99MTechnetium-sestamibi scintimammography in non-palpable breast lesions found on screening X-ray mammography

Gommans, G.M.M.; van der Zant, F.M.; van Dongen, A.; Boer, R.O.; Teule, G.J.J.; de Waard, J.W.D.

doi:10.1016/j.ejso.2006.10.025

« Previous Next »European Journal of Surgical Oncology
Volume 33, Issue 1 , Pages 23-27, February 2007

^99MTechnetium-sestamibi scintimammography in non-palpable breast lesions found on screening X-ray mammography

G.M.M. Gommans
- Department of Nuclear Medicine, Westfries Hospital Hoorn, PO BOX 600, 1620 AR Hoorn, The Netherlands
- Department of Nuclear Medicine (0030), Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
- Corresponding author. Department of Nuclear Medicine (0030), Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands. Tel.: +31 72 548 3480; fax: +31 72 548 3484.
F.M. van der Zant
- Department of Nuclear Medicine (0030), Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
A. van Dongen
- Department of Nuclear Medicine, Westfries Hospital Hoorn, PO BOX 600, 1620 AR Hoorn, The Netherlands
R.O. Boer
- Department of Nuclear Medicine, Westfries Hospital Hoorn, PO BOX 600, 1620 AR Hoorn, The Netherlands
- Department of Nuclear Medicine (0030), Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
G.J.J. Teule
- Department of Nuclear Medicine, University Maastricht, P Debyelaan 25, 6229 HX, The Netherlands
J.W.D. de Waard
- Department of Surgery, Westfries Hospital Hoorn, PO BOX 600, 1620 AR Hoorn, The Netherlands

Accepted 16 October 2006.

Abstract

Objective

The sensitivity and specificity of ^99mTc-sestamibi scintimammography in patients with non-palpable breast lesions diagnosed by screening mammography and the value of ^99mTc-sestamibi to detect axillary lymph node metastases was determined.

Methods

Between September 2000 and December 2003, 103 females with non-palpable breast lesions were included for further evaluation. X-ray mammography was repeated and 99mTc-sestamibi scintimammography performed within one-week. Anterior, and left and right lateral images were obtained. The scintimammography was analysed by 2 experienced observers who were blinded to the clinical, pathological, and radiological results. The sensitivity and specificity of scintimammography to diagnose non-palpable lesion(s), including the axillary regions, was compared with histopathology, clinical, and radiological follow up.

Results

Two patients (one non-small lung cancer and one non-Hodgkin's disease) were excluded. Both showed ^99mTc-sestamibi avid lesions in the breast and axillary region.

In the remaining 101 patients, 37 true positive (TP), 4 false positive (FP), 52 true negative (TN), and 8 false negative (FN) breast carcinomas were found. The specificity was 92.8%, sensitivity 82.2%, positive predictive value (PPV) 90.2%, and negative predictive value (NPV) 86.6%.

^99mTc-sestamibi scintimammography showed axillary lesions in 5/15 (33%) patients with axillary lymph node metastasis.

Conclusion

In patients with non-palpable lesions diagnosed by screening- X-ray-mammography, ^99mTc-sestamibi scintimammography provided high specificity and PPV. Furthermore, ^99mTc-sestamibi scintimammography detected 33% of patients with axillary lymph node metastases. Therefore, ^99mTc-sestamibi scintimammography could be of incremental value in the surgical work-up of these patients.

Keywords: ^99mTc-sestamibi, Breast Cancer, Scintimammography