Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography.
BACKGROUND
The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid (99mTc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile (99mTc-Sestamibi [99mTc-MIBI]) distribution in ductal breast carcinoma in situ and lobular breast carcinoma in situ (DCIS/LCIS), in relation to mammographic, histological and immunohistochemical parameters.


METHODS
One hundred and two patients with suspicious palpation or mammographic findings were submitted preoperatively to scintimammography (a total of 72 patients with 99mTc-(V)DMSA and a total of 75 patients with 99mTc-Sestamibi, 45 patients receiving both radiotracers). Images were acquired at 10 min and 60 min, and were evaluated for a pattern of diffuse radiotracer accumulation. The tumor-to-background ratios were correlated (T-pair test) with mammographic, histological and immunohistochemical characteristics.


RESULTS
Histology confirmed malignancy in 46/102 patients: 20/46 patients had DCIS/LCIS, with or without coexistent invasive lesions, and 26/46 patients had isolated invasive carcinomas. Diffuse 99mTc-(V)DMSA accumulation was noticed in 18/19 cases and 99mTc-Sestamibi in 6/13 DCIS/LCIS cases. Epithelial hyperplasia demonstrated a similar accumulation pattern. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for each tracer were calculated. Solely for 99mTc-(V)DMSA, the tumor-to-background ratio was significantly higher at 60 min than at 10 min and the diffuse uptake was significantly associated with suspicious microcalcifications, with the cell proliferation index > or = 40% and with c-erbB-2 > or = 10%.


CONCLUSIONS
99mTc-(V)DMSA showed high sensitivity and 99mTc-Sestamibi showed high specificity in detecting in situ breast carcinoma (99mTc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography.
Papantoniou
Vassilios
V
Department of Nuclear Medicine, Alexandra University Hospital, Athens, Greece. vpap@spark.net.gr
Tsiouris
Spyridon
S
Mainta
Ekaterini
E
Valotassiou
Varvara
V
Souvatzoglou
Michael
M
Sotiropoulou
Maria
M
Nakopoulou
Lydia
L
Lazaris
Dimitrios
D
Louvrou
Androniki
A
Melissinou
Maria
M
Tzannetaki
Artemis
A
Pirmettis
Ioannis
I
Koutsikos
John
J
Zerva
Cherry
C
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D017256:Technetium Tc 99m Sestamibi
D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D017256:Technetium Tc 99m Sestamibi