Skip to main content

Advertisement

SpringerLink
Log in

Use of a portable gamma camera for guiding surgical treatment in locally advanced breast cancer in a post-neoadjuvant therapy setting

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The aim of the present study was to assess the feasibility of a portable gamma camera (PGC) for guiding surgical treatment in locally advanced breast cancer (LABC) after neoadjuvant therapy (NT). Since January 2012, a PGC (Sentinella 102, ONCOVISION) has been available in our center. We planned to perform a feasibility monocentric prospective study involving 15–20 patients with LABC for assessing the diagnostic performance of this PGC after NT (Breast Cancer Surgery-S102). Before the surgical treatment and at the end of NT an injection of 99mTc-Sestamibi (100–150 MBq) was made. Conventional scintimmamography (SMM) and Sentinella 102 images were obtained from 18 patients. 10 (55.5 %) patients showed a focal uptake of tracer in the breast or lymph nodes before or after the surgical excision (on histological specimen), while 8 did not. The histological specimen concluded for a complete response to NT in 4 (22.2 %) patients and for a partial or no response to treatment in the remnant 14 subjects. The specificity and false-negative rate of the Sentinella 102 compared to SMM were 100 % for both and 38 % vs. 60 %, respectively. The global diagnostic accuracy of Sentinella 102 was: 66.7 % (95 % confidence interval: 44.88–88.44 %). The present feasibility study shows how a new nuclear imaging device can be useful in the operating theatre for guiding a radical surgery approach in patients with LABC after NT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. van der Hage JA, van de Valde CJ, Julien JP, Tubiana-Hulin M, Vandervelden C, Duchateau L (2001) Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. J Clin Oncol 19:4224–4237

    PubMed  Google Scholar 

  2. Yin HF, Wang YH, Qin XQ, Zhang H, Li T, Ye JM, Liu YH (2009) Effect of neoadjuvant chemotherapy on hiostologic grade and expression of biological markers in breast cancer. Zhonghua Zhong Liu Za Zhi 31:858–862

    PubMed  Google Scholar 

  3. Moll UM, Chumas J (1997) Morphologic effects of neoadjuvant chemotherapy in locally advanced breast cancer. Pathol Res Pract 193:187–196

    Article  CAS  PubMed  Google Scholar 

  4. Herrada J, Lyer RB, Atkinson EN, Sneige N, Buzdar AU, Hortobagyi GN (1997) Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastases in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res 3:1565–1569

    CAS  PubMed  Google Scholar 

  5. Chagpar AB, Middleton L, Sahin AA, Buzdar AU, Mirza AN, Ames FC et al (2006) Accuracy of physical examination, ultrasonography, and mammography in predicting residual tumor size in patients treated with neoadjuvant chemotherapy. Ann Surg 243:257–264

    Article  PubMed Central  PubMed  Google Scholar 

  6. Warren RM, Bobrow L, Earl HM, Britton PD, Gopalan D, Purushotham AD et al (2004) Can breast MRI help in the management of women with breast cancer treated by neoadjuvant chemotherapy? Br J Cancer 90:1349–1360

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Maini CL, Tofani A, Sciuto R, Semprebene A, Cavaliere R, Mottolese M et al (1997) Technetium-99m-MIBI scintigraphy in the assessment of neoadjuvant chemotherapy in breast carcinoma. J Nucl Med 38:1546–1551

    CAS  PubMed  Google Scholar 

  8. Marshall C, Eremin J, El-Sheemy M, Eremin O, Griffiths PA (2005) Monitoring the response of large (>3 cm) and locally advanced (T3-4, N0-2) breast cancer to neoadjuvant chemotherapy using (99m) Tc-Sestamibi uptake. Nucl Med Commun 26:9–15

    Article  CAS  PubMed  Google Scholar 

  9. Marinovich ML, Houssami N, Macaskill P, Sardanelli F, Irwing L, Mamounas EP et al (2013) Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst 105:321–333

    Article  CAS  PubMed  Google Scholar 

  10. Paredes P, Vidal-Sicart S, Zanòn G, Roè N, Rubì S, Lafuente S et al (2008) Radioguided occult lesion localization in breast cancer using an intraoperative portable gamma camera: first results. Eur J Nucl Med Mol Imaging 35:230–235

    Article  CAS  PubMed  Google Scholar 

  11. Abe A, Takahashi N, Lee J, Oka T, Shizukuishi K, Kikuchi T (2003) Performance evaluation of a hand-held, semiconductor (CdZnTe)- based gamma camera. Eur J Nucl Med Mol Imaging 30:805–811

    Article  CAS  PubMed  Google Scholar 

  12. Tsuchimochi M, Sakahara H, Hayama K, Funaki M, Ohno R, Shirahata T et al (2003) A prototype small CdTe gamma camera for radioguided surgery and other imaging applications. Eur J Nucl Med Mol Imaging 30(1605–14):1605

    Article  PubMed  Google Scholar 

  13. Pitre S, Menard L, Ricard M, Solal M, Garbay JR, Charon Y (2003) A hand-held imaging probe for radio-guided surgery: physical performance and preliminary clinical experience. Eur J Nucl Med Mol Imaging 30(339–43):339

    Article  PubMed  Google Scholar 

  14. Fernandez NM, Bennloch JM, Cerdà J, Escat B, Gimènez EN et al (2004) A flat-panel-based mini gamma camera for lymph nodes studies. Nucl Instrum Methods Phys Res A 527(92–6):92

    Article  CAS  Google Scholar 

  15. Khalkhail I, Mena I, Jouanne E et al (1994) Prone scintimammography in patients with suspicion of carcinoma of the breast. J Am Coll Surg 178:491–497

    Google Scholar 

  16. Travaini LL, Baio SM, Cremonesi M, De Cicco C, Ferrari M, Trifirò G et al (2007) Neoadjuvant therapy in locally advanced breast cancer: 99mTc-MIBI mammoscintigraphy is not a reliable technique to predict therapy response. Breast 16:262–270

    Article  PubMed  Google Scholar 

  17. Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Sperber F, Weinstein Y, Sarid D, Ben Yosef R, Shalmon A, Yaal-Hahoshen N (2006) Preoperative clinical, mammographic and sonographic assessment of neoadjuvant chemotherapy response in breast cancer. Isr Med Assoc J 8:342–346

    PubMed  Google Scholar 

  19. Scopinaro F, Schillaci O, Ussof W, Nordling K, Capoferro R, De Vincentis G et al (1997) A three center study on the diagnostic accuracy of 99mTc-MIBI scintimammography. Anticancer Res 17:1631–1634

    CAS  PubMed  Google Scholar 

  20. Buscombe JR, Cwikla JB, Thakrar DS, Hilson AJ (1997) Uptake of Tc-99m MIBI related to tumour size and type. Anticancer Res 17:1693–1694

    CAS  PubMed  Google Scholar 

  21. Mankoff DA, Dunwald LK, Gralow JR, Ellis GK, Drucker MJ, Livingston RB (1999) Monitoring the response of patients with locally advanced breast carcinoma to neoadjuvant chemotherapy using [technetium 99m]-sestamibi scintimammography. Cancer 85:2410–2423

    Article  CAS  PubMed  Google Scholar 

  22. Spanu A, Farris A, Chessa F, Sanna D, Pittalis M, Manca A et al (2008) Planar scintimammography and SPECT in neoadjuvant chemo or hormonotherapy response evaluation in locally advanced primary breast cancer. Int J Oncol 32:1275–1283

    PubMed  Google Scholar 

  23. Dunnwald LK, Gralow J, Ellis GK, Livingston RB, Linden HM, Lawton TJ et al (2005) Residual tumor uptake of [99mTc]-sestamibi after neoadjuvant chemotherapy for locally advanced breast carcinoma predicts survival. Cancer 103:680–688

    Article  CAS  PubMed  Google Scholar 

  24. Hruska CB, O’Connor MK (2013) Nuclear imaging of the breast: translating achievements in instrumentation into clinical use. Med Phys. doi:10.1118/1.4802733

    Google Scholar 

  25. Sun Y, Wei W, Yang HW, Liu JL (2013) Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis. Eur J Nucl Med Mol Imaging 40:450–463

    Article  PubMed  Google Scholar 

  26. Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316

    Article  PubMed  Google Scholar 

  27. Morrow M, Waters J, Morris E (2011) MRI for breast cancer screening, diagnosis, and treatment. Lancet 378:1804–1811

    Article  PubMed  Google Scholar 

  28. Groheux D, Espiè M, Giacchetti S, Hindiè E (2012) Performance of FDG PET/CT in the clinical management of breast cancer. Radiology 266:388–405

    Article  PubMed  Google Scholar 

  29. Vermeeren L, Valdès O, Klop C, Balm JM, van der Brekel WMM (2010) A portable y-camera for intraoperative detection of sentinel nodes in the head and neck region. J Nucl Med 51:700–703

    Article  PubMed  Google Scholar 

  30. Vermeeren L, Klop C, van der Brekel WMM, Balm AJM, Nieweg OE, Valdes Olmos RA (2009) Sentinel node detection in head and neck malignancies: innovations in radioguided surgery. J Oncol. doi:10.1155/2009/681746

    PubMed Central  PubMed  Google Scholar 

  31. Stoffels I, Poeppel T, Boy C, Mueller S, Wichmann F, Dissemond J et al (2011) Radio-guided surgery: advantages of a new portable γ-camera (Sentinella®) for intraoperative real time imaging and detection of sentinel lymph nodes in cutaneous malignancies. J Eur Acad Dermatol Venereol 26:308–313

    Article  PubMed  Google Scholar 

  32. Vermeeren L, Valdès O, Meinhardt W, Bex A, van der Poel HG, Vogel WV et al (2009) Intraoperative radioguidance with a portable gamma camera: a novel technique for laparoscopic sentinel node localisation in urological malignancies. Eur J Nucl Med Mol Imaging 36:1029–1036

    Article  CAS  PubMed  Google Scholar 

  33. Cassinello N, Ortega J, Lledo S (2009) Intraoperative real-time 99mTc-sestamibi scintigraphy with miniature gamma camera allows minimally invasive parathyroidectomy without ioPTH determination in primary hyperparathyroidism. Langenbecks Arch Surg 394:869–874

    Article  PubMed  Google Scholar 

  34. Omer WS, Elasa S, Mouslafa H, Farag H, Ezzat I, Abdel-Dayam HM (1997) Role of thallium-201 and Tc-99m-methoxy-iosobutylisonitril (sestamibi) in evaluation of breast masses: correlation with immunohistochemical characteristic parameters (ki-67, PCNA, Bcl-2 and antiangiogenesis) in malignant lesions. Anticancer Res 17:1639–1644

    Google Scholar 

  35. Scopinaro F, Schillaci O, Scarpini M, Mingazzini PL, Di Macio L, Di Banci M et al (1994) Technetium-99m-Sestamibi: an indicator of breast cancer invasiveness. Eur J Nucl Med 21:981–987

    Article  Google Scholar 

  36. Del Vecchio S, Zanetti A, Aloj L, Caraco O, Ciarmiello A, Salvatore M (2008) Inhibition of early 99mTc-MIBI uptake by Bcl-2 anti-apoptotic protein expression in untreated breast carcinoma. Eur J Nucl Med Mol Imaging 30:879–887

    Article  Google Scholar 

  37. Fuster D, Munoz M, Pavis J, Palacin A, Bellet N, Matoca JJ et al (2002) Quantified 99mTc-MIBI scintigraphy for predicting chemotherapy response in breast cancer patients: factors that influence the level of 99mTc-MIBI uptake. Nucl Med Commun 23:31–38

    Article  CAS  PubMed  Google Scholar 

  38. Sun SS, Haieh J, Tsai SC, Ho YJ, Lee JK, Kno CH (2000) Expression of mediated P-glycoprotein multidrug resistance related to Tc-99m MIBI scintimammography results. Cancer Lett 1053:95–100

    Article  Google Scholar 

  39. Takamura Y, Miyoshi Y, Taguchi T, Noguchi S (2001) Prediction of chemotherapeutic response to technetium 99m-MIBI scintigraphy in breast carcinoma patients. Cancer 92(232–239):232

    Article  CAS  PubMed  Google Scholar 

  40. Mankoff DA, Dunnwald L, Gralow JR, Ellis GK, Schubert E, Charlop A et al (2002) Tc-99m-Sestamibi uptake and washout in locally advanced breast cancer are correlated with tumor blood flow. Nucl Med Biol 29:719–727

    Article  CAS  PubMed  Google Scholar 

  41. Wahner-Roedler DL, Boughey J, Hruska CB, Chen B, Rhodes DJ et al (2012) The use of molecular breast imaging to assess response in women undergoing neoadjuvant therapy for breast cancer: a pilot study. Clin Nucl Med 37:344–350

    Article  PubMed Central  PubMed  Google Scholar 

  42. Riccardi L, Bignotto M, Paiusco M (2013) Intraoperative lymph node detection in cutaneous malignancies: an experimental benchmark for a mini gamma camera [ABSTRACT]. Clin Trasl Imaging 1:115–116P

    Google Scholar 

Download references

Acknowledgments

A mention thanking Dr. Renato Valdés Olmos and Dr. Daan Hellingman for their precious suggestions. We are grateful to Dr. Raffaello Grigoletto and Dr. Franco Barbazza for giving us the permission to collect the data in surgical theatre. Moreover, we are thankful to the surgical staff for the important help in the operating room. Finally, special thanks to Prof. Carlo Riccardo Rossi for giving us the opportunity to test the utility of Sentinella 102 in discovering the residual of breast cancer after neoadjuvant therapy.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV – IRCCS, Via Gattamelata, 64 35128, Padua, Italy

    Laura Evangelista, Anna Rita Cervino, Riccardo Sanco & Giorgio Saladini

  2. Medical Physics Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy

    Michele Bignotto & Marta Paiusco

  3. Surgical Oncology, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy

    Tania Saibene, Silvia Michieletto & Fernando Bozza

  4. Oncology Unit 2, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy

    Cristina Ghiotto

Authors
  1. Laura Evangelista
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Rita Cervino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Riccardo Sanco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Bignotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tania Saibene
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Silvia Michieletto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cristina Ghiotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fernando Bozza
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marta Paiusco
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giorgio Saladini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Evangelista.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 72 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Evangelista, L., Cervino, A.R., Sanco, R. et al. Use of a portable gamma camera for guiding surgical treatment in locally advanced breast cancer in a post-neoadjuvant therapy setting. Breast Cancer Res Treat 146, 331–340 (2014). https://doi.org/10.1007/s10549-014-3007-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-014-3007-6

Keywords

Search

Navigation