The effect of chemotherapy on the uptake of technetium-99m sestamibi in breast cancer

Technetium-99m sestamibi scintimammography has been used primarily in the diagnosis of breast cancer. It has also been suggested that this technique could be used to monitor response to chemotherapy and possibly to predict those patients in whom no response can be expected. An initial study was performed in nine patients with primary breast cancer. All patients underwent prone lateral and anterior^99mTc-sestamibi imaging at diagnosis and 4–7 months later, after they had received cytotoxic chemotherapy. The uptake of^99mTc-sestamibi in the breast was compared with that in normal surrounding breast tissue and this ratio was expressed as the target to background ratio. In all patients treated there was a reduction in uptake of^99mTc-sestamibi after treatment, such that whilst all the tumours could be seen before treatment, only three were visible following chemotherapy. There was a significant fall in the mean target to background ratio of the patients undergoing chemotherapy: the tumour to background ratio was 2.48 before chemotherapy and 1.40 after treatment (P<0.001, paired Student'st test). This fall in tumour activity was observed both in those patients in whom a clinical response was seen and in the two patients in whom the tumour enlarged despite chemotherapy. It appears that the reduced uptake of^99mTc-sestamibi seen after chemotherapy may be a non-specific change and therefore may not be predictive of the clinical response to treatment.     

Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy,ultrasound and conventional mammography

Axillary lymph node status is important in the staging of breast carcinoma. To evaluate the accuracy of technetium-99m sestamibi breast scintigraphy in detecting metastatic axillary lymph nodes as compared with other accepted imaging modalities, we performed^99mTc-sestamibi breast scintigraphy, conventional mammography and ultrasound in 36 patients with primary untreated breast carcinoma. With histopathology as the gold standard,^99mTc-sestamibi breast scintigraphy was found to yield true-positive results in 7 of 11 cases (64%) of axillary lymph node metastases and true-negative results in 18 of 20 cases (90%); it has an accuracy of 81%, a positive predictive value of 77.8% and a negative predictive value of 81.8%.     

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     

Technetium-99m-sestamibi scintimammography of benign and malignant phyllodes tumors

We presented two cases of phyllodes tumor of the breast examined by^99mTc-sestamibi (MIBI) two-phase scintimammography. In the case with malignant phyllodes tumor,^99mTc-MIBI accumulation was recognized on both early and delayed images. In the case with benign phyllodes tumor, however,^99mTc-MIBI accumulation was recognized on only the early image.^99mTc-MIBI delayed imaging may have the potential to distinguish between benign and malignant phyllodes tumors.     

In vivo detection of multidrug-resistant (MDR1) phenotype by technetium-99m sestamibi scan in untreated breast cancer patients

Technetium-99m sestamibi is a transport substrate recognised by the multidrug-resistant P-glycoprotein (Pgp). To test whether^99mTc-sestamibi efflux is enhanced in breast carcinomas overexpressing Pgp, we determined the efflux rates of^99mTc-sestamibi and Pgp levels in tumours from 30 patients with untreated breast carcinoma. Patients were intravenously injected with 740 MBq of^99mTc-sestamibi and underwent a 15-min dynamic study followed by the acquisition of static planar images at 0.5, 1, 2 and 4 h. Tumour specimens were obtained from each patient 24 h after^99mTc-sestamibi scan and Pgp levels were determined using¹²⁵I-MRK16 monoclonal antibody and in vitro quantitative autoradiography. All breast carcinomas showed high uptake of^99mTc-sestamibi and data from region of interest analysis on sequential images were fitted with a monoexponential function. The efflux rates of^99mTc-sestamibi, calculated from decay-corrected time-activity curves, ranged between 0.00121 and 0.01690 min⁻¹ and were directly correlated with Pgp levels measured in the same tumours (r=0.62;P<0.001). Ten out of 30 breast carcinomas (33%) contained 5 times more Pgp than benign breast lesions and showed a mean concentration of 5.73±1.63 pmol/g of tumour (group A). The remaining 20 breast carcinomas had a mean Pgp concentration of 1.29±0.64 pmol/g (group B), equivalent to that found in benign breast lesions.^99mTc-sestamibi efflux from tumours of group A was 2.7 times higher than that observed in tumours of group B (0.00686±0.00390 min⁻¹ vs 0.00250±0.00090 min⁻¹,P<0.001). The in vivo functional test with^99mTc-sestamibi showed a sensitivity and a specificity of 80% and 95%, respectively. In conclusion, the efflux rate of^99mTc-sestamibi may be used for the in vivo identification of the multidrug resistant (MDR1) phenotype in untreated breast cancer patients.     

Technetium-99m sestamibi: an indicator of breast cancer invasiveness

As recently shown, angiogenesis is the most reliable marker of breast cancer invasiveness. Unfortunately it must be assessed by immunohistochemistry on tissue specimens. We have used technetium-99m sestamibi, a marker of regional blood flow in other organs that often but not always images breast cancer, to assess the invasiveness of this tumour. Nineteen patients, ten with nodal metastases and nine without any metastases, were studied with ^99mTc-sestamibi scintigraphy before operation. Angiogenesis was quantitatively assessed by immunohistochemical staining of endothelia for factor VIII. All the node-positive (N+) patients at surgical revision showed a positive ^99mTc-sestamibi scan of the primary tumour and all the N-patients were negative. Nine out of ten N+ and sestamibi-positive tumours showed more than 135 microvessels/mm² and one showed 99 microvessels/mm²; by contrast there were 71.6±12.1 microvessels/mm² in the nine N- and sestamibi-negative tumours. Our study suggests that ^99mTc-sestamibi is a marker of breast cancer invasiveness: its uptake is related to angiogenesis and, possibly, to oxidative metabolism of the tumour.     

Breast cancer staging using technetium-99m sestamibi and indium-111 pentetreotide single-photon emission tomography

We evaluated the clinical usefulness of single-photon emission tomography (SPET) with technetium-99m sestamibi and indium-111 pentetreotide in breast cancer staging. Fifteen patients with clinical and/or mammographic findings suggesting T1-2N0-1 breast cancer were studied. SPET images were acquired 20 min after^99mTc-sestamibi injection and 4 and 24 h after¹¹¹In-pentetreotide injection. Patients underwent surgery the day after the later¹¹¹In-pentetreotide acquisition. Pathological examination showed 16 tumours in the 15 patients, with one bilateral carcinoma. The mean tumour diameter was 18.7 mm. Metastatic axillary involvement was found in 6/16 tumours, with a mean of five metastatic nodes per axilla. Both tracers correctly identified 15/16 primary tumours and five of the six cases of metastatic axillary node involvement. No difference between the tracers was observed in breast cancer staging.^99mTc-sestamibi seems to be the better tracer in terms of physical characteristics, execution time and cost-effectiveness. Our data suggest the future possibility of using nuclear medicine imaging to avoid axillary dissection in patients with T1 breast cancer.     

Optimization of X-ray mammography and technetium-99m methoxyisobutylisonitrile scintimammography in the diagnosis of non-palpable breast lesions

The purpose of this study was to evaluate the contribution of technetium-99m methoxyisobutylisonitrile (MIBI) scintimammography to the early diagnosis of breast cancer in 78 patients with non-palpable breast lesions detected by mammography. In all cases biopsy was indicated and they were classified into three groups according to the mammographic findings: high (28), intermediate (30) and low (20) mammographic probability of malignancy. Histological diagnosis confirmed 37 benign and 41 malignant lesions. In the high-probability group ^99mTc-MIBI scintimammography changed the four false-positives into true negatives at the expense of two false-negatives; in the intermediate group it changed nine of the 17 false-positives into true-negatives at the expense of one false-negative, and in the low-probability group it changed five of the 16 false-positives into true-negatives without false-negatives. Applying scintimammography to patients included in the intermediate and low-probability groups together, 14 of the 33 mammographic false-positives were changed into true-negatives with 1 false-negative; thus, 41% of the unnecessary biopsies would have been avoided. When MIBI scintimammography was applied to the low-probability group, the negative predictive value was 100% and the unnecessary biopsies would have been reduced by 31%. Received 10 November 1997 and in revised form 19 January 1998     

Three patients with bilateral breast tumors examined by technetium-99m-sestamibi scintimammography

We presented three patients with bilateral breast tumors (one with breast cancers, one with breast cancer and fibroadenoma, and one with fibroadenomas) examined by^99mTc-hexakis 2-methoxy-isobutylisonitrile (MIBI) scintimammography. In all cases^99mTc-MIBI uptake was recognized only in the breast cancers.^99mTc-MIBI scintimammography was useful in evaluating bilateral breast tumors since preoperative diagnosis is valuable in determining correct surgical treatment.     

New modalities in breast imaging: digital mammography,positron emission tomography,and sestamibi scintimammography

Digital mammography, PET, and sestamibi scintimammography are three new modalities in breast imaging. DM has advantages over film-screen mammography in image storage, retrieval, and processing and may lower the recall rate. Computer-aided detection may increase the sensitivity of mammographic screening without a substantial reduction in specificity. Whereas PET and sestambi scintimammography are not useful in breast cancer screening, PET may play a role in detecting nodal metastases and monitoring treatment response, and sestamibi scintimammography in selected cases may serve as an adjunct to conventional imaging. The cost-effectiveness of these new modalities remains to be evaluated, but all have the potential to significantly advance the diagnosis and management of women with breast cancer.     

High-resolution scintimammography improves the accuracy of technetium-99m methoxyisobutylisonitrile scintimammography: use of a new dedicated gamma camera

. The main disadvantage of technetium-99m methoxyisobutylisonitrile (MIBI) prone scintimammography is its limited sensitivity for T1a and T1b cancers with a size of less than 1 cm. We have developed a high-resolution scintimammographic technique using a gamma camera based on a new concept, namely a position-sensitive photo-multiplier tube. The field of view of this camera, previously known as the SPEM (single photon emission mammography) camera, was 10 cm diameter. Scintimammographic images were acquired in the axial view; each breast was compressed to a thickness of 3–6 cm, modal class 4 cm. When the compressed breast was larger than the field of view, more than one study was performed in order to image the entire gland. Fifty-three patients were studied with high-resolution-scintimammography (HRSM) and Anger camera prone scintimammography (ACPSM). HRSM was performed 70 min after i.v. administration of 740 Mbq of ^99mTc-MIBI; ACPSM images were acquired 10 and 60 min following the injection. Early 10-min ACPSM images were only evaluated for routine diagnostic purposes, while comparison was carried out between the 60-min ACPSM and 70-min HRSM images. At fine-needle aspiration (FNA) and/or open biopsy, 31 patients showed cancer: 15 T1c, 11 T1b and 5 T1a. In T1a-T1b cancers, the sensitivity of scintimammography was 50% with ACPSM and 81.2% with HRSM (P<0.01). Specificity was 86% with both techniques. HRSM is a promising new technique that improves the sensitivity of ^99mTc-MIBI scintimammography in tumours sized less than 1 cm without apparently reducing its specificity. We are now working on a larger field-of-view camera. Received 10 February and in revised form 28 April 1999     

Technetium-99m sestamibi imaging in paediatric neuroblastoma and ganglioneuroma and its relation to P-glycoprotein

Imaging with technetium-99m sestamibi offers a non-invasive approach to detect the presence of functional P-glycoprotein (Pgp), one of the major causes of multidrug resistance, in human malignancies. A clinical role for Pgp has been suggested in the subpopulation of primary neuroblastoma without amplification of the proto-oncogene MYCN. We wanted to evaluate the usefulness of ^99mTc-sestamibi scintigraphy in the screening of neural crest tumours for the presence of Pgp. In ten children suffering from MYCN-negative neuroblastoma, ganglioneuroblastoma or ganglioneuroma, ^99mTc-sestamibi imaging was performed at initial diagnosis. All patients underwent planar imaging 20–30 min and 3.5–4 h after intravenous injection of 740 MBq/1.73 m^{2 99m}Tc-sestamibi. Tumour to normal tissue ratios, as well as washout rates, were determined and compared with in vitro flow cytometric analysis of Pgp expression and function. Pgp expression was analysed flow cytometrically with the monoclonal antibodies 4E3 and MRK16, and Pgp function was evaluated by means of rhodamine 123 uptake and efflux either in the absence or in the presence of the Pgp inhibitor verapamil. In nine of ten patients, we found that the intratumoral ^99mTc-sestamibi activity was comparable to the background activity, which might be suggestive of Pgp presence. This was confirmed flow cytometrically in all but one patient. ^99mTc-sestamibi enhancement was seen in the primary tumour and the bone marrow metastases of one of the ten patients, and this result was concordant with a negative Pgp status. The findings presented suggest that ^99mTc-sestamibi imaging results might correlate with the presence of functional Pgp in neural crest tumours without MYCN amplification. Received 17 October and in revised form 13 December 1998     

Can scintimammography with (99m)Tc-MIBI identify multifocal and multicentric primary breast cancer?

Scintimammography with (99m)Tc-MIBI has been shown to be an effective adjunct to imaging of the breast with mammography. Uptake of (99m)Tc-MIBI is particularly high in sites of non-calcified cancer and ductal carcinoma in situ (DCIS), and as a consequence it may be possible to use this method of imaging in identifying multifocal or multicentric disease. The aim of this study was to evaluate the efficacy of preoperative scintimammography in the detection of multifocal and multicentric breast cancer and compare these results with mammography. A retrospective review was performed of 353 women imaged with (99m)Tc-MIBI as part of the clinical assessment of their suspected primary breast cancer. The results of the scintimammography and mammography were then compared with the final pathological diagnosis obtained after mastectomy in all patients. Histopathological assessments of breast tissue from mastectomy confirmed 40 women (12%) had multifocal (34) or multicentric (six) breast cancer. Scintimammography correctly identified 39 of these cancers and the multifocal or multicentric character of the cancer was identified in 22 (52%) of these patients. Anatomical imaging performed in all 40 patients including 25 with mammography alone, mammography and ultrasound in 11 cases and ultrasound alone in four patients. Anatomical imaging identified cancer to be present in 28 patients (70%) and the combination of mammography and ultrasound identified correctly that the cancer was multifocal or multicentric in eight patients (22%). In this study scintimammography was able to identify more cases of multifocal and multicentric cancer than mammography and/or ultrasound. In patients where pre-operative identification of multicentric or multifocal disease can alter treatment scintimammography may be a useful investigative tool.     

Preoperative evaluation of the chemosensitivity of breast cancer by means of double phase99mTc-MIBI scintimammography

The chemosensitivity of breast cancer is important for its management, but it is difficult to evaluate preoperatively. Tc-99m hexakis-2-methoxyisobutylisonitrile (MIBI) scintimammography has been reported to indicate the expression of P-glycoprotein, which is one factor concerned with multidrug resistance. We developed a chemosensitivity assay by using surgical specimens to investigate whether^99mTc-MIBI scintimammography findings before the operation are related to chemosensitivity according to our assay. Fifteen patients with primary breast cancer were enrolled into the study. Early and delayed images were obtained at 10 and 120 minutes after intravenous injection of^99mTc-MIBI, respectively. Regions of interest were placed on the tumors and the contralateral healthy breasts in each patient to estimate^99mTc-MIBI uptake in the tumor, and retention indices were then calculated to assess the washout of^99mTc-MIBI. Chemosensitivity assay was performed by incubating surgical specimens with anticancer agents such as doxorubicin, epirubicin, pinorubicin, mitomycin C, cisplatin and 5-fluorouracil.^99mTc-MIBI washout on scintimammography was successfully related to inhibition ratios on chemosensitivity tests when compared with^99mTc-MIBI uptake by the tumor. In particular, high correlation coefficients were obtained between the retention index of^99mTc-MIBI and the inhibition ratios of doxorubicin (r = 0.75), epirubicin (r = 0.60) and pinorubicin (r = 0.62), but poor correlation was found for mitomycin C (r = 0.44) and cisplatin (r = 0.31). Our results indicate that the retention index of^99mTc-MIBI is closely correlated to chemosensitivity to anthracyclines, suggesting that double-phase scintimammography allows preoperative prediction of chemosensitivity of breast cancer.     

99mTc-sestamibi uptake and histological malignancy grade in invasive breast carcinoma

The aim of this study was to investigate whether there is a correlation between (99m)Tc-sestamibi uptake and histological malignancy grade in breast carcinoma. Such a correlation could, prior to surgery and histopathological analysis, facilitate selection of patients who need adjuvant therapy. Ninety-six patients with mammographically determined lesions and/or a palpable tumour suspected for malignancy underwent (99m)Tc-sestamibi scintimammography prior to surgery. The final diagnosis was determined by histopathological examination. Benign lesions, cancer in situ and tumours located medially in the breast were excluded. Fifty-three invasive cancer lesions in 53 patients were finally included in the study. Planar scintigraphic breast imaging included two prone lateral projections and one anterior supine projection taken 10 min after injection of 700 MBq (99m)Tc-sestamibi. Focal (99m)Tc-sestamibi uptake in breast lesions was used as the scintigraphic criterion of abnormality. Tumour to background ratios were calculated with partial volume compensation, and histological malignancy grading was performed according to the Elston classification. A correlation was found between (99m)Tc-sestamibi uptake and histological malignancy grade in invasive breast carcinomas ( P相似文献   

Contribution of 99mTc-anti-carcinoembryonic antigen antibody and 99mTc-sestamibi scintimammography in the evaluation of high risk palpable breast lesions

Mammography is the screening test of choice for breast cancer. Its low specificity leads to a large number of unnecessary biopsies. Scintimammography, with either Tc-sestamibi (MIBI) or Tc-anti-carcinoembryonic antigen (CEA) Fab', has been proposed as a non-invasive test to lower the high false positive rate of mammography in certain patients. The two agents have not been compared, nor has their combined application been evaluated. We performed a prospective, non-randomized, open-label, single-centre study of 32 women with clinically and mammographically suspected breast cancer [Breast Imaging Reporting and Data System (BI-RADS, American College of Radiology) 4 or 5]. All patients underwent Tc-MIBI and Tc-anti-CEA Fab' scintimammography, and the results were correlated with histopathology. Overall, the accuracies for MIBI and CEA scans were 90.3% (28/31) and 77.4% (24/31), respectively. The probability of disease after mammography was 0.939+/-0.081 (95% confidence interval, CI). The post-mammography probabilities after positive MIBI or CEA scan were 0.965 and 0.960, respectively, and after negative MIBI or CEA scan 0.750 and 0.875, respectively. None of the above differences is significant. The post-test probability when both scans were positive (irrespective of which was performed first) was 0.977. It can be concluded that there are indications that scintimammography with Tc-MIBI is superior to that with Tc-anti-CEA Fab' when these tests are used as screening tests for breast cancer. However, mammography remains the screening test of choice for highly suspicious clinically palpable breast lesions. In this group of patients, the application of scintimammography with either Tc-MIBI or Tc-anti-CEA Fab' (alone or in combination) offers no additional advantage.     

Scintimammography with technetium-99m tetrofosmin in the diagnosis of breast cancer and lymph node metastases

The aim of the study was to evaluate the possible role of scintimammography (SMM) with technetium-99m tetrofosmin in breast cancer. Thirty-three patients with breast disease and ten normal controls were included in the study. Planar scintigraphic images in supine anterior, prone lateral and lateral views, with the patient lying in lateral recumbency, were acquired. A qualitative analysis evaluating both breasts and lymph nodes was performed. All breast lesions were verified after surgery and/or by fine-needle aspiration. In 8 of the 33 patients, mammography was inconclusive because of mastectomy or dense breasts. For mammography, a sensitivity of 95.6%, a specificity of 66.7% and an accuracy of 89.6% were obtained. At SMM, 26 out of 28 malignant lesions (average size 2.8 cm, range 0.4–12 cm), including two recurrences, were detected with a 92.8% sensitivity, a 100% specificity and a 95.1% accuracy. The smallest detectable carcinoma measured 0.6 cm. Two false-negative results on SMM were found in a 0.4-cm intraductal carcinoma and in the only mucinous papillary carcinoma in our series. With regard to lymph node analysis, 11 out of 12 axillary metastases (sensitivity=91.6%) were detected. A false-positive result, yielding a specificity of 92.3% was also obtained. A metastatic involvement of the internal mammary chain was observed. No uptake was seen in 11 benign mammary lesions or at the level of the breast and axilla when neoplastic involvement was absent. In conclusion, SMM with^99mTc-tetrofosmin is an effective technique for the evaluation of primary breast carcinomas, recurrences and lymph node metastases.     

Scintimammography with dedicated breast camera detects and localizes occult carcinoma.

This study assessed the utility of scintimammography using a standard gamma-camera and a dedicated breast camera as an adjuvant to mammography and clinical examination. METHODS: The study population comprised 37 patients with dense breasts and a family or personal history of breast cancer. The subjects had no suggestive clinical or mammographic findings. After intravenous administration of (99m)Tc-sestamibi, the patients were imaged using a conventional gamma-camera and a dedicated breast camera that allowed breast compression during image acquisition. Images were interpreted independently by 2 reviewers. All patients with positive scintimammography findings underwent biopsy. RESULTS: Dedicated breast camera results were positive in 13.5% (5/37) of patients. Biopsy of these 5 patients yielded 3 carcinomas: an infiltrating lobular carcinoma, a ductal carcinoma in situ, and an infiltrating tubular carcinoma. These 3 carcinomas were undetectable by clinical breast examination or mammography, even on retrospective review. Only one of these, the tubular carcinoma, was readily detectable by the standard gamma-camera. CONCLUSION: Scintimammography using a dedicated breast camera may augment mammography and clinical breast examination for the subset of women who have dense breast tissue and are at high risk of breast cancer.     

Efficacy of 99mTc-sestamibi SPECT/CT for minimally invasive parathyroidectomy: comparative study with 99mTc-sestamibi scintigraphy, SPECT, US and CT

Purpose

We evaluated the efficacy of ^99mTc-sestamibi SPECT/CT for planning minimally invasive parathyroidectomy (MIP), comparing with dual phase ^99mTc-sestamibi scintigraphy, ^99mTc-sestamibi SPECT and conventional imaging (US and CT).

Methods

Thirty-one patients (M:F?=?10:21, range 35?C78?years old) who showed high serum parathyroid hormone (intact PTH) level were included. ^99mTc-sestamibi scintigraphy was performed 15 and 150?min after injection of ^99mTc-sestamibi (555?MBq), and ^99mTc-sestamibi SPECT/CT was obtained just after the delayed scan. Comparison study between imaging modalities was done by patient-based and lesion location-based analysis. The location of the lesion was confirmed by the operative finding. An operation was performed in 24 patients. Seven patients had normal ^99mTc-sestamibi SPECT/CT, and followed for more than 6?months after SPECT/CT.

Results

Among 24 patients, parathyroid adenoma was detected in 19 patients and the other 5 had parathyroid hyperplasia (total 35 lesions). ^99mTc-sestamibi scintigraphy detected abnormal uptake in 15 patients with 24 lesions. Conventional imaging identified abnormal findings in 17 patients with 27 lesions. SPECT detected abnormal findings in 18 patients with 27 lesions. SPECT/CT identified abnormal findings in 24 patients with 35 lesions. SPECT/CT demonstrated 100?% sensitivity in a patient-based analysis. SPECT/CT exhibited significantly better sensitivity than ^99mTc-sestamibi scintigraphy, SPECT and conventional imaging (p?<?0.05). All lesion location was correctly identified to perform MIP. The final clinical diagnosis of 7 normal SPECT/CT patients was secondary hyperparathyroidism on 6?months follow-up.

Conclusions

We correctly identified the precise location of parathyroid adenomas or hyperplasia by ^99mTc-sestamibi SPECT/CT which was helpful to perform MIP.     

Technetium-99m sestamibi scintimammography: the influence of histopathological characteristics, lesion size and the presence of carcinoma in situ in the detection of breast carcinoma

The limit of detection of invasive carcinoma by scintimammography appears to be >10 mm, but not uncommonly smaller invasive carcinoma is detected in the presence of pre-invasive carcinoma (carcinoma in situ). The aims of this study were to determine whether a relationship exists between the presence of carcinoma in situ and the detection of invasive carcinoma using scintimammography, and to further characterise the influence of lesion size and histopathological characteristics on the diagnostic accuracy of scintimammography for the detection of invasive breast carcinoma. One hundred and seventeen patients were studied prospectively by scintimammography, X-ray mammography and, where appropriate, breast ultrasound prior to excision biopsy of all suspicious breast masses (n=123, 93% palpable). Thirty-five of these patients had a history of previous ipsilateral breast carcinoma. Sixteen percent of biopsy specimens were benign. The remaining specimens were malignant or pre-malignant. The overall diagnostic sensitivity of scintimammography was 84% and the specificity was 80%. The overall sensitivity and specificity for X-ray mammography (n=123), including those examinations combined with breast ultrasound (n=76), were 73% and 69%, respectively. The maximum size of the measured invasive carcinoma ranged from 5 to 80 mm (median 20 mm). Although the maximum size detected for invasive carcinoma in the presence of carcinoma in situ ranged from 3 to 40 mm (median 20 mm), this difference was not statistically significant (P=1.10, t test). Seven cases of carcinoma in situ were not detected by scintimammography. The diagnostic sensitivity of scintimammography for the detection of invasive carcinoma was 98% for lesions 16–25 mm, 91% for lesions 11–25 mm, 78% for lesions >25 mm and 55% for lesions <11 mm. Scintimammography may offer increased diagnostic accuracy for the detection of breast carcinoma, thereby complementing anatomical imaging. This is particularly evident in technically difficult patients who have had previously treated breast cancer. There appears to be no difference in the diagnostic sensitivity of scintimammography for the detection of invasive carcinoma in the presence or absence of carcinoma in situ. Received 12 April and in revised form 3 July 1999