Tl-201 scintigraphy, mammography and ultrasonography in the evaluation of palpable and nonpalpable breast lesions: a correlative study.
OBJECTIVE
To determine the feasibility of Tl-201 as a tumor localizing agent in palpable and nonpalpable breast lesions, in comparison with mammography and ultrasonography (US), and to evaluate the contribution of these modalities to each other in obviating biopsy.


METHODS
Seventy-two palpable and nonpalpable breast lesions were prospectively classified as benign, indeterminate, or malignant according to the sonographic and mammographic criteria and were further analyzed with Tl-201 scanning. These classifications were compared with biopsy results. The sensitivity, specificity, accuracy, false positive and false negative rates (FPR, FNR), negative and positive predictive values (npv, ppv) were calculated for each individual modality and combination of modalities to evaluate the contribution of these three techniques to each other.


RESULTS
Of 72 lesions 52 were histologically malignant and 20 were benign. Overall, mammography was the most sensitive (92%) and Tl-201 was the most specific (75%) of the three modalities. Mammography + Tl combination was the most specific (90%) and accurate (97%) of dual combinations. In mammographically or sonographically indeterminate cases, Tl-201 was much more specific (75% versus 37% for mammography and US) and more accurate (82% versus 36% for mammography and 54% for US) than the other two modalities, and mammography + Tl combination was significantly superior to other dual combinations (87% specific and 91% accurate). Use of Tl-201 scanning as an adjunct to mammography + US combination increased the specificity, ppv, and accuracy rates overall, particularly in mammographically or sonographically indeterminate cases.


CONCLUSIONS
In mammographically and sonographically indeterminate breast lesions thallium scanning may be offered as a third step of investigation to obviate biopsy.
Ozdemir
A
A
Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.
Oznur
I I
II
Vural
G
G
Atasever
T
T
Karabacak
N I
NI
Gökçora
N
N
Işik
S
S
Unlü
M
M
D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D018567:Breast Neoplasms, Male / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000000981:diagnostic imaging; D005188:False Negative Reactions; D005189:False Positive Reactions; D005240:Feasibility Studies; D005260:Female; D005348:Fibrocystic Breast Disease / Q000175:diagnosis / Q000000981:diagnostic imaging; D006177:Gynecomastia / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008327:Mammography; D008875:Middle Aged; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D016217:Ultrasonography, Mammary
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes