Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1997; 36(08): 282-288
DOI: 10.1055/s-0038-1629848

Originalarbeiten — Original Articles

Schattauer GmbH

²⁰¹Tl Scintigraphy in the Evaluation of Palpable and Nonpalpable Breast Lesions: Correlation with Mammography and Ultrasonography

²⁰¹Tl-Szintigraphie bei palpablen und nichtpalpablen Mammatumoren: Vergleich mit Mammographie und Sonographie

G. Vural

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

T. Atasever

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

A. Özdemir

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

I. Öznur

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

N. I. Karabacak

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

N. Gökçora

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

S. Işjk

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

,

M. Ünlü

¹From the Gazi University Faculty of Medicine, Departments of Nuclear Medicine and Radiology Ankara-Tiirkiye

› Author Affiliations

Summary

Aim: Our goal was to determine the clinical usefulness of TI-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. Methods: TI-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of TI-201. Visual and semiquantitative interpretation was performed. Results: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. TI-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by TI-201 scintigraphy. The smallest mass lesion detected by TI-201 measured 1.5x1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. TI-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed TI-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated TI-201. TI-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by TI-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 ± 0.38 (mean ± SD) and 1.48 ± 0.32 (p >0.05), 1.87 ± 0.65 and 1.34 ± 0.20 (p<0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p>0.05). Conclusion: Overall, TI-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of TI-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

Zusammenfassung

Ziel: Es war das Ziel dieser Untersuchung, die Wertigkeit der ²⁰¹TI-Szintigraphie zum Karzinomnachweis bei aufgrund von Mammographie oder Sonographie verdächtigen Mamma-Läsionen zu bestimmen. Methoden: 68 Patientinnen mit insgesamt 70 Läsionen (davon 51 palpable Tumoren) wurden untersucht: 15 Min. und 3 Std. nach Injektion von 111 MBq (3 mCi)²⁰¹ Tl-Cl wurden planare Aufnahmen von ventral, lateral und schräg-lateral durchgeführt. Die Auswertung erfolgte sowohl visuell-qualitativ als auch semiquantitativ. Ergebnisse: Von 52 Karzinomen wurden durch die ²⁰¹TI-Szintigraphie 47 (90%) richtig erkannt. Plapable Tumoren (38 von 40, Sensitivität: 95%) wurden besser erkannt als nicht-palpable (9 von 12, Sensitivität: 75%). Die kleinste durch ²⁰¹TI nachgewiesene Läsion maß 1,5 x 1,0 cm. 11 Läsionen waren zuvor durch Mammographie und/oder Sonographie als fraglich suspekt beurteilt worden: von den 8 letztlich gutartigen Tumoren konnte die ²⁰¹TI-Szinti-graphie bei 7 Fällen (88%) die Malignität richtig ausschließen. 5 der insgesamt 18 gutartigen Tumoren (28%) zeigten zwar eine ²⁰¹TI-Aufnahme, in keinem Fall aber handelte es sich hierbei um Fibroadenome oder fibrozystische Veränderungen. Die Sensitivität für ²⁰¹TI-Szintigraphie, Mammographie und Sonographie betrug 90%, 92% bzw. 85%, die Spezifität entsprechend 72%, 56% bzw. 61%. Der Quotient (ROI-Technik) Läsion/kontralaterale Mamma betrug bei den frühen Aufnahmen 1,58 ± 0,38 (Mittelwert ± SD) bei Karzinomen und 1,4 ± 0,32 (p>0,005) bei gutartigen Läsionen und für die späten Aufnahmen entsprechend 1,87 ± 0,65 bzw. 1,34 ± 0,2 (p<0,05). Die Quotienten der frühen und späten Aufnahmen zeigten bei beiden Gruppen keine statistisch signifikante Differenz (p>0,05). Zusätzlich wurden 21 der 28 axillären Lymphknotenmetastasen (75%) durch die ²⁰¹TI-Szintigraphie richtig erkannt. Schlußfolgerung: Die ²⁰¹TI-Szintigraphie erzielte gute Resultate bei palpablen Mammakarzinomen, während die Sinsitivität bei nichtpalpablen Karzinomen und axillären Metastasen niedriger lag. Die kombinierte Anwendung von ²⁰¹TI-Szintigraphie und Mammographie bzw. Sonographie könnte bei Problemfällen hilfreich sein, d.h. bei mammographisch dichtem Gewebe und nicht sicher klassifizierbaren Läsionen.

Key words

Key words

TI-201 - breast cancer - radionuclide imaging

Schlüsselwörter

Schlüsselwörter

²⁰¹TI - Mammakarzinom - Tumorszintigraphie

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