Evaluation of nuclear medicine tests for the diagnosis of breast carcinoma

In this paper, we evaluate nuclear medicine tests used for the diagnosis of breast carcinoma. Breast carcinoma is the most common carcinoma in women in Europe and its early diagnosis and treatment is important for the overall survival of the patients. Scintimammography technique, indications, contraindications and diagnostic procedures for the identification of the sentinel node and the axillary nodes infiltrated by tumour are described. Also, the use of the radiopharmaceuticals, radioactive thallium chloride-201, methylene diphosphonate labelled with technetium-99m, somatostatin receptors labelled with indium-111, diagnostic procedures with the PET camera, the labelled antibodies to CEA with technetium-99m and also the importance of the MRI and the US techniques are mentioned. These tests have greater diagnostic accuracy as compared to X-ray mammography, clinical examination, MRI and the US technique. Tumour markers in vitro are recommended for the follow- up of metastatic breast carcinoma

Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography

INTRODUCTION: The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid ((99m)Tc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile ((99m)Tc-Sestamibi [(99m)Tc-MIBI]) distribution in ductal breast carcinoma in situ and lobular breast carcinoma in situ (DCIS/LCIS), in relation to mammographic, histological and immunohistochemical parameters. MATERIALS AND METHODS: One hundred and two patients with suspicious palpation or mammographic findings were submitted preoperatively to scintimammography (a total of 72 patients with (99m)Tc-(V)DMSA and a total of 75 patients with (99m)Tc-Sestamibi, 45 patients receiving both radiotracers). Images were acquired at 10 min and 60 min, and were evaluated for a pattern of diffuse radiotracer accumulation. The tumor-to-background ratios were correlated (T-pair test) with mammographic, histological and immunohistochemical characteristics. RESULTS: Histology confirmed malignancy in 46/102 patients: 20/46 patients had DCIS/LCIS, with or without coexistent invasive lesions, and 26/46 patients had isolated invasive carcinomas. Diffuse (99m)Tc-(V)DMSA accumulation was noticed in 18/19 cases and (99m)Tc-Sestamibi in 6/13 DCIS/LCIS cases. Epithelial hyperplasia demonstrated a similar accumulation pattern. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for each tracer were calculated. Solely for (99m)Tc-(V)DMSA, the tumor-to-background ratio was significantly higher at 60 min than at 10 min and the diffuse uptake was significantly associated with suspicious microcalcifications, with the cell proliferation index ≥ 40% and with c-erbB-2 ≥ 10%. CONCLUSION: (99m)Tc-(V)DMSA showed high sensitivity and (99m)Tc-Sestamibi showed high specificity in detecting in situ breast carcinoma ((99m)Tc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography

Imaging of the Breast

Early detection of breast cancer combined with targeted therapy offers the best outcome for breast cancer patients. This volume deal with a wide range of new technical innovations for improving breast cancer detection, diagnosis and therapy. There is a special focus on improvements in mammographic image quality, image analysis, magnetic resonance imaging of the breast and molecular imaging. A chapter on targeted therapy explores the option of less radical postoperative therapy for women with early, screen-detected breast cancers

The role of Technetium-99m Sestamibi scintimammography to evaluate palpable breast lesions : a comparison with mammography and histological results

This study was conducted with the support of the Combined Breast Clinic at our institution which consists of the Departments of Surgery, Radiology and Radiation Oncology. The work was done in three parts. The literature showed somewhat lengthy imaging procedure for scintimammography which were not whole suitable to the setting of the Combined Breast Clinic. Initially a Pilot Study was conducted to determine the practicality of the imaging procedure. The results of this study were promising but the imaging procedure was time consuming. Certain modifications were subsequently done in the imaging method of the Formal Study to accommodate more number of patients into the study without jeopardizing the quality of the images. This study, however, had a shortcoming in that the way this study was structured one could not demonstrate lesion by lesion analysis of each breast lesion detected on clinical examination, mammography and scintimammography with their respective biopsy results. Our Formal Study and the literature suggested that scintimammography is of value in patients with indeterminate mammograms due to its high negative predictive value. Therefore, a separate Additional Study, with the same scintigraphic method, was conducted on patients with clinical breast lumps with indeterminate mammographic lesions. Special emphasis was placed on lesion by lesion comparison of each breast lesion detected by clinical examination or scintimammography or both with the biopsy results of that particular lesion

Radiopharmaceuticals for SPECT Cancer Detection

The purpose of the study was to assess the efficacy of single photon emission computed tomography (SPECT) with {199}Tl and {99}mTc-MIBI in the detection of breast, laryngeal and hypopharyngeal cancers. A total of 220 patients were included into the study: 120 patients with breast lesions (100 patients with breast cancer and 20 patients with benign breast tumors) and 100 patients with laryngeal/hypopharyngeal diseases (80 patients with laryngeal/hypopharyngeal cancer and 20 patients with benign laryngeal/hypopharyngeal lesions). No abnormal {199}Tl uptake was seen in all patients with benign breast and laryngeal lesions, indicating a 100% specificity of {199}Tl SPECT. In the breast cancer patients, the increased {199}Tl uptake in the breast was visualized in 94.8% patients, {99m}Tc-MIBI-in 93.4% patients. The increased {199}Tl uptake in axillary lymph nodes was detected in 60% patients, and {99m}Tc-MIBI-in 93.1% patients. In patients with laryngeal/hypopharyngeal cancer, the sensitivity of SPECT with {199}Tl and {99m}Tc-MIBI was 95%. The {199}Tl SPECT sensitivity in identification of regional lymph node metastases in the patients with laryngeal/hypopharyngeal cancer was 75% and the {99m}Tc-MIBI SPECT sensitivity was 17%. The data obtained showed that SPECT with {199}Tl and {99m}Tc-MIBI can be used as one of the additional imaging methods in detection of tumors

Application of Imaging Technologies in Breast Cancer Detection: A Review Article

One of the techniques utilised in the management of cancer in all stages is multiple biomedical imaging. Imaging as an important part of cancer clinical protocols can provide a variety of information about morphology, structure, metabolism and functions. Application of imaging technics together with other investigative apparatus including in fluids analysis and vitro tissue would help clinical decision-making. Mixed imaging techniques can provide supplementary information used to improve staging and therapy planning. Imaging aimed to find minimally invasive therapy to make better results and reduce side effects. Probably, the most important factor in reducing mortality of certain cancers is an early diagnosis of cancer via screening based on imaging. The most common cancer in women is breast cancer. It is considered as the second major cause of cancer deaths in females, and therefore it remained as an important medical and socio-economic issue. Medical imaging has always formed part of breast cancer care and has used in all phases of cancer management from detection and staging to therapy monitoring and post-therapeutic follow-up. An essential action to be performed in the preoperative staging of breast cancer based on breast imaging. The general term of breast imaging refers to breast sonography, mammography, and magnetic resonance tomography (MRT) of the breast (magnetic resonance mammography, MRM). Further development in technology will lead to increase imaging speed to meet physiological processes requirements. One of the issues in the diagnosis of breast cancer is sensitivity limitation. To overcome this limitation, complementary imaging examinations are utilised that traditionally includes screening ultrasound, and combined mammography and ultrasound. Development in targeted imaging and therapeutic agents calls for close cooperation among academic environment and industries such as biotechnological, IT and pharmaceutical industries