title: Detection of axillary lymph node metastasis of breast carcinoma with technetium-99m sestamibi scintimammography.
abstract: Several investigators have advocated management of breast cancer patients without axillary dissection, obviating the morbidity associated with this procedure. Approximately 30-40 per cent of all patients with breast carcinoma will have lymph node metastasis. Axillary dissection offers no therapeutic benefit to node-negative patients, and it may lead to unnecessary morbidity. It is apparent that a noninvasive test to determine the presence of axillary metastases may obviate the need for axillary dissection. The aim of this study was to determine the role of scintimammography (SMM) with technetium-99m sestamibi in the detection of axillary node metastasis in breast carcinoma. Thirty-one women with the diagnosis of breast carcinoma who had SMM and axillary lymphadenectomy were included. SMM was done following an intravenous injection of 20 mCi of Tc-99m sestamibi. Planar scintigraphic imaging was acquired in a lateral prone and an anterior view of the breasts for the evaluation of the axilla. SMM scans were interpreted by two nuclear medicine physicians blinded to the clinical presentation and histologic results. The correlation of SMM with histologic assessment showed a sensitivity of 75 per cent, specificity of 82 per cent, positive predictive value of 88 per cent, and negative predictive value of 64 per cent. The interobserver correlation of SMM interpretation between the two nuclear medicine physicians showed good agreement, with kappa = 0.49. Consistency in the interpretation of Tc-99m SMM was obtained when two independent radiologists reviewed the studies. Based on these data, we are unable to show that SMM is a reliable test for the detection of axillary metastases in patients with breast cancer. However, a high positive value of 88 per cent is encouraging and deserves further study.
authors.affiliation: Department of Surgery, Harbor UCLA Medical Center, Torrance, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tolmos
authors.forename: I
authors.initials: I
authors.lastname: Khalkhali
authors.forename: H
authors.initials: H
authors.lastname: Vargas
authors.forename: M
authors.initials: M
authors.lastname: Stuntz
authors.forename: J
authors.initials: J
authors.lastname: Cutrone
authors.forename: F
authors.initials: F
authors.lastname: Mishkin
authors.forename: L
authors.initials: L
authors.lastname: Diggles
authors.forename: R
authors.initials: R
authors.lastname: Venegas
authors.forename: S
authors.initials: S
authors.lastname: Klein
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001940:Breast / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D005069:Evaluation Studies as Topic; D005260:Female; D005544:Forecasting; D006801:Humans; D007275:Injections, Intravenous; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009683:Nuclear Medicine; D015588:Observer Variation; D011237:Predictive Value of Tests; D016684:Prone Position; D011871:Radiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi