title: Uptake and washout of 99mTcV-dimercaptosuccinic acid and 99mTc-sestamibi in the assessment of histological type and grade in breast cancer.
abstract: This study was performed to investigate the relationship between histological type and grade, with the uptake and washout of 99mTc-hexakis-2-methoxyisobutylisonitrile (99mTc-sestamibi, 99mTc-MIBI) and 99mTcV-dimercaptosuccinic acid (99mTcV-DMSA) in breast cancer. Forty-five patients with histologically proven breast cancer had previously been referred for 99mTcV-DMSA and/or 99mTc-MIBI scintimammography. Twenty-five of them underwent both 99mTcV-DMSA and 99mTc-MIBI scintigraphy in a double phase study. Lateral prone and anterior supine images were acquired at 15 and 60 min after administration of 740-925 MBq of each radiotracer. Uptake ratios and retention index were calculated and correlated with histology and grade of malignancy. Histology showed eight different histotypes: 77.7% were infiltrating ductal or lobular carcinomas. Mammography was definitely positive in 32/45, indeterminate in 10 and negative in three cases (sensitivity 71%). 99mTcV-DMSA was true positive in 37/40 (sensitivity 92.5%) and 99mTc-MIBI in 28/30 (sensitivity 93.3%) breast cancers. Uptake ratios were significantly higher in ductal than in lobular carcinomas on 99mTcV-DMSA and 99mTc-MIBI scintigrams at early and delayed phases. Grade II carcinomas had significantly lower values of retention index (rapid washout) than grade III carcinomas. This finding was statistically significant only on 99mTc-MIBI scans and was observed in ductal and lobular carcinomas. The retention index did not show any significant difference between ductal and lobular carcinomas. Uptake ratios were also not statistically different between grade II and III cancers. It is concluded that 99mTc-MIBI and 99mTcV-DMSA uptake in breast cancer is probably related to histological type and may distinguish ductal from lobular carcinomas. To a certain degree, the washout rate may reflect the histological grade, but since grade is not the only factor influencing this phenomenon it should be explored further in conjunction with other parameters by multivariate analysis in order to clarify eventual indirect correlations.
authors.affiliation: Department of Nuclear Medicine, Alexandra Hospital, University of Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papantoniou
authors.forename: J
authors.initials: J
authors.lastname: Christodoulidou
authors.forename: E
authors.initials: E
authors.lastname: Papadaki
authors.forename: V
authors.initials: V
authors.lastname: Valotassiou
authors.forename: M
authors.initials: M
authors.lastname: Souvatzoglou
authors.forename: A
authors.initials: A
authors.lastname: Louvrou
authors.forename: H
authors.initials: H
authors.lastname: Feida
authors.forename: M
authors.initials: M
authors.lastname: Sotiropoulou
authors.forename: G
authors.initials: G
authors.lastname: Pampouras
authors.forename: S
authors.initials: S
authors.lastname: Michalas
authors.forename: C
authors.initials: C
authors.lastname: Zerva
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D001943:Breast Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008327:Mammography; D009367:Neoplasm Staging / Q000379:methods*; D018299:Neoplasms, Ductal, Lobular, and Medullary / Q000000981:diagnostic imaging / Q000473:pathology; D003557:Phyllodes Tumor / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D017256:Technetium Tc 99m Sestamibi / Q000493:pharmacokinetics
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D017256:Technetium Tc 99m Sestamibi