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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.

Papantoniou V, Tsiouris S, Mainta E, Valotassiou V, Souvatzoglou M, Sotiropoulou M, Nakopoulou L, Lazaris D, Louvrou A, Melissinou M, Tzannetaki A, Pirmettis I, Koutsikos J, Zerva C - Breast Cancer Res. (2004)

Bottom Line: 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 99mTc-(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 > or = 40% and with c-erbB-2 > or = 10%. 99mTc-(V)DMSA showed high sensitivity and 99mTc-Sestamibi showed high specificity in detecting in situ breast carcinoma (99mTc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nuclear Medicine, Alexandra University Hospital, Athens, Greece. vpap@spark.net.gr

ABSTRACT

Introduction: The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid (99mTc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile (99mTc-Sestamibi [99mTc-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 99mTc-(V)DMSA and a total of 75 patients with 99mTc-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 99mTc-(V)DMSA accumulation was noticed in 18/19 cases and 99mTc-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 99mTc-(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 > or = 40% and with c-erbB-2 > or = 10%.

Conclusion: 99mTc-(V)DMSA showed high sensitivity and 99mTc-Sestamibi showed high specificity in detecting in situ breast carcinoma (99mTc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography.

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A 6-cm infiltrating ductal carcinoma, grade 2, with coexistent 5-cm ductal carcinoma in situ, comedo type, of the left breast (patient 1). (a) Mammography, medio-lateral projection. Multinodular opacity with abnormal radiating spicules and clustered microcalcifications (transparent arrow) behind the nipple. (b) Scintimammography, left lateral projection: 99mTc-Sestamibi (99mTc-MIBI) at 10 min and 65 min (upper row, i-ii); 99mTc-(V)DMSA at 15 min and 60 min (bottom row, iii-iv). Increased bifocal 99mTc-Sestamibi uptake (arrowheads) behind the nipple, clearly defining the invasive component of the tumor. Focal 99mTc-(V)DMSA accumulation in the same area (arrowhead), with additional diffuse uptake (arrow) extending inferiorly, more prominent at 60 min and corresponding to the in situ tumor component. No diffuse pattern is imaged with 99mTc-Sestamibi. (c) Scintimammography, left lateral projection: 99mTc-(V)DMSA at 60 min (same as (b) iv), with regions of interest (ROIs) drawn. ROI selection for diffuse uptake with each tracer is based on the comparison between early and late images (see text).
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Figure 3: A 6-cm infiltrating ductal carcinoma, grade 2, with coexistent 5-cm ductal carcinoma in situ, comedo type, of the left breast (patient 1). (a) Mammography, medio-lateral projection. Multinodular opacity with abnormal radiating spicules and clustered microcalcifications (transparent arrow) behind the nipple. (b) Scintimammography, left lateral projection: 99mTc-Sestamibi (99mTc-MIBI) at 10 min and 65 min (upper row, i-ii); 99mTc-(V)DMSA at 15 min and 60 min (bottom row, iii-iv). Increased bifocal 99mTc-Sestamibi uptake (arrowheads) behind the nipple, clearly defining the invasive component of the tumor. Focal 99mTc-(V)DMSA accumulation in the same area (arrowhead), with additional diffuse uptake (arrow) extending inferiorly, more prominent at 60 min and corresponding to the in situ tumor component. No diffuse pattern is imaged with 99mTc-Sestamibi. (c) Scintimammography, left lateral projection: 99mTc-(V)DMSA at 60 min (same as (b) iv), with regions of interest (ROIs) drawn. ROI selection for diffuse uptake with each tracer is based on the comparison between early and late images (see text).

Mentions: Of the 20/46 breast cancer patients with DCIS/LCIS, 19/20 underwent 99mTc-(V)DMSA and 13/20 underwent 99mTc-Sestamibi scintimammography (12/20 were part of the head-to-head subgroup of 45 patients that underwent both). Locally diffuse, heterogeneous (patchy), poorly circumscribed increased 99mTc-(V)DMSA accumulation, sometimes covering and surrounding focal increased accumulation (if present), was noticed in 16/17 of DCIS cases (Figs 2,3,4) and in 2/2 LCIS cases (Fig. 5), a total of 18/19 (95%) patients. The one lesion that was not detected had a size of 0.8 cm (patient 9). A similar pattern of distribution was found with 99mTc-Sestamibi, but only in 6/13 (46%) patients. Among those 12/20 DCIS/LCIS patients that underwent both examinations, this pattern of tracer distribution was noticed in 11/12 patients (92%) with 99mTc-(V)DMSA and in 5/12 patients (42%) with 99mTc-Sestamibi (Tables 3 and 4).


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.

Papantoniou V, Tsiouris S, Mainta E, Valotassiou V, Souvatzoglou M, Sotiropoulou M, Nakopoulou L, Lazaris D, Louvrou A, Melissinou M, Tzannetaki A, Pirmettis I, Koutsikos J, Zerva C - Breast Cancer Res. (2004)

A 6-cm infiltrating ductal carcinoma, grade 2, with coexistent 5-cm ductal carcinoma in situ, comedo type, of the left breast (patient 1). (a) Mammography, medio-lateral projection. Multinodular opacity with abnormal radiating spicules and clustered microcalcifications (transparent arrow) behind the nipple. (b) Scintimammography, left lateral projection: 99mTc-Sestamibi (99mTc-MIBI) at 10 min and 65 min (upper row, i-ii); 99mTc-(V)DMSA at 15 min and 60 min (bottom row, iii-iv). Increased bifocal 99mTc-Sestamibi uptake (arrowheads) behind the nipple, clearly defining the invasive component of the tumor. Focal 99mTc-(V)DMSA accumulation in the same area (arrowhead), with additional diffuse uptake (arrow) extending inferiorly, more prominent at 60 min and corresponding to the in situ tumor component. No diffuse pattern is imaged with 99mTc-Sestamibi. (c) Scintimammography, left lateral projection: 99mTc-(V)DMSA at 60 min (same as (b) iv), with regions of interest (ROIs) drawn. ROI selection for diffuse uptake with each tracer is based on the comparison between early and late images (see text).
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Related In: Results  -  Collection

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Figure 3: A 6-cm infiltrating ductal carcinoma, grade 2, with coexistent 5-cm ductal carcinoma in situ, comedo type, of the left breast (patient 1). (a) Mammography, medio-lateral projection. Multinodular opacity with abnormal radiating spicules and clustered microcalcifications (transparent arrow) behind the nipple. (b) Scintimammography, left lateral projection: 99mTc-Sestamibi (99mTc-MIBI) at 10 min and 65 min (upper row, i-ii); 99mTc-(V)DMSA at 15 min and 60 min (bottom row, iii-iv). Increased bifocal 99mTc-Sestamibi uptake (arrowheads) behind the nipple, clearly defining the invasive component of the tumor. Focal 99mTc-(V)DMSA accumulation in the same area (arrowhead), with additional diffuse uptake (arrow) extending inferiorly, more prominent at 60 min and corresponding to the in situ tumor component. No diffuse pattern is imaged with 99mTc-Sestamibi. (c) Scintimammography, left lateral projection: 99mTc-(V)DMSA at 60 min (same as (b) iv), with regions of interest (ROIs) drawn. ROI selection for diffuse uptake with each tracer is based on the comparison between early and late images (see text).
Mentions: Of the 20/46 breast cancer patients with DCIS/LCIS, 19/20 underwent 99mTc-(V)DMSA and 13/20 underwent 99mTc-Sestamibi scintimammography (12/20 were part of the head-to-head subgroup of 45 patients that underwent both). Locally diffuse, heterogeneous (patchy), poorly circumscribed increased 99mTc-(V)DMSA accumulation, sometimes covering and surrounding focal increased accumulation (if present), was noticed in 16/17 of DCIS cases (Figs 2,3,4) and in 2/2 LCIS cases (Fig. 5), a total of 18/19 (95%) patients. The one lesion that was not detected had a size of 0.8 cm (patient 9). A similar pattern of distribution was found with 99mTc-Sestamibi, but only in 6/13 (46%) patients. Among those 12/20 DCIS/LCIS patients that underwent both examinations, this pattern of tracer distribution was noticed in 11/12 patients (92%) with 99mTc-(V)DMSA and in 5/12 patients (42%) with 99mTc-Sestamibi (Tables 3 and 4).

Bottom Line: 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 99mTc-(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 > or = 40% and with c-erbB-2 > or = 10%. 99mTc-(V)DMSA showed high sensitivity and 99mTc-Sestamibi showed high specificity in detecting in situ breast carcinoma (99mTc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nuclear Medicine, Alexandra University Hospital, Athens, Greece. vpap@spark.net.gr

ABSTRACT

Introduction: The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid (99mTc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile (99mTc-Sestamibi [99mTc-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 99mTc-(V)DMSA and a total of 75 patients with 99mTc-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 99mTc-(V)DMSA accumulation was noticed in 18/19 cases and 99mTc-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 99mTc-(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 > or = 40% and with c-erbB-2 > or = 10%.

Conclusion: 99mTc-(V)DMSA showed high sensitivity and 99mTc-Sestamibi showed high specificity in detecting in situ breast carcinoma (99mTc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography.

Show MeSH
Related in: MedlinePlus