Review of imaging techniques for the diagnosis of breast cancer: a new role of prone scintimammography using technetium-99m sestamibi

Abstract

Imaging techniques currently used for the diagnosis of breast cancer are reviewed and compared. Besides mammography, magnetic resonance imaging, positron emission tomography, and thallium-201 scintimammography, a new role of technetium-99m sestamibi scintimammography is discussed. It is concluded that while mammography remains the procedure of choice in screening asymptomatic women for breast cancer, other imaging methods play an important role in detecting malignancies in symptomatic patients. 99mTc-sestamibi scintimammography has high sensitivity and improves the specificity of conventional mammography for the detection of breast cancer; with this technique, prone imaging is preferable to supine imaging. 99mTc-sestamibi scintimammography thus deserves further study as a screening technique.

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

“…It has been reported that 99m Tc-MIBI scintimammography is a highly sensitive test for the evaluation of breast masses and that it improves the specificity of conventional mammography by differentiating benign from malignant lesions. 99m Tc-MIBI breast imaging shows a sensitivity of 84%-96% for the detection of primary breast cancer [12,13,14,15,16,17,18]. In the present study, the rate of detection of breast cancer using 99m Tc-MIBI was within the range of these previous results.…”

“…In the present study, the rate of detection of breast cancer using 99m Tc-MIBI was within the range of these previous results. The value of imaging with patients in the prone position has been well established [13,14,16,17], in that it permits better separation of the deep breast structures from the high activity of myocardium and liver. In this study, nevertheless, patients were placed in an upright posterior oblique lateral position with the ipsilateral arm raised and with the face turned away from the side of the known breast lesion.…”

“…However, it also concentrates in tumour cells in vitro and can help to detect several types of malignant tumour by scintigraphy [38,39]. 99m Tc-MIBI scintimammography is a recently developed imaging procedure with a target to non-target ratio that allows good visualization of breast tumour [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. Published results show a good overall sensitivity of 84%-96% for the detection of breast cancer [12,13,14,15,16,17,18].…”

“…There is growing interest in the scintigraphic evaluation of suspicious breast masses. Radiopharmaceuticals including fluorine-18 fluorodeoxyglucose (FDG), thallium-201, technetium-99m hexakis 2-methoxyisobutylisonitrile (MIBI), 99m Tc-tetrofosmin and 99m Tc complexes of diphosphonates such as methylene diphosphonate (MDP) and hydroxymethylene diphosphonate (HMDP) have been investigated as complements to diagnostic imaging procedures in patients with suspected breast cancer [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. FDG positron emission tomography (PET) has been suggested as a reliable technique for breast cancer detection, but its use is restricted by the high cost and by manpower considerations.…”

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

“…Hence, scintimammography was typically performed with the patient prone and with the camera positioned laterally, a technique pioneered by Khalkhali et al to improve separation of the breast from the chest and abdomen. 21,22 Even with this positioning, the distance between the gamma camera and the pendant, uncompressed breast during planar scintimammography was ∼5 cm. As the average thickness of the pendant breast is ∼16 cm, 23 a tumor in the middle of the breast could be 10-15 cm from the collimator face.…”