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Incremental Diagnostic Value of Quantitative Analysis of Double Phase Tc-99m MIBI Scintimammography for the Detection of Primary Breast Cancer Additive to Visual Analysis

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Abstract

Tc-99m MIBI scintimammography (SMM) is known to be a useful diagnostic tool for primary breast cancer. We conducted this study to establish optimal visual grades for the detection of primary breast cancer and to investigate whether the quantitative indices of double phase SMM could provide incremental diagnostic value additive to visual analysis.

Methods. Five hundred and twenty highly suspected breast cancer patients (malignant: 370; benign: 150) were included in this study. Double phase Tc-99m MIBI SMM (early: 10 min; delayed: 3 h) was performed after injection of 750 MBq of Tc-99m MIBI. For visual analysis, five scoring method was used. The early and delayed lesion to non-lesion ratios (L/N) and retention index (RI) were calculated. Receiver operating characteristic curve (ROC) analyses was performed to determine the optimal visual grade, to calculate cut-off value of quantitative indices for differentiation malignant and benign diseases and to investigate whether the quantitative indices could provide incremental diagnostic value additive to visual analysis. To investigate the incremental diagnostic value of quantitative index in variable tumor size groups, the patients were subdivided into four groups (group A: size ≤ 1 cm, group B: 1 cm < size ≤ 3 cm, group C: 3 cm < size ≤ 5 cm, group D: size > 5 cm).

Results. When over visual grade 3 was used as the cut-off grade for the diagnosis of breast cancer, the sensitivity and specificity were 75.5, 86.4%, respectively. Early L/N of malignant breast disease was significantly higher than that of benign (2.00 ± 1.88 vs. 0.60 ± 0.7; p < 0.01). However, delayed L/N and RI had no significant difference between malignant and benign breast diseases. When early L/N of 1.27 was used as the cut-off value, the sensitivity and specificity of SMM were 77.6, 83.3%, respectively. When the early L/N was added to visual grade, the area under curve (AUC) of visual + quantitative analysis (V + Q) was higher than that of visual anlysis (V) alone (AUC 0.893 vs. 0.803; p < 0.01). In group A, the AUC of V + Q was higher than that of V alone (0.843 vs. 0.808; p = 0.029). In group B, the AUC of V + Q was also higher (0.913 vs. 0.781; p < 0.01). However, in groups C and D, the AUCs of V + Q and V were not different (0.926 vs. 0.915; p = 0.144: 0.663 vs. 0.570; p = 0.093). For axillary lymph node involvement, the sensitivity, specificity, and of SMM were 66.9, 70.1, and 68%, respectively.

Conclusion. From this study, the optimal visual interpretation grades for diagnosis of breast cancer were grades 4 and 5 and cut-off value of early L/N was 1.27. Also, we found that delayed image was not required for breast cancer detection and quantitative index of early L/N provide incremental diagnostic value additive to visual analysis. Especially, when the tumor is small (size ≤ 3 cm), the early L/N should be obtained for the diagnosis of breast cancer.

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Authors and Affiliations

  1. Department of Nuclear Medicine, College of Medicine, Pusan National University, Pusan, South Korea

    Seong-Jang Kim, In-Ju Kim & Yong-Ki Kim

  2. Department of Surgery, College of Medicine, Pusan National University, Pusan, South Korea

    Young-Tae Bae

  3. Emeritus Professor of Internal Medicine and Nuclear Medicine, College of Medicine, Pusan National University, Pusan, South Korea

    Dong-Soo Kim

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Kim, SJ., Kim, IJ., Bae, YT. et al. Incremental Diagnostic Value of Quantitative Analysis of Double Phase Tc-99m MIBI Scintimammography for the Detection of Primary Breast Cancer Additive to Visual Analysis. Breast Cancer Res Treat 83, 129–138 (2004). https://doi.org/10.1023/B:BREA.0000010705.31599.89

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