Scintimammography using 99mTc sestamibi – use and limitations

2002 ◽  
Vol 41 (03) ◽  
pp. 148-156 ◽  
Author(s):  
R. Linke ◽  
M. Keßler ◽  
M. Untch ◽  
H. Sommer ◽  
K. Brinkbäumer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Physical Examination ◽  
Tumour Size ◽  
Tumour Response ◽  
Breast Lesions ◽  
Non Palpable Lesions ◽  
Definite Role ◽  
99Mtc Sestamibi ◽  
Response To Neoadjuvant Chemotherapy

Summary Aim: Until now scintimammography did not achieve any definite role in the assessment of breast lesions. Purpose of this study was to elaborate its use as well as the limitations of scintimammography after 500 examinations completed. Methods: Scintigraphic findings were correlated with the histopathologic outcome of 219 patients, who underwent surgery or biopsy for histopathological confirmation. The results were determined with respect to palpability of the lesion and tumour size. Additionally, a distinct analysis was performed for the patient subpopulation with indeterminate results of previously performed physical examination, mammography, and sonography. Results: Overall sensitivity for scintimammography was 82.1% at a specificity of 87.5%. For palpable lesions sensitivity was 91.7% which was evidently higher as compared to 64.9% for non palpable lesions. For palpable lesions specificity was 81.1% and 88.6% for non palpable lesions. According to tumour size sensitivity ranged between 65.2% for carcinoma with a diameter <1 cm and 93.7% for carcinoma >1 cm. In the patients subgroup with indeterminate preliminary diagnosis (n = 143) sensitivity decreased to 71.7% at a specificity of 87.8%. Patients undergoing neoadjuvant chemotherapy showed decreasing sestamibi uptake as early as 8 days after therapy if tumour response was evident. However, small residual invasive tumours in patients with complete remission could not be visualised. Conclusion: Scintimammography is neither suited for screening, nor early diagnosis of breast cancer, nor for the further evaluation of small and unclear mammographic findings. Scintimammography should not be used whenever histopathological clarification of a suspicious lesion is necessary. It is useful to further investigate patients with unclear or probably benign findings in physical examination and/or mammography and to monitor tumour response to neoadjuvant chemotherapy.

18F-FDG PET and 99mTc-sestamibi scintimammography for monitoring breast cancer response to neoadjuvant chemotherapy: a comparative study

2001 ◽  
Vol 28 (6) ◽  
pp. 711-720 ◽  
Author(s):  
Reinhold Tiling ◽  
Rainer Linke ◽  
Michael Untch ◽  
Almuth Richter ◽  
Siegrid Fieber ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Comparative Study ◽  
Fdg Pet ◽  
18F Fdg ◽  
99Mtc Sestamibi ◽  
Response To Neoadjuvant Chemotherapy

Tumor clearance of technetium 99m-sestamibi as a predictor of response to neoadjuvant chemotherapy for locally advanced breast cancer.

1998 ◽  
Vol 16 (5) ◽  
pp. 1677-1683 ◽  
Author(s):  
A Ciarmiello ◽  
S Del Vecchio ◽  
P Silvestro ◽  
M I Potena ◽  
M V Carriero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Response ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Advanced Breast ◽  
Tumor Clearance ◽  
99Mtc Sestamibi ◽  
Response To Neoadjuvant Chemotherapy

PURPOSE Since we have previously shown that the efflux rate of technetium 99m (99mTc) sestamibi, a transport substrate of P-glycoprotein (Pgp), is directly correlated with Pgp levels in untreated breast carcinoma, we tested whether tumor clearance of 9mTc-sestamibi may be predictive of therapeutic response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. PATIENTS AND METHODS Thirty-nine patients with stage III disease, median tumor diameter 5.8 cm (range, 3 to 10) were enrolled onto this prospective clinical trial and underwent 99mTc-sestamibi scan before neoadjuvant chemotherapy. Patients were injected intravenously (i.v.) with 740 MBq of 99mTc-sestamibi; a 15-minute dynamic study was performed, and static planar images were obtained at 0.5, 1, 2, and 4 hours. The time to half clearance of 99mTc-sestamibi was calculated in each patient from decay corrected time-activity curves using a monoexponential fitting. Patients were treated with epirubicin 150 mg/m2 i.v. every 2 weeks for three courses and then underwent surgery within 3 weeks from the completion of chemotherapy. Residual tumor was assessed by pathologic examination of mastectomy specimens. RESULTS Seventeen of 39 patients showed a rapid tumor clearance of 9mTc-sestamibi (time to half clearance [t1/2] < or = 204 minutes) and 15 of these 17 (88%) showed a highly cellular macroscopic residual tumor at histology that indicated lack of tumor response to neoadjuvant chemotherapy. In contrast, only eight of 22 (36%) with prolonged retention of 99mTc-sestamibi (t1/2 > 204 minutes) showed residual macroscopic tumor at histology (Fisher's exact test, P < .01). CONCLUSION A rapid tumor clearance of 99mTc-sestamibi may predict lack of tumor response to neoadjuvant chemotherapy with drugs affected by the multidrug-resistant phenotype in patients with locally advanced breast carcinoma.

scholarly journals Assessment of the predictive role of oestrogen and progesterone receptor status in breast cancer patients treated with neoadjuvant chemotherapy: A retrospective analysis for 689 patients

2020 ◽  
Author(s):  
Ying Ye ◽  
Rui Chen ◽  
Yong Fu ◽  
Yang Peng ◽  
Fanli Qu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Progesterone Receptor ◽  
Tumour Size ◽  
Tumour Response ◽  
Therapy Response ◽  
Breast Cancer Patients ◽  
Predictive Role ◽  
Her 2

Abstract Background : To explore the predictive indicators in hormone receptor (HR)-positive breast cancer (BC) patients receiving neoadjuvant chemotherapy (NACT) and to evaluate the value of quantitative oestrogen receptor (ER) and progesterone receptor (PR) in predicting tumour response. Methods : Six hundred eighty-nine BC patients with HR-positive status who were treated with anthracycline, epirubicin and taxane NACT treatment were retrospectively analysed. Clinical and pathological features of the patients were used to evaluate the response to NACT. Results : Patients with larger tumour sizes ( OR 1.657 CI 1.186-2.313 p=0.003 ), those who were in a premenopausal status ( OR 1.458 CI 1.039-2.045 p=0.029 ) and those with higher Ki67 levels ( OR 1.735 CI 1.231-2.444 p=0.002 ) exhibited a better therapy response. Among the patients in the postmenopausal subgroup, a lower pretreatment ER or PR expression were associated with a reduction in tumour size, and the cut-off values for ER and PR were 87.5% and 65%, respectively ( p=0.006 and p=0.05 ). Decreased expression of ER and PR was also observed after NACT treatment ( p=0.028 and p<0.001, respectively ) but played only a predictive role in the Her-2-negative subgroup; the cut-off values for decreased ER and PR were 17.5% and 26.5%, respectively ( p=0.044 and p<0.001 ). Conclusions : Semiquantified pretreatment HR expression can be used to predict the response of NACT in postmenopausal BC patients. Decreased ER and PR expression is also associated with a reduction in tumour size in Her-2-negative subtypes treated with NACT.

scholarly journals Diagnostic accuracy of MRI to evaluate tumour response and residual tumour size after neoadjuvant chemotherapy in breast cancer patients

2016 ◽  
Vol 50 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Alberto Bouzón ◽  
Benigno Acea ◽  
Rafaela Soler ◽  
Ángela Iglesias ◽  
Paz Santiago ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Residual Disease ◽  
Tumour Size ◽  
Tumour Response ◽  
Breast Mri ◽  
Residual Tumour ◽  
Breast Cancer Patients ◽  
Tumour Grade

Background The aim, of the study was to estimate the accuracy of magnetic resonance imaging (MRI) in assessing residual disease in breast cancer patients receiving neoadjuvant chemotherapy (NAC) and to identify the clinico-pathological factors that affect the diagnostic accuracy of breast MRI to determine residual tumour size following NAC. Patients and methods 91 breast cancer patients undergoing NAC (92 breast lesions) were included in the study. Breast MRI was performed at baseline and after completion of NAC. Treatment response was evaluated by MRI and histopathological examination to investigate the ability of MRI to predict tumour response. Residual tumour size was measured on post-treatment MRI and compared with pathology in 89 lesions. Clinicopathological factors were analyzed to compare MRI-pathologic size differences. Results The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosing invasive residual disease by using MRI were 75.00%, 78.57%, 88.89%, 57.89%, and 76.09% respectively. The Pearson’s correlation coefficient (r) between tumour sizes determined by MRI and pathology was r = 0.648 (p < 0.001). The size discrepancy was significantly lower in cancers with initial MRI size ≤ 5 cm (p = 0.050), in cancers with high tumour grade (p < 0.001), and in patients with hormonal receptor-negative cancer (p = 0.033). Conclusions MRI is an accurate tool for evaluating tumour response after NAC. The accuracy of MRI in estimating residual tumour size varies with the baseline MRI tumour size, the tumour grade and the hormonal receptor status.

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