The value of early and double phase 99Tcm-sestamibi scintimammography in the diagnosis of breast cancer

• Published in: Nuclear medicine communications Vol. 21; no. 4; p. 341
• Main Authors: Paz, A, Melloul, M, Cytron, S, Koren, R, Ohana, G, Michalevich, D, Gal, R, Wolloch, Y
• Format: Journal Article
• Language: English
• Published: England 01.04.2000
• Subjects: Adult; Aged; Biopsy, Needle; Breast Neoplasms - diagnosis; Breast Neoplasms - diagnostic imaging; Evaluation Studies as Topic; Female; Humans; Mammography - methods; Mammography - statistics & numerical data; Middle Aged; Palpation; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Sestamibi
• ISSN: 0143-3636
• DOI: 10.1097/00006231-200004000-00008

The aim of this study was to assess the additional value of early and double phase scintimammography (SMM) with 99Tcm-sestamibi in the detection of breast cancer following initial evaluation by palpation and mammography. Altogether, 322 women with breast lesions evaluated prospectively by palpation, fine-needle aspiration and mammography were assigned a malignancy risk according to the results. Scintimammography was performed in all patients in the prone breast dependent position. Immediate and delayed views were obtained. Acquisition of immediate tracer uptake was termed 'early phase' SMM, whereas a combination of both immediate and delayed phase images was termed 'double phase' SMM. All patients underwent breast biopsy. Both early phase and double phase SMM detected eight of nine tumours in the low-risk group (88.8% sensitivity). In the uncertain cases (moderate-risk group), early phase SMM detected all malignant tumours, but double phase SMM missed one (92.3% sensitivity). In the high-risk group, early phase SMM missed two breast cancers (94.6% sensitivity) and double phase SMM missed four (89.2% sensitivity). Overall, early phase SMM had a sensitivity of 94.9% and a specificity of 80.2% in detecting breast cancer, whereas double phase SMM had a sensitivity of 89.8% and a specificity of 94.3%. Both methods had 100% sensitivity for tumours larger than 1 cm. In conclusion, SMM detected additional breast cancers following an initial evaluation by palpation, fine-needle aspiration and mammography. Our results suggest that double phase SMM is more specific than early phase SMM, although early phase SMM is more sensitive. Whether the interpretation of SMM results should rely on both early and delayed images, or early images alone, should be based on the relative risk of malignancy of the breast lesion as estimated by the initial evaluation.