Scintimammography using ^99mTc sestamibi – use and limitations

Summary

Aim: Until now scintimammography did not achieve any definite role in the assessment of breast lesions. Purpose of this study was to elaborate its use as well as the limitations of scintimammography after 500 examinations completed. Methods: Scintigraphic findings were correlated with the histopathologic outcome of 219 patients, who underwent surgery or biopsy for histopathological confirmation. The results were determined with respect to palpability of the lesion and tumour size. Additionally, a distinct analysis was performed for the patient subpopulation with indeterminate results of previously performed physical examination, mammography, and sonography. Results: Overall sensitivity for scintimammography was 82.1% at a specificity of 87.5%. For palpable lesions sensitivity was 91.7% which was evidently higher as compared to 64.9% for non palpable lesions. For palpable lesions specificity was 81.1% and 88.6% for non palpable lesions. According to tumour size sensitivity ranged between 65.2% for carcinoma with a diameter <1 cm and 93.7% for carcinoma >1 cm. In the patients subgroup with indeterminate preliminary diagnosis (n = 143) sensitivity decreased to 71.7% at a specificity of 87.8%. Patients undergoing neoadjuvant chemotherapy showed decreasing sestamibi uptake as early as 8 days after therapy if tumour response was evident. However, small residual invasive tumours in patients with complete remission could not be visualised. Conclusion: Scintimammography is neither suited for screening, nor early diagnosis of breast cancer, nor for the further evaluation of small and unclear mammographic findings. Scintimammography should not be used whenever histopathological clarification of a suspicious lesion is necessary. It is useful to further investigate patients with unclear or probably benign findings in physical examination and/or mammography and to monitor tumour response to neoadjuvant chemotherapy.

Zusammenfassung

Ziel: Evaluation vorhandener und fehlender Indikationen für die kontrovers diskutierte Mammaszintigraphie mit Tc- 99m Sestamibi, die bislang noch kein klinisches Routineverfahren ist, anhand von 500 Untersuchungen mit unterschiedlichen Fragestellungen. Methoden: Korrelation szintigraphischer Diagnosen mit histopathologischen Resultaten bei 219 Patientinnen unter Berücksichtigung von Tastbefund, Tumorgröße und Vordiagnostik. Ergebnisse: Die Sensitivität der Mammaszintigraphie für das Gesamtkollektiv betrug 82,1% bei einer Spezifität von 82,1%. Bei Patientinnen mit palpablem Befund war die Sensitivität 91,7% und die Spezifität 81,1%. Bei nicht palpablen Läsionen lag die Sensitivität bei 64,9%, die Spezifität bei 88,6%. Bei invasiven Karzinomen lag die Sensitivität je nach Karzinomgröße bei 65,2% (Tumor <1 cm) bis 93,7% (Tumor ≥1 cm). Bei unklarer Vordiagnostik (n = 143) reduzierte sich die Sensitivität der Mammaszintigraphie auf 71,7% bei einer Spezifität von 87,8%. Bei den Untersuchungen zum Therapiemonitoring wurde bei Tumoransprechen auf eine neoadjuvante Chemotherapie bereits nach dem 1. Zyklus eine rückläufige Speicherintensität beobachtet, doch residuale Tumoranteile bei klinischer Vollremission entgingen dem szintigraphischen Nachweis. Schlussfolgerung: Die Mammaszintigraphie ist weder zum Screening, noch zur Karzinomfrüherkennung, noch zur Diagnostik von Befunden im Millimeterbereich geeignet. Sie sollte bei suspektem Befund nicht zum Einsatz kommen, da hier die histologische Klärung angezeigt ist. Zur weiterführenden Abklärung von unklaren oder vermutlich benignen Palpations- oder Mammographiebefunden, z.B. bei dichtem Drüsenparenchym und bei Monitoring von Karzinomen unter neoadjuvanter Chemotherapie, bestehen jedoch diagnostische Lücken und Indikationen für die Mammaszintigraphie.

Keywords

Breast cancer - scintimammography - Tc-99m sestamibi

Schlüsselwörter

Mammakarzinom - Mammaszintigraphie - Tc-99m Sestamibi

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