Scintimammography enhances negative predictive value of non-invasive pre-operative assessment of breast lesions.
OBJECTIVE
The aim of this study was to develop a criterion with a high negative predictive value for the evaluation of breast lesions. We aimed to determine the value of combining three non-invasive tests, mammography (MM), ultrasonography (USS) and 99mTc-methoxyisobutylisonitrite (99mTc-MIBI) scintimammography (scinti-MM).


METHODS
We included 94 consecutive patients with suspected lesions detected by mammography or on physical examination. MM, USS and scinti-MM were performed no more than 4 weeks prior to excisional biopsy in all patients. We then compared the biopsy results with a score calculated for each patient, derived from the results of the three tests, which we termed 'mamma malignancy index' (MMI).


RESULTS
Each of the three exams yielded a score ranging from 0 to 2, with 0 representing an almost certainly benign lesion, 1 an indeterminate finding and 2 a likely malignant lesion, and hence giving a total score ranging from 0 to 6. The biopsy results showed that the lesions in 64 patients were benign. Forty-nine (77%) of these patients had received an MMI score of 0 or 1. The negative predictive value for malignancy in patients with a score less than 2 was 100%.


CONCLUSIONS
Since the smallest detected lesion was 9 mm in diameter, we conclude that MMI may be a highly useful diagnostic tool in the delineation of breast lesions > or =1 cm which should not be routinely referred for biopsy but may be followed non-invasively. Although fine needle aspiration has limitations, we would recommend it as a less invasive method to evaluate suspected lesions smaller than 1 cm.
Mirzaei
S
S
Institute of Nuclear Medicine, Wilhelminenspital, Vienna, Austria. siroos.mirazaei@nuk.wil.magwien.gv.at
Zajicek
S M
SM
Knoll
P
P
Lipp
C
C
Lipp
R W
RW
Salzer
H
H
Umek
H
H
Kohn
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging / Q000379:methods*; D013667:Technetium; D016217:Ultrasonography, Mammary
D013667:Technetium