Planar scintimammography and SPECT in neoadjuvant chemo or hormonotherapy response evaluation in locally advanced primary breast cancer.
Conventional imaging procedures have proved of limited value in assessing tumor response to neoadjuvant chemotherapy in locally advanced primary breast cancer (LAPBC). We evaluated the usefulness of radioisotopic procedures comparing planar scintimammography (SM) to SPECT, monitoring pre-surgery neoadjuvant chemo- or hormonotherapy response in 32 LAPBC patients. In all cases, 99mTc-tetrofosmin conventional planar SM and SPECT were acquired by dual-head gamma camera with HR parallel hole collimators. In 15 cases, planar SM with small field of view high resolution dedicated breast camera (DBC) was also acquired. Scintigraphic data always correlated with histopathological findings. At surgery, 4/32 patients had pathological complete remission (pCR), while 28/32 patients had residual tumors. Both conventional planar SM and SPECT were true negative in 4/4 (100%) pCR patients, as was DBC in the only studied case. Conventional planar SM and SPECT detected residual tumors in 23/28 (82%) and in 25/28 (89.2%) cases, respectively. Both procedures missed 2 multifocal, scattered microscopic residues, only evidenced at DBC. Conventional planar SM also missed 3 further macroscopic residues (15-20 mm), while SPECT only one of these, a mucinous BC, in which DBC was not performed. DBC correctly classified all other 12 patients in whom the procedure was performed. Both conventional planar SM and SPECT proved useful diagnostic tools in monitoring neoadjuvant chemo/hormono therapy response in LAPBC with SPECT appearing more sensitive; however, our data, although in a limited number of cases, suggest that sensitivity can further be increased using high resolution DBC, especially in detecting microscopic residual tumor foci.
Spanu
Angela
A
Department of Nuclear Medicine, University of Sassari, I-07100 Sassari, Italy.
Farris
Antonio
A
Chessa
Francesca
F
Sanna
Daniela
D
Pittalis
Maria
M
Manca
Alessandra
A
Madeddu
Giuseppe
G
D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000188:drug therapy; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D000730:Androstadienes; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; C056516:exemestane