Vol.12, No 1, 2005 pp. 23 - 27
UC 618.19-006.6-073
SCINTIMAMMOGRAPHY WITH 99mTc
SESTAMIBI IN BREAST CANCER
Zvezdana Rajkovača1,2, Jasenka
Mijatović1,
Amela Matavulj2, Peđa Kovačević2,
Nenad Ponorac2
1Department
of Nuclear Medicine, Banja Luka Clinical Center, Bosnia and Herzegovina
2Department
of Physiology, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
E-mail: zvezdana@blic.net
Summary. Physical breast examination and mammography are
currently
the most recognized and most frequently used screening tools for
detection
of breast cancer. Breast mammography has some limitations.
Scintimammography
using 99mTc sestamibi has been shown to have the potential to reduce
the
number of false negative mammography findings and also has a comparable
diagnostic accuracy in patients with radiologically dense breasts and
those
with non-dense breasts. The aim of this study was to investigate the
contribution
of scintimammography with 99mTc sestamibi in the diagnosis of breast
cancer.
Forty-two (42) women (median age 46 years, range 21-78 years) with
clinical
and/or mammographic and/or cytological suspicion of breast cancer were
investigated. All of them underwent clinical investigation,
ultrasonography,
mammography, and level of tumor markers - CA15.3 and CEA, fine needle
aspiration
cytology (FNA) and scintimammography before the surgery. The final
diagnosis
was determined by histopathological examination. A dose of 740 MBq of
99mTc
sestamibi for scintimammography was injected into a foot vein. Imaging
was performed 10 minutes after injection. The results of
scintimammography
were compared with histopathology. The histopathological findings were
malignant in 33 (78.6%) and benign in 9 (21.4%) cases.
Scintimammography
showed true positive findings in 31 (73.8%) cases with breast cancer.
Scintimammography
was negative in 2 cases with breast cancer (1 - invasive ductal
carcinoma,
2 � invasive lobular carcinoma). True negative findings with no focally
increased uptake were found in 8 (88.9%) cases with benign conditions.
Scintimamography was suspicious for malignancy in 1 (11.1%) case with
benign
lesions (pathohistology � fibroadenoma). The diagnostic positive
predictive
value, negative predictive value, sensitivity specificity and accuracy
of 99mTc sestamibi scintimammography were 93.9%, 80%, 93.9%, 88.9 and
92.9%,
respectively. 99mTc sestamibi imaging had high sensitivity and
accuracy
in the diagnosis of breast cancer. It could provide reliable
information
in confirming the diagnosis in patients with clinically suspected
breast
cancer.
Key words: Scintimammography, sestamibi, breast cancer
SCINTIMAMOGRAFIJA 99MTc
SESTAMIBIJEM
KOD KARCINOMA DOJKE
Kratak sadržaj: Najčešće korištene i poznate skrining metode za
otkrivanje karcinoma dojke danas su klinički pregled dojki i
mamografija.
Mamoghrafija ima izvjesna ograničenja. Utvrđeno je da scintimamografija
sa 99mTc sestamibijem ima mogućnosti da smanji broj lažno negativnih
nalaza
mamografije kao i da ima istu dijagnostičku tačnost kod bolesnica sa
mamografski
detektovanim veoma gustim dojkama kao i kod onih kod kojih dojke na
mamografiji
nisu guste. Cilj ove studije je da utvrdi doprinos scintimamografije sa
99mTc sestamibijem u dijagnostici karcinoma dojke.
U studiju su uključene četrdest dve (42) žene (srednje životne dobi
od 46 godina, starosti 21-78 godina) sa kliničkom i/ili mamografskom
i/ili
citološkom sumnjom da imaju karcinom dojke. Sve one su podvrgnute
kliničkom
pregledu, ehotomografiji dojki, mamografiji, određivanju vrijednosti
tumor
markera�CA 15.3 i CEA, punkciji čvora u dojci i scintimamografiji prije
upućivanja na operativni zahvat. Konačna dijagnoza je postavljena
histopatološkim
pregledom. Doza od 740 MBq 99mTc sestamibija za scintimamografiju
je inicirana u venu na stopalu. Slikanje je započeto 10 minuta nakon
injiciranja.
Rezultati scintimamografije su upoređivani sa histopatološkim nalazom.
Histopatološki nalaz je pokazao malignu leziju u 33 (78,6%) i benignu
u 9 (21,4%) slučajeva. Scintimamografija je bila tačno pozitivna u 31
(73,8%)
slučaju karcinoma dojke. Scintimamografija je bila negativna u 2
slučaja
karcinoma dojke (1-invazivni duktalni karcinom i 2-invazivni lobularni
karcinom). Tačno negativan nalaz karakteriziran izostankom
lokaliziranog
nakupljanja radiofarmaka u dojci je nađen u 8 (88,9%) slučajeva sa
benignom
lezijom. Scintimamografija je pokazala sumnju na malignitet u 1 (11,1%)
slučaju benigne lezije (patohistološki nalaz-fibroadenom). Pozitivna
prediktivna
vrijednost, negativna prediktivna vrijednost, senzitivnost,
specifičnost
i tačnost 99mTc sestamibi scintimamografije je bila 93,9%, 80%, 93,9%,
88,9% i 92,9%.
99mTc sestamibi scintimamografija ima veliku senzitivnost i tačnost
u dijagnostici karcinoma dojke. Ona može obezbjediti pouzdane podatke u
potvrđivanju dijagnoze kod bolesnika sa kliničkom sumnjom na karcinom
dojke.
Ključne reči: Scintimamografija, sestamibi, karcinom dojke
