Diagnostic Performance of Breast-Specific Gamma Imaging (BSGI) for Breast Cancer: Usefulness of Dual-Phase Imaging with (99m)Tc-sestamibi

Overview

Journal Nucl Med Mol Imaging

Publisher Springer

Date 2014 Jun 5

PMID 24895504

Citations 4

Authors

Ji Sun Park

Ah Young Lee

Kyung Pyo Jung

Su Jung Choi

Seok Mo Lee

Sang Kyun Bae

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to investigate the usefulness of breast-specific gamma imaging (BSGI) with dual-phase imaging for increasing diagnostic performance and interpreter confidence.

Methods: We studied 76 consecutive patients (mean age: 49.3 years, range: 33-61 years) who received 925 MBq (25 mCi) (99m)Tc-sestamibi intravenously. Craniocaudal and mediolateral oblique planar images were acquired for all patients. Delayed images were obtained from all patients 1 h after tracer injection, except for patients with no definite abnormal uptake. All images were classified into four categories: group 1 (definite negative) = no definite abnormal uptake; group 2 (possible negative) = symmetrically diffuse and amorphous uptake; group 3 (possible positive) = asymmetrically mild and nodular uptake; group 4 (definite positive) = asymmetrically intense and nodular uptake. To evaluate diagnostic performance, the BSGI studies were classified as positive (group 3 or 4) or negative (group 1 or 2) for malignancy according to a visual analysis. The final diagnoses were derived from histopathological confirmation and/or imaging follow-up after at least 6 months (range: 6-14 months) by both ultrasonography and mammography.

Results: The patients' ages ranged from 33 to 61 years, with an average of 49.3 years. Thirteen patients were diagnosed with malignancy, and 63 patients were diagnosed as negative for malignancy. Using early images, 43 patients were classified as group 1, 12 as group 2, 10 as group 3 and 11 as group 4. Based on early images, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of BSGI were 77 %, 83 %, 48 %, 95 % and 82 %, respectively. Dual-phase BSGI had a sensitivity, specificity, PPV, NPV and accuracy of 69 %, 95 %, 75 %, 94 % and 91 %, respectively. The BSGI specificity was significantly higher with dual-phase imaging than with single-phase imaging (p = 0.0078), but the sensitivity did not differ significantly (p = 1.0). Based on dual-phase imaging, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of BSGI for the evaluation of US BI-RADS 4 lesions were 60 %, 86 %, 67 %, 83 % and 78 %, respectively.

Conclusion: Dual-phase imaging in BSGI showed good diagnostic performance and would be useful for increasing interpreter diagnostic confidence, with higher specificity, positive predictive value and accuracy for breast cancer screening as well as the differential diagnosis of breast disease compared with single-phase imaging.

Citing Articles

Breast-Specific Gamma Imaging: An Added Value in the Diagnosis of Breast Cancer, a Systematic Review.

De Feo M, Sidrak M, Conte M, Frantellizzi V, Marongiu A, De Cristofaro F Cancers (Basel). 2022; 14(19).

PMID: 36230540 PMC: 9559460. DOI: 10.3390/cancers14194619.

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

Liu H, Zhan H, Sun D, Zhang Y BMC Med Imaging. 2020; 20(1):98.

PMID: 32799808 PMC: 7429706. DOI: 10.1186/s12880-020-00497-w.

Comparison of Tc-MIBI scintigraphy, ultrasound, and mammography for the diagnosis of BI-RADS 4 category lesions.

Liu H, Zhan H, Sun D BMC Cancer. 2020; 20(1):463.

PMID: 32448217 PMC: 7245809. DOI: 10.1186/s12885-020-06938-7.

Retrospective and comparative analysis of (99m)Tc-Sestamibi breast specific gamma imaging versus mammography, ultrasound, and magnetic resonance imaging for the detection of breast cancer in Chinese women.

Yu X, Hu G, Zhang Z, Qiu F, Shao X, Wang X BMC Cancer. 2016; 16:450.

PMID: 27401536 PMC: 4940883. DOI: 10.1186/s12885-016-2537-1.

References

van Dijck J, Verbeek A, Hendriks J, Holland R . The current detectability of breast cancer in a mammographic screening program. A review of the previous mammograms of interval and screen-detected cancers. Cancer. 1993; 72(6):1933-8. DOI: 10.1002/1097-0142(19930915)72:6<1933::aid-cncr2820720623>3.0.co;2-n. View

Tafreshi N, Kumar V, Morse D, Gatenby R . Molecular and functional imaging of breast cancer. Cancer Control. 2010; 17(3):143-55. DOI: 10.1177/107327481001700302. View

Liberman M, Sampalis F, Mulder D, Sampalis J . Breast cancer diagnosis by scintimammography: a meta-analysis and review of the literature. Breast Cancer Res Treat. 2003; 80(1):115-26. DOI: 10.1023/A:1024417331304. View

Goldsmith S, Parsons W, Guiberteau M, Stern L, Lanzkowsky L, Weigert J . SNM practice guideline for breast scintigraphy with breast-specific gamma-cameras 1.0. J Nucl Med Technol. 2010; 38(4):219-24. DOI: 10.2967/jnmt.110.082271. View

Schillaci O, Buscombe J . Breast scintigraphy today: indications and limitations. Eur J Nucl Med Mol Imaging. 2004; 31 Suppl 1:S35-45. DOI: 10.1007/s00259-004-1525-x. View

Morton M, Whaley D, Brandt K, Amrami K . Screening mammograms: interpretation with computer-aided detection--prospective evaluation. Radiology. 2006; 239(2):375-83. DOI: 10.1148/radiol.2392042121. View

Scopinaro F, Schillaci O, Ussof W, Nordling K, Capoferro R, De Vincentis G . A three center study on the diagnostic accuracy of 99mTc-MIBI scintimammography. Anticancer Res. 1997; 17(3B):1631-4. View

Williams M, Pisano E, SCHNALL M, Fajardo L . Future directions in imaging of breast diseases. Radiology. 1998; 206(2):297-300. DOI: 10.1148/radiology.206.2.9457176. View

Brem R, Michener K, Zawistowski G . Approaches to improving breast cancer diagnosis using a high resolution, breast specific gamma camera. Phys Med. 2007; 21 Suppl 1:17-9. DOI: 10.1016/S1120-1797(06)80017-7. View

10.

Ganott M, Harris K, Klaman H, Keeling T . Analysis of False-Negative Cancer Cases Identified with a Mammography Audit. Breast J. 2001; 5(3):166-175. DOI: 10.1046/j.1524-4741.1999.98035.x. View

11.

Brem R, Schoonjans J, Kieper D, Majewski S, Goodman S, Civelek C . High-resolution scintimammography: a pilot study. J Nucl Med. 2002; 43(7):909-15. View

12.

Bird R, WALLACE T, Yankaskas B . Analysis of cancers missed at screening mammography. Radiology. 1992; 184(3):613-7. DOI: 10.1148/radiology.184.3.1509041. View

13.

Brem R, Petrovitch I, Rapelyea J, Young H, Teal C, Kelly T . Breast-specific gamma imaging with 99mTc-Sestamibi and magnetic resonance imaging in the diagnosis of breast cancer--a comparative study. Breast J. 2007; 13(5):465-9. DOI: 10.1111/j.1524-4741.2007.00466.x. View

14.

Brem R, Shahan C, Rapleyea J, Donnelly C, Rechtman L, Kidwell A . Detection of occult foci of breast cancer using breast-specific gamma imaging in women with one mammographic or clinically suspicious breast lesion. Acad Radiol. 2010; 17(6):735-43. DOI: 10.1016/j.acra.2010.01.017. View

15.

Kopans D . The positive predictive value of mammography. AJR Am J Roentgenol. 1992; 158(3):521-6. DOI: 10.2214/ajr.158.3.1310825. View

16.

Brem R, Floerke A, Rapelyea J, Teal C, Kelly T, Mathur V . Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radiology. 2008; 247(3):651-7. DOI: 10.1148/radiol.2473061678. View

17.

Scopinaro F, Schillaci O, Scarpini M, Mingazzini P, Di Macio L, Banci M . Technetium-99m sestamibi: an indicator of breast cancer invasiveness. Eur J Nucl Med. 1994; 21(9):984-7. DOI: 10.1007/BF00238124. View

18.

Brem R, Fishman M, Rapelyea J . Detection of ductal carcinoma in situ with mammography, breast specific gamma imaging, and magnetic resonance imaging: a comparative study. Acad Radiol. 2007; 14(8):945-50. DOI: 10.1016/j.acra.2007.04.004. View

19.

Lehman C, Blume J, Weatherall P, Thickman D, Hylton N, Warner E . Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005; 103(9):1898-905. DOI: 10.1002/cncr.20971. View

20.

Brem R, Rapelyea J, Zisman G, Mohtashemi K, Raub J, Teal C . Occult breast cancer: scintimammography with high-resolution breast-specific gamma camera in women at high risk for breast cancer. Radiology. 2005; 237(1):274-80. DOI: 10.1148/radiol.2371040758. View