乳腺癌及腋淋巴结转移^99Tc^m—tetrofosmin与^99Tc^m—MIBI显像的对比研究

目的 研究^99Tc^m-tetrofosmin和^99Tc^m-甲氧基异丁基异腈（MIBI）显像诊断乳腺癌和腋淋巴结转移的临床价值。方法 对52例乳腺肿瘤患者进行^99Tc^m-tetrofosmint和^99Tc^m-MIBI显像。患者均为2周内行外科手术治疗,并做病理检查。结果 26例患者病理检查证实为乳腺癌,其中30例为良性病变。^99Tc^m-tetrofosmin显像发现乳腺癌21例,其中11例合并腋淋巴结转移;^99Tc^m-MIBI显像发现乳腺癌19例,其中12例合并腋淋巴结转移。^99Tc^m-tetrofosmin和^99Tc^m-MIBI显像对乳腺癌诊断的灵敏度、特异性和准确性分别为80．8％、76．7％、78．6％和73．1％、73．3％、73．2％;诊断腋淋巴结转移的灵敏度、特异性和准确性分别为68．8％、80．0％、76．0％和75．0％、80．0％、76．9％。结论 ^99Tc^m-tetrofosmin显像对乳腺癌的检出优于^99Tc^m-MIBI显像。     

99Tcm-octreotide显像在乳腺癌诊断中的应用

目的　探讨99Tcm 奥曲肽 (octreotide)显像对乳腺癌诊断的临床价值。方法　 36例乳腺肿块患者 ,据手术及病理检查结果分为乳腺癌组 (19例 )和乳腺良性病变组 (17例 )。术前分次进行乳腺99Tcm octreotide及99Tcm 甲氧基异丁基异腈 (MIBI)显像 ,行定性及半定量 [放射性摄取比值 (UR)测定 ]分析。结果　99Tcm octreotide显像对乳腺癌诊断的灵敏度 (6 8 4 %)低于99Tcm MIBI (94 7%,P <0 0 5 ) ,特异性 (10 0 %)明显高于99Tcm MIBI(76 5 %,P <0 0 5 ) ,准确性 (83 3%)与99Tcm MIBI (86 1%)差异无显著性 (P >0 0 5 )。联合99Tcm octreotide与99Tcm MIBI显像特异性高 (10 0 %) ,但准确性(80 6 %)无明显变化 (P >0 0 5 )。结论　99Tcm octreotide显像对乳腺癌诊断特异性高 ,准确性与99Tcm MIBI显像无明显差别。     

99Tcm-sandostatin生长抑素受体显像用于诊断肺癌

目的　探讨99Tcm sandostatin生长抑素受体显像对肺癌的诊断价值。方法　 35例肺部肿瘤患者静脉注射99Tcm sandostatin (991 6± 187 5 9)MBq后行平面及胸部断层SPECT显像 ,重建后获得发射 透射图像及融合图像。勾画感兴趣区 ,计算肿瘤和对侧正常肺组织的放射性比值 (T N)。所有病灶均经病理检查及 (或 )其他检查证实。 5例孤立性肺结节 (SPN)行1 8F 脱氧葡萄糖 (FDG)符合线路显像 ,1例小细胞肺癌 (SCLC)治疗前后均行99Tcm sandostatin显像。 15例受检者于99Tcm sandostatin显像后 1周内行全身骨显像。结果　99Tcm sandostatin显像诊断肺癌的灵敏度、特异性和准确性分别为 93 3%、5 5例和 94 3%。 2例鳞癌99Tcm sandostatin显像假阴性。 4例SCLC99Tcm sandostatin显像发现胸膜异常放射性浓聚区 ,病理检查证实为胸膜转移。15例骨显像中 12例发现骨转移 ,99Tcm san dostatin仅发现 5例骨转移。SCLC、非小细胞肺癌 (NSCLC)T N分别为 3 4 3± 0 6 6、2 2 4± 0 31,差异有显著性 (t=4 0 72 ,P <0 0 0 1)。SCLC对99Tcm sandostatin的摄取明显高于NSCLC。结论　99Tcm san dostatin生长抑素受体显像无创、安全、经济 ,对肺癌有较好的诊断价值。     

乳腺癌及腋淋巴结转移~(99)Tc~m-tetrofosmin与~(99)Tc~m-MIBI显像的对比研究

目的　比较99Tcm tetrofosmin和99Tcm 甲氧基异丁基异腈 (MIBI)显像诊断乳腺癌和腋淋巴结转移的临床价值。方法　对 5 2例乳腺肿瘤患者进行99Tcm tetrofosmin和99Tcm MIBI显像。患者均在 2周内行外科手术治疗 ,并做病理检查。结果　 2 6例患者病理检查证实为乳腺癌 ,其中 30例为良性病变。99Tcm tetrofosmin显像发现乳腺癌 2 1例 ,其中 11例合并腋淋巴结转移 ;99Tcm MIBI显像发现乳腺癌 19例 ,其中 12例合并腋淋巴结转移。99Tcm tetrofosmin和99Tcm MIBI显像对乳腺癌诊断的灵敏度、特异性和准确性分别为 80 8%、76 7%、78 6 %和 73 1%、73 3%、73 2 % ;诊断腋淋巴结转移的灵敏度、特异性和准确性分别为 6 8 8%、80 0 %、76 0 %和 75 0 %、80 0 %、76 9%。结论　99Tcm tetrofosmin显像对乳腺癌的检出优于99Tcm MIBI显像     

^99Tc^m—tetrofosmin在乳腺癌及其转移灶显像中的应用

^99Tc^m-tetrofosmin作为亲肿瘤显像剂,对乳腺癌原发病灶和腋窝淋巴结转移的诊断有良好的灵敏度,特异性和准确率,可应用于乳腺癌全身骨转移和术后复发的诊断,其应用于乳腺癌前哨淋巴结转移的诊断、作为P－糖蛋白功能显像剂和三维立体定位引导孔针型活检等领域有着良好的发展前景。^99Tc^m-tetrofosmin乳腺癌及转移灶显像可与其他乳腺癌检查方法相结合提高乳腺癌诊断的准确率。     

~（99m）Tc-MIBI显像对甲状腺“冷（凉）结节”良、恶性鉴别的临床价值

目的探讨99mTc-MIBI显像对甲状腺冷（凉）结节良、恶性鉴别的临床价值。方法 75例99mTcO4-甲状腺显像为＂凉（冷）结节＂患者,均行99mTc-MIBI显像,其显像结果与术后病理结果相对照。结果 75例患者中,99mTc-MIBI显像呈阳性者32例,其中经病理诊断18例为恶性肿瘤,14例为良性病变;99mTc-MIBI显像呈阴性者43例,经病理诊断后40例为良性病变,3例为恶性肿瘤。本组99mTc-MIBI显像的诊断灵敏度为85.71%,特异性为74.07%,准确性为77.33%。结论 99mTc-MIBI核素显像对甲状腺结节良、恶性鉴别诊断的特异性低,单独应用受限,但可作为其他诊断方式非常重要的辅助手段。     

^99mTc-MIBI甲状腺显像半定量分析鉴别甲状腺结节的价值

目的评价99mTc-MIBI甲状腺显像半定量分析法鉴别甲状腺结节的价值.材料和方法36例Na99mTcO4甲状腺显像为单发"冷结节"患者,行99mTc-MIBI甲状腺双时相显像,分别计算15和120min甲状腺结节摄取比值(ER、DR),以良性结节组的DR均值+标准差(0.90+0.21)为诊断恶性病变的阈值.结果手术证实良性病变22例,ER与DR值分别为0.89±0.33、0.90±0.21,恶性病变14例,ER和DR值分别为1.16±0.51、1.34±0.64,ER值两组间比较无差异(p＞0.05),DR两组间比较有显著性差异(p＜0.01).99mTc-MIBI甲状腺显像DR值诊断良恶性病变的灵敏度85.7%,特异性86.4%,阳性预测值80.0%,阴性预测值90.5%.结论99mTc-MIBI甲状腺显像半定量分析能较好的鉴别甲状腺结节的性质,DR比ED更有价值.     

99mTc-depreotide生长抑素受体显像的临床应用研究

生长抑素受体显像近年来研究较多，depreotide已成为其研究热点之一。Depreotide在诊断与鉴别诊断临床常见的孤立性肺结节方面有其独特优势；此外，^99mTc—depreotide生长抑素受体显像在乳腺癌、甲状腺癌、淋巴瘤等肿瘤及甲状腺相关性眼病等非肿瘤性疾病也有一定应用前景。     

99mTc-MIBI双时相显像对继发性甲状旁腺功能亢进症的诊断价值

目的评价99mTc-MIBI双时相显像对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPD)的应用价值。方法 58例临床确诊或疑诊的SHPD患者,行99mTc-MIBI 20 min和2 h双时相显像,同期行甲状旁腺B超检查。最后诊断方法为术后病理或血清IPTH水平与临床随访综合分析。确诊为SHPD 52例,排除诊断6例。其中25例手术后病理诊断为:甲状旁腺增生10例,甲状旁腺增生伴腺瘤9例,甲状旁腺腺瘤6例。结果 58例患者99mTc-MIBI双时相显像阳性50例,阴性8例。其中真阳性49例,假阳性1例,真阴性5例,假阴性3例。99mTc-MIBI双时相显像诊断SHPD的敏感性、特异性和准确率分别为94.2%、83.3%和93.1%。对于49例真阳性,99mTc-MIBI双时相显像共发现SHPD病灶114个,其中1个病灶为14例,2个病灶为21例,3个以上病灶14例。同组资料B超诊断SHPD的敏感性、特异性和准确率分别为88.5%、50%和84.4%。结论99mTc-MIBI双时相显像对SHPD的定性、定位诊断均有很高的价值,应作为术前的常规检查。     

^99mTc-硫胶体监测移植肾后急性排异的再评价

目的重新评估99mTc-硫胶体(99mTc-SC)显像在移植肾急性排异方面的临床价值;分析误诊原因;改进方法,以提高诊断的准确性.材料和方法对140例移植肾患者的99mTc-SC显像进行回顾性分析;为避免骨髓影像的干扰,在常规方法的基础上建立镜相法,并对其中20例显像作镜相法和常规法的对比研究.结果99mTc-SC显像(常规法)诊断急性排异的灵敏性84.8%,特异性80.0%,准确性82.1%;使用OKT3的患者的假阳性的发生率明显高于对照组.结论虽然OKT3增加了假阳性的发生率,但99mTc-SC显像仍是目前鉴别诊断移植肾急性排异和急性肾小管坏死的最佳方法;镜相法尚无法替代常规法,但可作为常规法的有效辅助手段.     

Comparison of planar and SPECT scintimammography with 99mTc-sestamibi in the diagnosis of breast carcinoma

PURPOSE: To compare results of planar and SPECT breast imaging with 99mTc-MIBI in detecting primary breast cancer. MATERIAL AND METHODS: Twenty-six consecutive patients with 34 suspected breast lesions underwent both planar and SPECT scintimammography. Ten minutes after injection of 700 MBq 99mTc-MIBI, 2 prone lateral projections were obtained, followed by a supine anterior projection. Forty minutes after injection, a SPECT study was done. All lesions were operated upon and verified with histopathology. RESULTS: A sensitivity of 85% and specificity of 88% of planar scintimammography in diagnosis of primary breast lesions were achieved. The corresponding values for SPECT were 61% and 64%. CONCLUSION: The diagnostic accuracy of planar scintimammography was not improved by using SPECT imaging.     

Comparative evaluation of 99mTc-MIBI and 99mTc-HMDP scintimammography for the diagnosis of breast cancer and its axillary metastases

The purpose of the present study was to compare scintimammography using technetium-99m hexakis 2-methoxyisobutylisonitrile (MIBI) with that using 99mTc-hydroxymethylene diphosphonate (HMDP) in the detection of breast cancer and its axillary lesions. The study population comprised 50 consecutive females with breast cancer who were scheduled for surgery. All patients underwent scintimammography with 99mTc-MIBI and 99mTc-HMDP. The images were acquired 5 min (early) and 2 h (delayed) after injection of each radiopharmaceutical. Regions of interest were placed over the breast tumour (T), the axillary lesion (A) and the normal ipsilateral breast tissue (N). The two count ratios were calculated, i.e. the tumour to normal breast tissue ratio (T/N) and the axillary lymph node to normal breast tissue ratio (A/N). For the breast tumours, using 99mTc-MIBI the positive rate was 86% (43/50) for the early and 72% (36/50) for the delayed images. The corresponding values using 99mTc-HMDP were 72% (36/50) and 40% (20/50), respectively. Histopathological examination revealed metastatic lymph node involvement in 22 patients. For the axillary lesions, using 99mTc-MIBI the positive rate was 72.7% (16/22) for the early and 54.5% (12/22) for the delayed images. Using 99mTc-HMDP, the positive rate was only 18.2% (4/22) for the early and 4.5% (1/22) for the delayed images. Using 99mTc-MIBI, the mean T/N (+/- SD) ratios on early and delayed images were 2.69 +/- 1.64 and 2.03 +/- 1.16, respectively, and the mean A/N (+/- SD) ratios on early and delayed images were 2.20 +/- 1.23 and 1.80 +/- 1.20, respectively. The corresponding values using 99mTc-HMDP were 1.77 +/- 0.91, 1.42 +/- 0.72, 1.27 +/- 0.63 and 1.08 +/- 0.25, respectively. The T/N and A/N ratios on the early and delayed 99mTc-MIBI images were both significantly higher than those obtained using 99mTc-HMDP. 99mTc-MIBI scintimammography is more sensitive than 99mTc-HMDP scintimammography for the detection of breast cancer and its axillary lymph node metastases.     

Evaluation of planar scintimammography with 99mTc-MIBI in the detection of axillary lymph node metastases of breast carcinoma.

PURPOSE: The aim of our prospective study was to evaluate the role of planar scintimammography with 99mTc-MIBI in detecting axillary lymph node metastases in women with primary breast carcinoma. MATERIAL AND METHODS: Fifty-eight patients underwent scintimammography rior to axillary lymph node dissection. Ten minutes after injection of 700 MBq 99mTc-MIBI, two prone lateral projections were obtained, followed by a supine anterior projection. Sixty-one axillae (3 bilateral) were operated upon and the status of the lymph nodes verified with histopathology. The scintigraphic result was compared to the histopathologic findings. RESULTS: A sensitivity of 67% and a specificity of 80% of planar scintimammography in detecting axillary lymph node metastases were achieved. CONCLUSION: Scintimammography with 99mTc-MIBI is not recommended as a routine method for the detection of axillary lymph node metastases in patients with breast carcinoma.     

Sensitivity and specificity of planar scintimammography with 99mTc-sestamibi.

PURPOSE: The aim of our prospective study was to determine the diagnostic accuracy of planar breast imaging with 99mTc-MIBI in detecting malignant disease. MATERIAL AND METHODS: Ninety-six consecutive patients with 121 clinically- and/or mammographically-detected breast lesions underwent preoperative planar scintimammography. Ten minutes after injection of 700 MBq 99mTc-MIBI, two lateral prone and one anterior supine projections with an acquisition time of 8 minutes each were obtained. Interpretation of scintimammographic results was made blindly and any focal accumulation of MIBI in the breasts was the criterion for an abnormal scintigram. All lesions were operated on and histologically verified. RESULTS: Histologically, 86 malignant and 35 benign lesions were found in 121 breast lesions. A sensitivity of 83.7% and a specificity of 74.2% for malignancy was achieved at planar scintimammography. CONCLUSION: Scintimammography with 99mTc-MIBI is an imaging modality of modest usefulness in the investigation of breast lesions. The method has a low sensitivity in lesions smaller than 10 mm in diameter, which decreases the clinical use of the method.     

The comparison of dual phase Tc-99m MIBI and Tc-99m MDP scintimammography in the evaluation of breast masses: Preliminary report

The aim of this prospective study was to determine the diagnostic value of Tc-99m MDP scintimammography (SMG) for the detection of breast cancer in patients with breast masses and to compare the results with Tc-99m MIBI scintimammography. Twenty patients, categorized as suspicious, positive or benign for breast cancer according to the mammographic findings were included in the study. Dual phase Tc-99m MIBI and Tc-99m MDP SMG were performed in the prone lateral position within 5 days of each other. Although early and late Tc-99m MIBI SMG showed equal (90.4%) sensitivity, the specificity of late Tc-99m MIBI (87.5%) was found superior to early (62.5%) imaging. The overall sensitivity and specificity of early Tc-99m MDP SMG were 71.4% and 62.5%, respectively. Although late Tc-99m MDP imaging showed 100% specificity, its sensitivity was only 23.8%. In the patients with palpable masses, both early Tc-99m MDP and Tc-99m MIBI showed equal sensitivity (100%), but the sensitivity of early Tc-99m MIBI (37.5%) was found slightly higher than Tc-99m MDP (25.0%) for nonpalpable breast lesions. The sensitivity of Tc-99m MIBI and Tc-99m MDP SMG in detecting metastatic axillary involvement was 66.6% and 50%, respectively. High sensitivity and specificity together with its low cost, easy availability and the possibility of detecting bone metastases seems to make Tc-99m MDP a contributive agent in the evaluation of breast lesions as an alternative to Tc-99m MIBI.     

Scintimammography with technetium-99m methoxyisobutylisonitrile: results of a prospective European multicentre trial

The aim of the trial was to determine the diagnostic accuracy of scintimmammography with technetium-99m methoxyisobutylisonitrile (^99mTc-MIBI) in the detection of primary breast cancer and to verify its clinical usefulness. A total of 246 patients with a suspicious breast mass or positive mammogram were included in this prospective European multicentre trial. At 5 min and 60 min (optional) p.i. two lateral prone images were acquired for 10 min each; 30 min p.i. one anterior image was acquired for 10 min. There were 253 lesions (195 palpable and 58 non-palpable), in respect of which histology revealed 165 cancers and 88 benign lesions. Institutional and blinded read results were correlated to core laboratory histopathology results obtained during excisional biopsy. Diagnostic accuracy for the detection of breast cancer was calculated per lesion. The overall sensitivity and specificity of blinded read scintimammography were 71% and 69%, respectively. For palpable lesions, the sensitivity of blinded read and institutional read scintimammography was 83% and 91%, respectively. Sensitivity was not dependent on the density of the breast tissue. Invasive ductal and invasive lobular cancers showed similar sensitivity. The sensitivity and specificity of mammography were 91% and 42%, respectively, and did not depend on the tumour size. In 60% of false-negative mammograms, ^99mTc-MIBI was able to diagnose malignancy (true-positive). High-quality imaging with ^99mTc-MIBI has a high diagnostic accuracy for the detection of primary breast cancer. Used as a complementary method, scintimammography with ^99mTc-MIBI can help to diagnose breast cancer at an earlier stage in patients with dense breasts. Received 11 October and in revised form 12 December 1997     

Uptake and washout of 99mTcV-dimercaptosuccinic acid and 99mTc-sestamibi in the assessment of histological type and grade in breast cancer

This study was performed to investigate the relationship between histological type and grade, with the uptake and washout of 99mTc-hexakis-2-methoxyisobutylisonitrile (99mTc-sestamibi, 99mTc-MIBI) and 99mTcV-dimercaptosuccinic acid (99mTcV-DMSA) in breast cancer. Forty-five patients with histologically proven breast cancer had previously been referred for 99mTcV-DMSA and/or 99mTc-MIBI scintimammography. Twenty-five of them underwent both 99mTcV-DMSA and 99mTc-MIBI scintigraphy in a double phase study. Lateral prone and anterior supine images were acquired at 15 and 60 min after administration of 740-925 MBq of each radiotracer. Uptake ratios and retention index were calculated and correlated with histology and grade of malignancy. Histology showed eight different histotypes: 77.7% were infiltrating ductal or lobular carcinomas. Mammography was definitely positive in 32/45, indeterminate in 10 and negative in three cases (sensitivity 71%). 99mTcV-DMSA was true positive in 37/40 (sensitivity 92.5%) and 99mTc-MIBI in 28/30 (sensitivity 93.3%) breast cancers. Uptake ratios were significantly higher in ductal than in lobular carcinomas on 99mTcV-DMSA and 99mTc-MIBI scintigrams at early and delayed phases. Grade II carcinomas had significantly lower values of retention index (rapid washout) than grade III carcinomas. This finding was statistically significant only on 99mTc-MIBI scans and was observed in ductal and lobular carcinomas. The retention index did not show any significant difference between ductal and lobular carcinomas. Uptake ratios were also not statistically different between grade II and III cancers. It is concluded that 99mTc-MIBI and 99mTcV-DMSA uptake in breast cancer is probably related to histological type and may distinguish ductal from lobular carcinomas. To a certain degree, the washout rate may reflect the histological grade, but since grade is not the only factor influencing this phenomenon it should be explored further in conjunction with other parameters by multivariate analysis in order to clarify eventual indirect correlations.     

Comparative value of 99mTc-sestamibi scintimammography and sonography in the diagnostic workup of breast masses

OBJECTIVE: This study was conducted to assess the relative roles of 99mTc-sestamibi scintimammography and sonography in the evaluation of breast lesions that are indeterminate or suspicious on mammography or clinical examination. SUBJECTS AND METHODS: Twenty-five patients with 33 biopsy-proven breast lesions underwent both scintimammography and sonography. Lesions were categorized as benign or requiring biopsy on the basis of the absence or presence of a focus of increased activity on scintimammography and the shape, orientation, and echogenicity of the lesion on sonography. RESULTS: Sensitivity and specificity in detecting breast cancer were 92% and 95%, respectively, for scintimammography and 100% and 48%, respectively, for sonography. The higher specificity of scintimammography was statistically significant (p < 0.01). CONCLUSION: Although the overall accuracy of 99mTc-sestamibi scintimammography in the diagnosis of breast cancer was high, it has several disadvantages in comparison with sonography. Scintimammography has a slightly higher false-negative rate for breast cancer, is unable to reveal cysts, is more expensive, takes longer to perform, and involves ionizing radiation. For these reasons, scintimammography with 99mTc-sestamibi is unlikely to either replace sonography or be frequently used in addition to sonography.     

Review of imaging techniques for the diagnosis of breast cancer: a new role of prone scintimammography using technetium-99m sestamibi

Imaging techniques currently used for the diagnosis of breast cancer are reviewed and compared. Besides mammography, magnetic resonance imaging, positron emission tomography, and thallium-201 scintimammography, a new role of technetium-99m sestamibi scintimammography is discussed. It is concluded that while mammography remains the procedure of choice in screening asymptomatic women for breast cancer, other imaging methods play an important role in detecting malignancies in symptomatic patients.^99mTc-sestamibi scintimammography has high sensitivity and improves the specificity of conventional mammography for the detection of breast cancer; with this technique, prone imaging is preferable to supine imaging.^99mTc-sestamibi scintimammography thus deserves further study as a screening technique.     

Mammography and 99mTc-MIBI scintimammography in suspected breast cancer.

The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-methoxyisobutyl isonitrile (MIBI) scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. METHODS: We performed prone scintimammography in 90 patients with suspected breast cancer, involving 97 lesions. In all patients, the diagnosis was established by way of biopsy. On mammography, we evaluated the degree of suspicion of malignancy and the size of the lesion (smaller or larger than 1 cm in diameter). RESULTS: The results of only 41 of the biopsies indicated malignancy. On mammography, 20 lesions (of which 1 was breast cancer) were considered to be of low suspicion of malignancy, 31 (of which 4 were breast cancer) as indeterminate and 46 (of which 36 were breast cancer) as high. Fourteen lesions (2 low probability, 2 indeterminate and 10 high) were smaller than 1 cm, whereas 83 (18 low probability, 29 indeterminate and 36 high) were larger. The sensitivity, specificity, positive predictive value and negative predictive value of scintimammography were 85%, 79%, 74% and 88%, respectively. Scintimammography was positive in all cases of breast cancer that initially had a low or indeterminate suspicion of malignancy according to mammography, as well as in 30 cases of breast cancer that initially were highly suspicious. Six false-negative scintimammography studies were obtained in lesions with a high suspicion of malignancy. CONCLUSION: We propose a diagnostic protocol with a biopsy performed on lesions that have a high suspicion of malignancy as well as those with low or indeterminate suspicion that are smaller than 1 cm or with positive scintimammography results. This would have reduced the total number of biopsies performed by 34%. More importantly, there would have been a 65% reduction in number of biopsies performed in the low and indeterminate mammographic suspicion groups. All 41 cases of breast cancer would have been detected.