title: Comparative Diagnostic Utility of Low-Dose Breast-Specific Gamma Imaging to Current Clinical Standard.
abstract: To retrospectively compare low-dose (7-10 mCi) to high-dose (15-30 mCi) breast-specific gamma imaging (BSGI) in the detection of breast cancer. A retrospective review of 223 consecutive women who underwent BSGI exam between February 2011 and August 2013 with subsequent pathologic analysis was performed. Women were divided into low-dose and high-dose groups. The results of BSGI and pathology were compared, and the sensitivity, positive predictive value (PPV), and negative predictive value (NPV) were determined. A subgroup analysis was performed to evaluate specificity using benign follow-up imaging to establish true-negative results. There were 223 women who met inclusion criteria with 109 patients with 153 lesions in the low-dose group and 114 patients with 145 lesions in the high-dose group. Pathologic correlation demonstrates sensitivities of 97.6% (95% CI = 90.9-99.6%) and 94.6% (95% CI = 84.2-98.6%; p = 0.093), PPVs of 62.1% (95% CI = 53.2-70.3%) and 50.5% (95% CI = 40.6-60.3%, p = 0.089), and NPVs of 90.5% (95% CI = 68.2-98.3%) and 92.5% (95% CI = 78.5-98.0%, p = 0.781) in the low-dose and high-dose groups, respectively. Subgroup analysis included 72 patients with 98 lesions in the low-dose group and 116 patients with 132 lesions in the high-dose group, with a specificity of 53.7% (95% CI = 39.7-67.1%) and 66.3% (95% CI = 56.2-75.2%%, p = 0.143), respectively. Low-dose BSGI demonstrated high sensitivity and NPV in the detection of breast cancer comparable to the current standard dose BSGI, with moderate specificity and PPV in a limited subgroup analysis, which was associated with a substantial number of false-positives.
authors.affiliation: Department of Breast Imaging, The George Washington University Medical Faculty Associates, Washington, DC.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Kuhn
authors.affiliation: Department of Breast Imaging, The George Washington University Medical Faculty Associates, Washington, DC.
authors.forename: Jocelyn A
authors.initials: JA
authors.lastname: Rapelyea
authors.affiliation: Department of Breast Imaging, The George Washington University Medical Faculty Associates, Washington, DC.
authors.forename: Jessica
authors.initials: J
authors.lastname: Torrente
authors.affiliation: Breast Care Center, The George Washington University Medical Faculty Associates, Washington, DC.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Teal
authors.affiliation: Department of Breast Imaging, The George Washington University Medical Faculty Associates, Washington, DC.
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Brem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005189:False Positive Reactions; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D008875:Middle Aged; D011829:Radiation Dosage; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: breast cancer detection; breast imaging; breast-specific gamma imaging; molecular imaging