Skip to main content
SpringerLink
Log in

Nuclear Medicine Imaging in Breast Cancer

  • Chapter
  • First Online:
Breast Cancer

Abstract

Nuclear medicine offers many diagnostic tools for the primary detection, staging, and evaluation of treatment response in breast cancer. The recent developments in breast imaging have been achieved include a diversity of breast imaging modalities, including whole-body PET systems. While molecular imaging with PET is a rapidly emerging approach in breast cancer, conventional single-photon nuclear medicine imaging, including bone scintigraphy and sentinel lymph node scintigraphy, still has an important role in the management of breast cancer. This chapter outlines the role of nuclear medicine imaging in patients with breast cancer.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Brem R, Rechtman L. Nuclear medicine imaging of the breast: a novel, physiological approach to breast cancer detection and diagnosis. Radiol Clin N Am. 2010;48:1055–74.

    Article  Google Scholar 

  2. de Cesare A, Giuseppe DV, Stefano G, Crescentini G, Fiori E, Bonomi M, et al. Single photon emission computed tomography (SPECT) with technetium-99m sestamibi in the diagnosis of small breast cancer and axillary lymph node involvement. World J Surg. 2011;35:2668–72.

    Article  Google Scholar 

  3. Jacobsson H. Single-photon-emission computed tomography (SPECT) with 99mTechnetium sestamibi in the diagnosis of small breast cancer and axillary node involvement. World J Surg. 2011;35:2673–4.

    Article  Google Scholar 

  4. Lee J, Rosen E, Mankoff D. The role of radiotracer imaging in the diagnosis and management of patients with breast cancer: part 1 – overview, detection and staging. J Nucl Med. 2009;50:569–81.

    Article  Google Scholar 

  5. Delmon-Moingeon LI, Piwnica-Worms D, Van den Abbeele AD, Holman BL, Davison A, Jones AG. Uptake of the cation hexakis(2-methoxyisobutylisonitrile)-technetium-99m by human carcinoma cell lines in vitro. Cancer Res. 1990;50:2198–202.

    CAS  PubMed  Google Scholar 

  6. Carvalho PA, Chiu ML, Kronauge JF, Kawamura M, Jones AG, Holman BL, et al. Subcellular distribution and analysis of technetium-99m-MIBI in isolated perfused rat hearts. J Nucl Med. 1992;33:1516–22.

    CAS  PubMed  Google Scholar 

  7. Archer CD, Parton M, Smith IE, Ellis PA, Salter J, Ashley S, et al. Early changes in apoptosis and proliferation following primary chemotherapy for breast cancer. Br J Cancer. 2003;89:1035–41.

    Article  CAS  Google Scholar 

  8. Cutrone JA, Yospur LS, Khalkhali I, Tolmos J, Devito A, Diggles L, et al. Immunohistologic assessment of technetium-99m-MIBI uptake in benign and malignant breast lesions. J Nucl Med. 1998;39:449–53.

    CAS  PubMed  Google Scholar 

  9. Zhang A, Li P, Liu Q, Song S. Breast-specific gamma camera imaging with 99mTc-MIBI has better diagnostic performance than magnetic resonance imaging in breast cancer patients: a meta-analysis. Hell J Nucl Med. 2017;20(1):26–35.

    PubMed  Google Scholar 

  10. 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(5):465–9.

    Article  Google Scholar 

  11. Meissnitzer T, Seymer A, Keinrath P, Holzmannhofer J, Pirich C, Hergan K, et al. Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI. Br J Radiol. 2015;88(1051):20150147.

    Article  CAS  Google Scholar 

  12. Novikov SN, Krzhivitskii PI, Kanaev SV, Krivorotko PV, Ilin ND, Jukova LA, et al. Axillary lymph node staging in breast cancer: clinical value of single photon emission computed tomography-computed tomography (SPECT-CT) with 99mTc methoxyisobutylisonitrile. Ann Nucl Med. 2015;29(2):177–83.

    Article  CAS  Google Scholar 

  13. Hendrick RE. Radiation doses and cancer risks from breast imaging studies. Radiology. 2010;257:246–53.

    Article  Google Scholar 

  14. Guo C, Zhang C, Liu J, Tong L, Huang G. Is Tc-99m sestamibi scintimammography useful in the prediction of neoadjuvant chemotherapy responses in breast cancer? A systematic review and meta-analysis. Nucl Med Commun. 2016;37(7):675–88.

    Article  CAS  Google Scholar 

  15. Lee HS, Ko BS, Ahn SH, Son BH, Lee JW, Kim HJ, et al. Diagnostic performance of breast-specific gamma imaging in the assessment of residual tumor after neoadjuvant chemotherapy in breast cancer patients. Breast Cancer Res Treat. 2014;145:91–100.

    Article  CAS  Google Scholar 

  16. Bromham N, Schmidt-Hansen M, Astin M, Hasler E, Reed MW. Axillary treatment for operable primary breast cancer. Cochrane Database Syst Rev. 2017;4(1):CD004561.

    Google Scholar 

  17. Johnson MT, Guidroz JA, Smith BJ, Graham MM, Scott-Conner CE, Sugg SL, et al. A single institutional experience of factors affecting successful identification of sentinel lymph node in breast cancer patients. Surgery. 2009;146:671–6.

    Article  Google Scholar 

  18. Caruso G, Cipolla C, Costa R, Morabito A, Latteri S, Fricano S, et al. Lymphoscintigraphy with peritumoral injection versus lymphoscintigraphy with subdermal periareolar injection of technetium-labeled human albumin to identify sentinel lymph nodes in breast cancer patients. Acta Radiol. 2014;55:39–44.

    Article  Google Scholar 

  19. Somasundaram SK, Chicken DW, Waddington WA, Bomanji J, Ell PJ, Keshtgar MRS. Sentinel node imaging in breast cancer using superficial injections: technical details and observations. Eur J Surg Oncol. 2009;35:1250–6.

    Article  CAS  Google Scholar 

  20. Aliakbarian M, Memar B, Jangjoo A, Zakavi SR, Reza Dabbagh Kakhki V, Aryana K, et al. Factors influencing the time of sentinel node visualization in breast cancer patients using intradermal injection of the radiotracer. Am J Surg. 2011;202:199–202.

    Article  Google Scholar 

  21. Mudun A, Sanli Y, Ozmen V, Turkmen C, Ozel S, Eroglu A, et al. Comparison of different injection sites of radionuclide for sentinel lymph node detection in breast cancer: single institution experience. Clin Nucl Med. 2008;33:262–7.

    Article  Google Scholar 

  22. Hindie E, Groheux D, Brenot-Rossi I, Rubello D, Moretti JL, Espié M. The sentinel node procedure in breast cancer: nuclear medicine as the starting point. J Nucl Med. 2001;52:405–14.

    Article  Google Scholar 

  23. Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23:7703–20.

    Article  Google Scholar 

  24. G M, Rubello D, Tardelli E, Giammarile F, Mazzarri S, Boni G, et al. Sentinel lymph node biopsy in breast cancer: indications, contraindications, and controversies. Clin Nucl Med. 2016;41(2):126–33.

    Article  Google Scholar 

  25. Giammarile F, Alazraki N, Aarsvold JN, Audisio RA, Glass E, Grant SF, et al. The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer. Eur J Nucl Med Mol Imaging. 2013;40:1932–47.

    Article  CAS  Google Scholar 

  26. Sun X, Liu JJ, Wang YS, et al. Roles of preoperative lymphoscintigraphy for sentinel lymph node biopsy in breast cancer patients. Jpn J Clin Oncol. 2010;40:722–5.

    Article  Google Scholar 

  27. Ahmed M, Purushotham AD, Horgan K, Klaase JM, Douek M. Meta-analysis of superficial versus deep injection of radioactive tracer and blue dye for lymphatic mapping and detection of sentinel lymph nodes in breast cancer. Br J Surg. 2015;102(3):169–81.

    Article  CAS  Google Scholar 

  28. Hidar S, Bibi M, Gharbi O, Tebra S, Trabelsi A, Korbi S, et al. Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg. 2009;7:272–5.

    Article  Google Scholar 

  29. Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(5):561–4.

    Article  Google Scholar 

  30. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol. 2006;7:983–90.

    Article  Google Scholar 

  31. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol. 2007;8:881–8.

    Article  CAS  Google Scholar 

  32. Hunt KK, Ballman KV, McCall LM, Boughey JC, Mittendorf EA, Cox CE, et al. Factors associated with localregional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial. Ann Surg. 2012;256:428–36.

    Article  Google Scholar 

  33. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ, et al. 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. 2011;22:1736–47.

    Article  CAS  Google Scholar 

  34. Jung SY, Rosenzweig M, Sereika S, Linkov F, Brufsky A, Weissfeld JL. Factors associated with mortality after breast cancer metastasis. Cancer Causes Control. 2012;23:103–12.

    Article  Google Scholar 

  35. Schneider JA, Divgi CR, Scott AM, Macapinlac HA, Seidman AD, Goldsmith SJ, et al. Flare on bone scintigraphy following Taxol chemotherapy for metastatic breast cancer. J Nucl Med. 1994;35:1748–52.

    CAS  PubMed  Google Scholar 

  36. Coombes RC, Dady P, Parsons C, Rose C, Tubiana-Hulin M, Bastit P, et al. Assessment of response of bone metastases to systemic treatment in patients with breast cancer. Cancer. 1983;52:610–4.

    Article  CAS  Google Scholar 

  37. Choi YJ, Shin YD, Kang YH, Lee MS, Lee MK, Cho BS, et al. The effects of preoperative 18F-FDG PET/CT in breast cancer patients in comparison to the conventional imaging study. J Breast Cancer. 2012;15:441–8.

    Article  Google Scholar 

  38. Groheux D, Giacchetti S, Moretti JL, Porcher R, Espié M, Lehmann-Che J, et al. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 2011;38:426–35.

    Article  Google Scholar 

  39. Tchou J, Sonnad SS, Bergey MR, Basu S, Tomaszewski J, Alavi A, et al. Degree of tumor FDG uptake correlates with proliferation index in triple negative breast cancer. Mol Imaging Biol. 2010;12:657–62.

    Article  Google Scholar 

  40. Jeong YJ, Kang DY, Yoon HJ, Son HJ. Additional value of F-18 FDG PET/CT for initial staging in breast cancer with clinically negative axillary nodes. Breast Cancer Res Treat. 2014;145:137–42.

    Article  Google Scholar 

  41. Manohar K, Mittal BR, Bhoil A, Bhattacharya A, Singh G. Role of 18F-FDG PET/CT in identifying distant metastatic disease missed by conventional imaging in patients with locally advanced breast cancer. Nucl Med Commun. 2013;34:557–61.

    Article  CAS  Google Scholar 

  42. Seo MJ, Lee JJ, Kim HO, Chae SY, Park SH, Ryu JS, et al. Detection of internal mammary lymph node metastasis with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer. Eur J Nucl Med Mol Imaging. 2014;41:438–45.

    Article  Google Scholar 

  43. Fuster D, Duch J, Paredes P, Velasco M, Muñoz M, Santamaría G, et al. Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin. 2008;26:4746–51.

    Article  Google Scholar 

  44. Groheux D, Giacchetti S, Espié M, Vercellino L, Hamy AS, Delord M, et al. The yield of 18F-FDG PET/CT in patients with clinical stage IIA, IIB, or IIIA breast cancer: a prospective study. J Nucl Med. 2011;52:1526–34.

    Article  CAS  Google Scholar 

  45. Segaert I, Mottaghy F, Ceyssens S, De Wever W, Stroobants S, Van Ongeval C, et al. Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 2010;16:617–24.

    Article  Google Scholar 

  46. Champion L, Lerebours F, Cherel P, Edeline V, Giraudet AL, Wartski M, et al. 18F-FDG PET/CT imaging versus dynamic contrast-enhanced CT for staging and prognosis of inflammatory breast cancer. Eur J Nucl Med Mol Imaging. 2013;40:1206–13.

    Article  CAS  Google Scholar 

  47. Joo Hyun O, Choi WH, Han EJ, Choi EK, Chae BJ, Park YG, et al. The prognostic value of (18)F-FDG PET/CT for early recurrence in operable breast cancer: comparison with TNM stage. Nucl Med Mol Imaging. 2013;47:263–7.

    Article  Google Scholar 

  48. Aogi K, Kadoya T, Sugawara Y, Kiyoto S, Shigematsu H, Masumoto N, et al. Utility of (18)F FDG-PET/CT for predicting prognosis of luminal-type breast cancer. Breast Cancer Res Treat. 2015;150:209–17.

    Article  CAS  Google Scholar 

  49. Kadoya T, Aogi K, Kiyoto S, Masumoto N, Sugawara Y, Okada M, et al. Role of maximum standardized uptake value in fluorodeoxyglucose positron emission tomography/computed tomography predicts malignancy grade and prognosis of operable breast cancer: a multi-institute study. Breast Cancer Res Treat. 2013;141:269–75.

    Article  Google Scholar 

  50. García Vicente AM, Soriano Castrejón A, López-Fidalgo JF, Amo-Salas M, Muñoz Sanchez Mdel M, Álvarez Cabellos R, et al. Basal 18F-FDG PET/CT as a prognostic biomarker in patients with locally advanced breast cancer. Eur J Nucl Med Mol Imaging. 2015;42:1804–13.

    Article  Google Scholar 

  51. Song BI, Lee SW, Jeong SY, Chae YS, Lee WK, Ahn BC, et al. 18F-FDG uptake by metastatic axillary lymph nodes on pretreatment PET/CT as a prognostic factor for recurrence in patients with invasive ductal breast cancer. J Nucl Med. 2012;53:1337–44.

    Article  CAS  Google Scholar 

  52. Rousseau C, Devillers A, Sagan C, Ferrer L, Bridji B, Campion L, et al. Monitoring of early response to neoadjuvant chemotherapy in stage II and III breast cancer by [18F]fluorodeoxyglucose positron emission tomography. J Clin Oncol. 2006;24:5366–72.

    Article  Google Scholar 

  53. Schwarz-Dose J, Untch M, Tiling R, Sassen S, Mahner S, Kahlert S, et al. Monitoring primary systemic therapy of large and locally advanced breast cancer by using sequential positron emission tomography imaging with [18F]fluorodeoxyglucose. J Clin Oncol. 2009;27:535–41.

    Article  Google Scholar 

  54. Wang Y, Zhang C, Liu J, Huang G. Is 18F-FDG PET accurate to predict neoadjuvant therapy response in breast cancer? A meta-analysis. Breast Cancer Res Treat. 2012;131:357–69.

    Article  CAS  Google Scholar 

  55. Morris PG, Lynch C, Feeney JN, Patil S, Howard J, Larson SM, et al. Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J Clin Oncol. 2010;28:3154–9.

    Article  Google Scholar 

  56. Morris PG, Ulaner GA, Eaton A, Fazio M, Jhaveri K, Patil S, et al. Standardized uptake value by positron emission tomography/computed tomography as a prognostic variable in metastatic breast cancer. Cancer. 2012;118:5454–62.

    Article  Google Scholar 

  57. Tateishi U, Gamez C, Dawood S, Yeung HW, Cristofanilli M, Macapinlac HA. Bone metastases in patients with metastatic breast cancer: morphologic and metabolic monitoring of response to systemic therapy with integrated PET/CT. Radiology. 2008;247:189–96.

    Article  Google Scholar 

  58. Xiao Y, Wang L, Jiang X, She W, He L, Hu G. Diagnostic efficacy of 18F-FDG-PET or PET/CT in breast cancer with suspected recurrence: a systematic review and meta-analysis. Nucl Med Commun. 2016;37(11):1180–8.

    Article  Google Scholar 

  59. Schirrmeister H, Guhlmann A, Kotzerke J, Santjohanser C, Kühn T, Kreienberg R. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol. 1999;17:2381–9.

    Article  CAS  Google Scholar 

  60. Dittmann H, Jusufoska A, Dohmen BM, Smyczek-Gargya B, Fersis N, Pritzkow M, et al. 3′-deoxy-3′-[18F]fluorothymidine (FLT) uptake in breast cancer cells as a measure of proliferation after doxorubicin and docetaxel treatment. Nucl Med Biol. 2009;36:163–9.

    Article  CAS  Google Scholar 

  61. Pio BS, Park CK, Pietras R, Hsueh WA, Satyamurthy N, Pegram MD, et al. Usefulness of 3′-[F-18]fluoro-3′-deoxythymidine with positron emission tomography in predicting breast cancer response to therapy. Mol Imaging Biol. 2006;8:36–42.

    Article  Google Scholar 

  62. Peterson LM, Mankoff DA, Lawton T, Yagle K, Schubert EK, Stekhova S, et al. Quantitative imaging of estrogen receptor expression in breast cancer with pet and 18F-fluoroestradiol. J Nucl Med. 2008;49:367–74.

    Article  Google Scholar 

  63. Kenny LM, Al-Nahhas A, Aboagye EO. Novel PET biomarkers for breast cancer imaging. Nucl Med Commun. 2011;32:333–5.

    Article  Google Scholar 

  64. Linden HM, Stekhova SA, Link JM, Gralow JR, Livingston RB, Ellis GK, et al. Quantitative fluoroestradiol positron emission tomography imaging predicts response to endocrine treatment in breast cancer. J Clin Oncol. 2006;24:2793–9.

    Article  CAS  Google Scholar 

  65. Melsaether AN, Raad RA, Pujara AC, Ponzo FD, Pysarenko KM, Jhaveri K, et al. Comparison of whole-body (18)F FDG PET/MR imaging and whole-body (18)F FDG PET/CT in terms of lesion detection and radiation dose in patients with breast cancer. Radiology. 2016;281(1):193–202.

    Article  Google Scholar 

  66. Catalano OA, Nicolai E, Rosen BR, Luongo A, Catalano M, Iannace C, et al. Comparison of CE-FDG-PET/CT with CE-FDG-PET/MR in the evaluation of osseous metastases in breast cancer patients. Br J Cancer. 2015;112:1452–60.

    Article  CAS  Google Scholar 

  67. Grueneisen J, Nagarajah J, Buchbender C, Hoffmann O, Schaarschmidt BM, Poeppel T, et al. Positron emission tomography/magnetic resonance imaging for local tumor staging in patients with primary breast cancer: a comparison with positron emission tomography/computed tomography and magnetic resonance imaging. Investig Radiol. 2015;50:505–13.

    Article  CAS  Google Scholar 

  68. Heusner TA, Kuemmel S, Koeninger A, Hamami ME, Hahn S, Quinsten A, et al. Diagnostic value of diffusion-weighted magnetic resonance imaging (DWI) compared to FDG PET/CT for whole-body breast cancer staging. Eur J Nucl Med Mol Imaging. 2010;37:1077–86.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul University, Istanbul, Turkey

    Cuneyt Turkmen

Authors
  1. Cuneyt Turkmen
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Internal Medicine, Medical Oncology, Istanbul Medical Faculty, Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey

    Adnan Aydiner

  2. General Surgery, Istanbul Medical Faculty, Department of Surgery, Istanbul University, Istanbul, Turkey

    Abdullah Igci

  3. Surgical Oncology, Magee-Women’s Hospital, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA

    Atilla Soran

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Turkmen, C. (2019). Nuclear Medicine Imaging in Breast Cancer. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-96947-3_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96947-3_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96946-6

  • Online ISBN: 978-3-319-96947-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation