young women and more slowly among the very old. A simple model provides some insight that may simplify the explanation of these observations.METHODSThe simple model of breast carcinoma growth assumes that there are three types of breast carcinoma that begin each year in a cohort of women. It assumes that all breast carcinomas begin as DCIS and take 9 years to go from a single cell to an invasive lesion for the slowest growing lesions, 6 years for intermediate growing DCIS lesions, and 3 years for fast‐growing DCIS lesions. Furthermore, once an invasive clone forms, the model assumes that it will double in 60 days for fast‐growing lesions, 120 days for intermediate growing lesions, and 180 days for slow‐growing lesions. Three new tumors begin to grow in each successive year (one of each type). The model uses simple vectors that are defined by the size of the tumors and the time since tumor initiation, and it assumes that all tumors are detected when they reach 2 cm in greatest dimension. The model can be used to show graphically how many undetected tumors (DCIS as well as invasive carcinomas) there may be in the population to sustain the detection of three invasive tumors each year.RESULTSUsing the assumptions described above, the model showed that, by the time the first slow‐growing breast carcinoma reaches 2 cm in greatest dimension, there will be 29 other slow‐growing tumors that have not reached that size (9 DCIS and 20 smaller invasive carcinomas), 19 moderately growing tumors (6 DCIS and 13 smaller invasive carcinomas), and 9 fast‐growing tumors (3 DCIS and 6 smaller invasive carcinomas). This means that, for every three breast tumors that reach 2 cm, the model predicted that there would be another 57 tumors (39 smaller invasive carcinomas and 18 DCIS) that would be undetected “below the surface”. The model showed clearly that faster growing tumors would be expected to predominate among the youngest women, because they are the first to “reach the surface”; and, if the number of newly initiated tumors decreases with age, then there will be more of the slowest growing tumors that are left to reach the surface among the oldest women in the population.CONCLUSIONSEven if the authors' assumptions are incorrect, their model made it clear that, to diagnose several breast carcinomas per 1000 women each year means that there have to be many more undetected carcinomas in the population to sustain the rate of detection. Although the model did not prove that DCIS may become potentially invasive and lethal, it did demonstrate that, even if all of these in situ lesions become invasive and lethal, many more DCIS lesions would have to be expected in the population than the number of invasive carcinomas detected each year and the number of deaths from breast carcinoma each year. Furthermore, the model provided a simple, purely mechanical illustration that may explain the preponderance of faster growing breast carcinomas among very young women and the preponderance of slower growing tumors among elderly women. Cancer 2003;97:2951–9. © 2003 American Cancer Society.DOI 10.1002/cncr.11434

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“…Many studies have demonstrated that x-ray mammography is the most effective tool and is superior to phyical examination alone for the early detection of breast cancer. [2,3] Mammography has a relatively high sensitivity in the range of 85% -90%, especially in the examination of fatty breasts. Unfortunately, mammography is limited and less reliable in detecting breast cancer in women with dense breasts.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Thallium-201 SPECT Scintimammography to Differentiate Benign from Malignant Breast Masses in Mammographically Dense Breasts

Chiou¹,

Lin²,

Chen³

et al. 2003

Cancer Investigation

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The purpose of this study was to assess the usefulness of thallium-201 (Tl-201) single-photon emission-computed tomography (SPECT) scintimammography to differentiate benign from malignant breast masses in 32 female Taiwanese patients with indeterminate mammographic probability of malignancy because of mammographically dense breasts. All breast masses were removed, and final histopathological diagnoses were obtained in all cases. The results showed that thallium-201 SPECT scintimammography findings were true-positive in 22 cases, false-positive in 1 case, true-negative in 7 cases, and false-negative in 2 cases. The diagnostic sensitivity, specificity, and accuracy were 91.7%, 87.5%, and 90.6%, respectively, for detecting breast cancer in mammographically dense breasts. In conclusion, thallium-201 SPECT scintimammography is a useful tool for differentiating benign from malignant breast masses in patients with indeterminate mammograms because of mammographically dense breasts.

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Occult breast cancer: prevalence and radiographic detectability.

Cited by 49 publications

References 0 publications

Comparative evaluation of 99mTc-MIBI and 99mTc-HMDP scintimammography for the diagnosis of breast cancer and its axillary metastases

Comparative evaluation of 99mTc-MIBI and 99mTc-HMDP scintimammography for the diagnosis of breast cancer and its axillary metastases

A simple model of breast carcinoma growth may provide explanations for observations of apparently complex phenomena

Usefulness of Thallium-201 SPECT Scintimammography to Differentiate Benign from Malignant Breast Masses in Mammographically Dense Breasts

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