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Methodological aspects of 99m Tc-sestamibi guided biopsy in breast cancer

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ABSTRACT

Purpose: This review aims to discuss the methodological aspects of dedicated molecular breast imaging (MBI) using 99mTc-sestamibi as radiotracer to guide biopsy of occult or unclear breast lesions on mammography (MG) and ultrasound (US) that are suspicious on MBI (BI-RADS criteria 4 and 5), including its advantages, limitations and future clinical applications.

Methods: Literature search was performed using the PubMed/MEDLINE database and “99mTc-sestamibi”, “biopsy” and “breast cancer” as keywords. The search was restricted to English language.

Results: There are few studies on 99mTc-sestamibi guided biopsy methods; to our knowledge, no full studies have yet been reported on clinical validation of this new biopsy procedure. This review describes technical aspects of 99mTc-sestamibi guided biopsy and discusses the advantages and limitations of this procedure in comparison with MG, US and MRI-guided biopsy.

Conclusions: MBI-guided biopsy appears to be a complementary modality and is principally indicated in the case of occult or unclear breast lesions on MG/US, that are suspicious on MBI. The future indication is in targeted biopsies in patients with large heterogeneous tumours. Further studies are needed to define the accuracy of this biopsy procedure.

No MeSH data available.


Examples of MBI according to BI-RADS classification [12] displayed together with corresponding mammography. Left craniocaudal view (a) showing homogeneous uptake (BI-RADS I); left craniocaudal view (b) showing diffusely increased uptake (BI-RADS II); right craniocaudal view (c) showing multiple patchy areas of uptake (BI-RADS III) pointed by arrows; right craniocaudal view (d) showing small focal area of increased uptake (BI-RADS IV, arrow); right craniocaudal (e) showing intense uptake (BI-RADS V, arrow)
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Fig2: Examples of MBI according to BI-RADS classification [12] displayed together with corresponding mammography. Left craniocaudal view (a) showing homogeneous uptake (BI-RADS I); left craniocaudal view (b) showing diffusely increased uptake (BI-RADS II); right craniocaudal view (c) showing multiple patchy areas of uptake (BI-RADS III) pointed by arrows; right craniocaudal view (d) showing small focal area of increased uptake (BI-RADS IV, arrow); right craniocaudal (e) showing intense uptake (BI-RADS V, arrow)

Mentions: In both single-head and dual-head MBI devices, the patient is seated during the entire study and the breast is positioned directly on the detector(s) with light compression to limit patient motion. Patients receive an intravenous injection of the radiotracer (600–800 MBq 99mTc-sestamibi for single-head MBI or 300 MBq for dual-head MBI-systems) in an antecubital vein contralateral to the breast lesion. Approximately 5–10 min after the injection of the radiotracer, standard planar images are performed for each breast in the craniocaudal (CC) and mediolateral oblique (MLO) projections. The acquisition time for each image is 8–10 min with a total acquisition time of approximately 40 min per study. If needed, additional images may be acquired (lateromedial or mediolateral view, anteroposterior view (axilla) or axillary craniocaudal view). These projections correspond to the standard projections used in MG (Fig. 1). For interpretation of the images a viewing system should be available which enables the adjustment of the image contrast and simultaneous display of the mammographic and scintigraphic images. The scintigraphic images are interpreted according to a functional BI-RADS classification, based on the guidelines of the Society of Nuclear Medicine (SNM) as shown in Table 2 and Fig. 2 [12]. Recently, a lexicon for the description of MBI images has been developed [22], based on familiar radiological BI-RADS lexicon terminology, as well as on the proposed BI-RADS-type lexicon for positron emission mammography (PEM).Fig. 1


Methodological aspects of 99m Tc-sestamibi guided biopsy in breast cancer
Examples of MBI according to BI-RADS classification [12] displayed together with corresponding mammography. Left craniocaudal view (a) showing homogeneous uptake (BI-RADS I); left craniocaudal view (b) showing diffusely increased uptake (BI-RADS II); right craniocaudal view (c) showing multiple patchy areas of uptake (BI-RADS III) pointed by arrows; right craniocaudal view (d) showing small focal area of increased uptake (BI-RADS IV, arrow); right craniocaudal (e) showing intense uptake (BI-RADS V, arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC5037160&req=5

Fig2: Examples of MBI according to BI-RADS classification [12] displayed together with corresponding mammography. Left craniocaudal view (a) showing homogeneous uptake (BI-RADS I); left craniocaudal view (b) showing diffusely increased uptake (BI-RADS II); right craniocaudal view (c) showing multiple patchy areas of uptake (BI-RADS III) pointed by arrows; right craniocaudal view (d) showing small focal area of increased uptake (BI-RADS IV, arrow); right craniocaudal (e) showing intense uptake (BI-RADS V, arrow)
Mentions: In both single-head and dual-head MBI devices, the patient is seated during the entire study and the breast is positioned directly on the detector(s) with light compression to limit patient motion. Patients receive an intravenous injection of the radiotracer (600–800 MBq 99mTc-sestamibi for single-head MBI or 300 MBq for dual-head MBI-systems) in an antecubital vein contralateral to the breast lesion. Approximately 5–10 min after the injection of the radiotracer, standard planar images are performed for each breast in the craniocaudal (CC) and mediolateral oblique (MLO) projections. The acquisition time for each image is 8–10 min with a total acquisition time of approximately 40 min per study. If needed, additional images may be acquired (lateromedial or mediolateral view, anteroposterior view (axilla) or axillary craniocaudal view). These projections correspond to the standard projections used in MG (Fig. 1). For interpretation of the images a viewing system should be available which enables the adjustment of the image contrast and simultaneous display of the mammographic and scintigraphic images. The scintigraphic images are interpreted according to a functional BI-RADS classification, based on the guidelines of the Society of Nuclear Medicine (SNM) as shown in Table 2 and Fig. 2 [12]. Recently, a lexicon for the description of MBI images has been developed [22], based on familiar radiological BI-RADS lexicon terminology, as well as on the proposed BI-RADS-type lexicon for positron emission mammography (PEM).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: This review aims to discuss the methodological aspects of dedicated molecular breast imaging (MBI) using 99mTc-sestamibi as radiotracer to guide biopsy of occult or unclear breast lesions on mammography (MG) and ultrasound (US) that are suspicious on MBI (BI-RADS criteria 4 and 5), including its advantages, limitations and future clinical applications.

Methods: Literature search was performed using the PubMed/MEDLINE database and “99mTc-sestamibi”, “biopsy” and “breast cancer” as keywords. The search was restricted to English language.

Results: There are few studies on 99mTc-sestamibi guided biopsy methods; to our knowledge, no full studies have yet been reported on clinical validation of this new biopsy procedure. This review describes technical aspects of 99mTc-sestamibi guided biopsy and discusses the advantages and limitations of this procedure in comparison with MG, US and MRI-guided biopsy.

Conclusions: MBI-guided biopsy appears to be a complementary modality and is principally indicated in the case of occult or unclear breast lesions on MG/US, that are suspicious on MBI. The future indication is in targeted biopsies in patients with large heterogeneous tumours. Further studies are needed to define the accuracy of this biopsy procedure.

No MeSH data available.