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) 99mTc-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.
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References
van Dijck JA, Verbeek AL, Hendriks JH, 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;72:1933–8.
Lehman CD, Blume JD, Weatherall P, Thickman D, Hylton N, Warner E, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005;103:1898–905.
Bird RE, Wallace TW, Yankaskas BC. Analysis of cancers missed at screening mammography. Radiology. 1992;184:613–7.
Ganott MA, Harris KM, Klaman HM, Keeling TL. Analysis of false-negative cancer cases identified with a mammography audit. Breast J. 1999;5:166–75.
Morton MJ, Whaley DH, Brandt KR, Amrami KK. Screening mammograms: interpretation with computer-aided detection–prospective evaluation. Radiology. 2006;239:375–83.
Williams MB, Pisano ED, Schnall MD, Fajardo LL. Future directions in imaging of breast diseases. Radiology. 1998;206:297–300.
Kopans DB. The positive predictive value of mammography. AJR Am J Roentgenol. 1992;158:521–6.
Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V. Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radiology. 2008;247:651–7.
Brem RF, Schoonjans JM, Kieper DA, Majewski S, Goodman S, Civelek C. High-resolution scintimammography: a pilot study. J Nucl Med. 2002;43:909–15.
Brem RF, Petrovitch I, Rapelyea JA, 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;13:465–9.
Tafreshi NK, Kumar V, Morse DL, Gatenby RA. Molecular and functional imaging of breast cancer. Cancer Control. 2010;17:143–55.
Schillaci O, Buscombe JR. Breast scintigraphy today: indications and limitations. Eur J Nucl Med Mol Imaging. 2004;31 Suppl 1:35–45.
Liberman M, Sampalis F, Mulder DS, Sampalis JS. Breast cancer diagnosis by scintimammography: a meta-analysis and review of the literature. Breast Cancer Res Treat. 2003;80:115–26.
Brem RF, Kieper DA, Rapelyea JA, Majewski S. Evaluation of a high-resolution, breast-specific, small-field-of-view gamma camera for the detection of breast cancer. Nucl Instrum Meth Phys Res A. 2003;497:39–45.
Brem RF, Shahan C, Rapleyea JA, Donnelly CA, Rechtman LR, Kidwell AB, et al. 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;17:735–43.
Brem RF, Rapelyea JA, Zisman G, Mohtashemi K, Raub J, Teal CB, et al. Occult breast cancer: Scintimammography with high-resolution breast-specific gamma camera in women at high risk for breast cancer. Radiology. 2005;237:274–80.
Brem RF, Fishman M, Rapelyea JA. Detection of ductal carcinoma in situ with mammography, breast specific gamma imaging, and magnetic resonance imaging: a comparative study. Acad Radiol. 2007;14:945–50.
Brem RF, Michener KH, Zawistowski G. Approaches to improving breast cancer diagnosis using a high resolution, breast specific gamma camera. Phys Med. 2006;21 Suppl 1:17–9.
Scopinaro F, Schillaci O, Scarpini M, Mingazzini PL, Di Macio L, Banci M, et al. 99mTc sestamibi: an indicator of breast cancer invasiveness. Eur J Nucl Med. 1994;21:984–7.
Sung Mo Hur SHK, Lee SK, Kim WW, Choi JH, Kim S, Lee S-J, et al. The preoperative role of breast-specific gamma imaging for the breast cancer patients: In comparison with conventional imaging modality. J Breast Cancer. 2010;13:198–205.
Arthur Cho HC, Yun M, Park B-W, Kim MJ, Kim E-K, et al. The value of dedicated 99mTc MIBI scintimammogram in the evaluation of patients with palpable breast lesions in comparison with mammogram: Preliminary result. Nucl Med Mol Imaging. 2009;43:48–54.
Scopinaro F, Schillaci O, Ussof W, Nordling K, Capoferro R, De Vincentis G, et al. A three center study on the diagnostic accuracy of 99mTc MIBI scintimammography. Anticancer Res. 1997;17:1631–4.
Reporting BI. Data System. Breast Imaging Atlas. 4th ed. Reston: American College of Radiology. 2003
Goldsmith SJ, Parsons W, Guiberteau MJ, Stern LH, Lanzkowsky L, Weigert J, et al. SNM practice guideline for breast scintigraphy with breast-specific gamma-cameras 1.0. J Nucl Med Technol. 2010;38:219–24.
Acknowledgments
This research was supported by 2011 Collaborative Research Program of Nuclear Medical Sciences through the Dongnam Institute of Radiological & Medical Sciences (DIRAMS) funded by the Ministry of Education, Science and Technology (MEST) and Busan Metropolitan city.
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Park, J.S., Lee, A.Y., Jung, K.P. et al. Diagnostic Performance of Breast-Specific Gamma Imaging (BSGI) for Breast Cancer: Usefulness of Dual-Phase Imaging with 99mTc-sestamibi. Nucl Med Mol Imaging 47, 18–26 (2013). https://doi.org/10.1007/s13139-012-0176-2
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DOI: https://doi.org/10.1007/s13139-012-0176-2