Tc-99m-Tetrofosmin Scintimammography: A Prospective Study in Primary Breast Lesions

P. Lind; H.-J. Gallowitsch; D. Kogler; E. Kresnik; P. Mikosch; I. Gomez

doi:10.1055/s-0038-1629780

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1996; 35(06): 225-229
DOI: 10.1055/s-0038-1629780

Original Article

Schattauer GmbH

Tc-99m-Tetrofosmin Scintimammography: A Prospective Study in Primary Breast Lesions

Tc-99m-Tetrofosmin-Mammoszintigraphie: Eine prospektive Studie bei primären Mammatumoren

Authors

P. Lind

¹From the Department of Nuclear Medicine and Special Endocrinology and the, LKH Klagenfurt, Austria
H.-J. Gallowitsch

¹From the Department of Nuclear Medicine and Special Endocrinology and the, LKH Klagenfurt, Austria
D. Kogler

²From the Department of Radiology LKH Klagenfurt, Austria
E. Kresnik

¹From the Department of Nuclear Medicine and Special Endocrinology and the, LKH Klagenfurt, Austria
P. Mikosch

¹From the Department of Nuclear Medicine and Special Endocrinology and the, LKH Klagenfurt, Austria
I. Gomez

¹From the Department of Nuclear Medicine and Special Endocrinology and the, LKH Klagenfurt, Austria

Abstract

Summary

Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In addition high frequency ultrasonography (US) or magnetic resonance imaging (MRI) can improve breast cancer diagnosis. However there is a lack of conventional imaging to improve the high rate of false positive results that make biopsy or surgery necessary. Aim: The purpose of our study was to evaluate prospectively the sensitivity, specificity, PPV and NPV of scintimammography with a new cationic complex Tc-99m-tetrofosmin. Methods: Fourtyeight patients in whom mammography and/or high resolution ultrasonography (10MHz) revealed suspicious breast lesions were studied with Tc-99m-tetrofosmin scintimammography. In thirtyfour of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m-tetrofosmin dynamic images over three minutes (1 frame/10 sec.) planar images in anterior and lateral projections (5 min. p.i.) and SPECT imaging including 3-D-reconstruction (20 min. p.i.) were performed. Scintimammography was evaluated as negative, equivocal (+), probably (++) or definitely (+++) positive. Results: Scintimammography with Tc-99m-tetrofosmin was negative in 18 patients (17 t.n.; 1 f.n.) and positive in 16 patients (10 t.p., 6 f.p.). The false negative scintimammography was observed in a patient with infiltrating ductal carcinoma pT1, the false positive result in a patient with fibrocystic disease; all of the five fibroadenomas were also “false” positive. Sensitivity of Tc-99m-tetrofosmin scintimammography in this prospective study was 91 %, specificity 74%, PPV 63% and NPV 94%. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m-tetrofosmin accumulates in breast cancer as well as in fibroadenoma. However the high NPV of 94 % excludes breast cancer in suspicious mammographie lesions in a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients. Conclusion: Our first results show that scintimammography with Tc-99m-tetrofosmin might play a role as further diagnostic step before surgery for women in whom mammography and/or ultrasonography show suspicious lesions.

Zusammenfassung

Die Mammographie ist trotz niedriger Spezifität die Methode der Wahl für das Screening von Mammakarzinomen. Obwohl die Mammasonographie und Kernspintomographie die Diagnose von Mammakarzinomen weiter verbessert haben, zeigen die konventionellen Methoden eine hohe Rate an falsch-positiven Befunden, die eine chirurgisch/bioptische Abklärung notwendig machen. Ziel unserer prospektiven Studie war es, die Sensitivität, Spezifität sowie den positiven (PVW) und negativen Voraussagewert (NVW) der Mammoszintigraphie mittels eines neuen kationischen Komplexes Tc-99m-Tetrofosmin zu überprüfen. Methoden: An 48 Patienten mit pathologischer Mammographie und/oder Mammasonographie wurde eine Mammoszintigraphie mit Tc-99m-Tetrofosmin durchgeführt. Bei 34 der 48 Patienten lag zur entgültigen Beurteilung der Mammoszintigraphie eine Histologie vor. Nach intravenöser Injektion von 555 MBq Tc-99m-Tetrofosmin wurden dynamische Aufnahmen über drei Minuten (1 Bild pro 10 Sekunden), planare Aufnahmen in anteriorer und seitlicher Projektion (5 Minuten p.i.) und SPECT Aufnahmen sowie eine 3-D-Rekonstruktion (20 Minuten p.i.) durchgeführt. Die Ergebnisse der Mammoszintigraphie wurden als negativ (-), fraglich (+), wahrscheinlich (++) und sicher pathologisch (+++) bewertet. Ergebnisse: Die Mammoszintigraphie mit Tc-99m-Tetrofosmin war bei 18 Patienten negativ (17 richtig-negativ; 1 falschnegativ) und bei 16 Patienten positiv (10 richtig-positiv, 6 falsch-positiv). Der falsch-negative Befund wurde bei einem duktalen Mammakarzinom pT1, das falsch-positive Ergebnis bei einer fibrös zystischen Mastopathie beobachtet; alle fünf Fibroadenome zeigten ebenfalls einen pathologischen Tetrofosmin-uptake. Die Sensitivität der Tc-99m-Tetrofosmin-Mammoszintigraphie in der vorliegenden prospektiven Studie lag bei 91 %, die Spezifität bei 74%, der PVW bei 63% und der NVW bei 94%. Unsere vorläufigen Ergebnisse der Mammoszintigraphie bei Patienten mit pathologischer Mammographie zeigen, daß sich Tetrofosmin in Mammakarzinomen aber auch in Fibroadenomen anreichert. Der hohe negative Voraussagewert der Mammoszintigraphie von 94% schließt bei pathologischer Mammographie das Vorliegen eines Mammakarzinoms mit hoher Wahrscheinlichkeit aus. Schlußfolgerung: Die Mammoszintigraphie mit Tc-99m-Tetrofosmin könnte daher in der Zukunft die Bedeutung als weiterer diagnostischer Schritt vor Durchführung einer chirurgisch/histologischen Abklärung bekommen, wenn die Mammographie oder Sonographie eine pathologische Veränderung zeigt.

Keywords

Scintimammography - Tc-99m-tetrofosmin - breast cancer

Schlüsselwörter

Mammoszintigraphie - Tc-99m-Tetrofosmin - Mammakarzinom

Full Text

References

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