The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality

Sung Mo Hur; Sung Hoon Kim; Se Kyung Lee; Wan Wook Kim; Jae Hyuck Choi; Sangmin Kim; Su-Jin Lee; Jun-Young Choi; Jun-Ho Choe; Jung-Han Kim; Jee Soo Kim; Seok-Jin Nam; Jung-Hyun Yang; Jeong Eon Lee

doi:10.4048/jbc.2010.13.2.198

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Hur, Kim, Lee, Kim, Choi, Kim, Lee, Choi, Choe, Kim, Kim, Nam, Yang, and Lee: The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2010; 13(2): 198-205.

Published online: 29 June 2010

DOI: https://doi.org/10.4048/jbc.2010.13.2.198

The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality

Sung Mo Hur, Sung Hoon Kim, Se Kyung Lee, Wan Wook Kim, Jae Hyuck Choi, Sangmin Kim, Su-Jin Lee¹, Jun-Young Choi¹, Jun-Ho Choe, Jung-Han Kim, Jee Soo Kim, Seok-Jin Nam, Jung-Hyun Yang, Jeong Eon Lee

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

¹Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (paojlus@hanmail.net)

Received 21 August 2009 Accepted 4 January 2010

Abstract

Purpose

We wanted to assess the clinical efficacy of breast-specific gamma imaging (BSGI) as compared with that of conventional imaging modalities (mammography, ultrasonography and magnetic resonance imaging) as a preoperative examination for patients with breast cancer.

Methods

From April to May 2009, a retrospective review was performed for the prospectively collected 143 patients who were diagnosed with breast cancer. All the patients received a conventional imaging examination and BSGI before definitive surgery. The patients underwent BSGI with intravenous injection of 30 mCi of ^99mTc-sestamibi through the contralateral antecubital vein. After 10 minutes, the craniocaudal and mediolateral oblique images were obtained. All the imaging findings were correlated with the final pathologic examination.

Results

The mean age of the patients was 49.7±9.4 years (range, 27-77). In 143 patients, 166 malignant lesions were identified by pathologic examination (invasive cancer: 96 (67.1%), ductal carcinoma in situ 14 (9.8%) and invasive cancer with carcinoma in situ 33 (23.1%). The conventional imaging modalities found 166 malignant lesions and BSGI found 156 malignant lesions. The rate of correspondence was 94.0% between the conventional imaging modalities and BSGI for malignant lesions. For BSGI, there were 4 false positive findings and 10 false negative findings. BSGI found no occult cancers that were missed by conventional imaging modality. For making the diagnosis of axillary lymph node metastasis, the sensitivity, specificity and accuracy were 33.3%, 92.1%, and 69.9% for BSGI, and 55.6%, 77.5%, and 69.2%, for ultrasonography, respectively.

Conclusion

BSGI may have the potentiality to make a correct diagnosis in breast cancer patients. However, in this study, it seems that BSGI is not superior to conventional imaging modalities. BSGI is not a standard method to evaluate breast cancer lesions before surgery.

Keywords: Axillary, Breast neoplasms, Gamma cameras, Lymph nodes, Technetium 99m Sestamibi

Figures and Tables

Figure 1

Malignant lesion on imaging study. (A) Breast-specific gamma imaging in left craniocaudal and left mediolateral oblique view. (B) Mammography in left craniocaudal and left mediolateral oblique view. (C) Ultrasonography. (D) Magnetic resonance imaging. Pathologic examination demonstrated 1.6 cm-sized invasive ductal carcinoma.

Table 1

Clinical characteristics of the patients

SLNB=sentinel lymph node biopsy.

^*Partial mastectomy with axillary lymph node dissection.

Table 2

BSGI false positive lesions

BSGI=breast-specific gamma imaging; MMG=mammography; USG=ultrasonography; MRI=magnetic resonance imaging.

^*Categories are classified according to Breast Imaging and Reporting Data System (0=incomplete; 1=negative; 2=benign finding; 3=probably benign).

Table 3

Analysis of 10 BSGI detection-failed cases and the final pathologic results

BSGI=breast-specific gamma imaging; LVI=lymphovascular invasion; ER=estrogen receptor; PR=progesterone recepter; HER2=human epidermal growth factor receptor-2; CK=cytokeratin; EGFR=epidermal growth factor receptor; IDC=invasive ductal carcinoma; DCIS=ductal carcinoma in situ; Micropapil ca=micropapillary carcinoma.

^*One metastatic lymph node; ^†Six metastatic lymph nodes.

Table 4

Comparison of BSGI and USG in the evaluation of axillary lymph node metastasis

PPV=positive predictive value; NPV=negative predictive value; USG=ultrasonography; BSGI=breast-specific gamma imaging.

Table 5

Axillary lymph node metastasis of USG and BSGI in true positive and false negative cases

LN=lymph node; USG=ultrasonography; BSGI=breast-specific gamma imaging.

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