title: Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer.
abstract: OBJECTIVE
  To retrospectively determine the sensitivity and specificity of breast-specific gamma imaging (BSGI) for the detection of breast cancer by using pathologic results as the reference standard.
  
  
  METHODS
  This study was Institutional Review Board approved and Health Insurance Portability and Accountability Act compliant. Informed consent was obtained for participants who were not imaged as part of their clinical protocol but were participating in other Institutional Review Board-approved studies that used BSGI. A retrospective review of 146 women (aged 32-98 years) undergoing BSGI and breast biopsy was performed. Patients underwent BSGI with intravenous injection of 30 mCi (1110 MBq) of technetium 99 ((99m)Tc)-sestamibi and were imaged in craniocaudal and mediolateral oblique projections. Study images were assigned scores, and scores were classified as positive (focal increased radiotracer uptake) or negative (no uptake or scattered heterogeneous physiologic uptake) and compared with biopsy results. The sensitivity, specificity, and positive and negative predictive values were determined.
  
  
  RESULTS
  In 146 patients, 167 lesions underwent biopsy, of which 83 (16 ductal carcinoma in situ [DCIS] and 67 invasive cancers) were malignant. Of 84 nonmalignant lesions, 82 were benign and two showed atypical histologic results (one atypical lobular hyperplasia and one lobular carcinoma in situ). BSGI helped detect cancer in 80 of 83 malignant lesions with a sensitivity of 96.4% (95% confidence interval [CI]: 92%, 99%) and correctly identified 50 of 84 nonmalignant lesions as negative for cancer with a specificity of 59.5% (95% CI: 49%, 70%). The positive predictive value for 80 of 114 malignant lesions with a BSGI examination with findings positive for cancer was 68.8% (95% CI: 60%, 78%) and the negative predictive value for 50 of 53 nonmalignant lesions was 94.3% (95% CI: 88%, 99%). The smallest invasive cancer and DCIS detected were both 1 mm. BSGI helped detect occult cancer not visualized at mammography or ultrasonography in six patients.
  
  
  CONCLUSIONS
  BSIG has high sensitivity (96.4%) and moderate specificity (59.5%) helping detect breast cancers.
authors.affiliation: Departments of Radiology and Surgery, George Washington University, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA. rbrem@mfa.gwu.edu
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Brem
authors.forename: Angelique C
authors.initials: AC
authors.lastname: Floerke
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Rapelyea
authors.forename: Christine
authors.initials: C
authors.lastname: Teal
authors.forename: Tricia
authors.initials: T
authors.lastname: Kelly
authors.forename: Vivek
authors.initials: V
authors.lastname: Mathur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi