technetium-tc-99m-tetrofosmin and Carcinoma--Ductal--Breast

Topics: Adult; Artifacts; Axilla; Biopsy; Breast Diseases; Breast Neoplasms; Carcinoma; Carcinoma, Ductal, Breast; Chemotherapy, Adjuvant; Drug Resistance, Multiple; Drug Resistance, Neoplasm; False Positive Reactions; Female; Forecasting; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Mammography; Middle Aged; Multicenter Studies as Topic; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Organophosphorus Compounds; Organotechnetium Compounds; Patient Selection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Ultrasonography

To assess the clinical value of (99m)Tc-tetrofosmin ((99m)Tc-TF) planar and single-photon emission computed tomography (SPECT) in comparison with ultrasonography in the diagnosis of breast cancer.. Fifty women underwent (99m)Tc-TF planar imaging, SPECT and ultrasonographic examinations, and with the results of histopathological examination as the golden standard, the diagnostic value of the 3 modalities were compared in the detection of malignancies of the breast neoplasms.. The sensitivity of planar imaging, SPECT and ultrasonography in breast cancer diagnosis was 74.2%, 93.5%, and 87.1%, with specificity of 66.7%, 77.3%, and 80.0%, respectively.. (99m)Tc-TF imaging is a new and effective method for diagnosis of breast cancer.

Topics: Adult; Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Mammary

Conventional imaging procedures have proved of limited value in assessing tumor response to neoadjuvant chemotherapy in locally advanced primary breast cancer (LAPBC). We evaluated the usefulness of radioisotopic procedures comparing planar scintimammography (SM) to SPECT, monitoring pre-surgery neoadjuvant chemo- or hormonotherapy response in 32 LAPBC patients. In all cases, 99mTc-tetrofosmin conventional planar SM and SPECT were acquired by dual-head gamma camera with HR parallel hole collimators. In 15 cases, planar SM with small field of view high resolution dedicated breast camera (DBC) was also acquired. Scintigraphic data always correlated with histopathological findings. At surgery, 4/32 patients had pathological complete remission (pCR), while 28/32 patients had residual tumors. Both conventional planar SM and SPECT were true negative in 4/4 (100%) pCR patients, as was DBC in the only studied case. Conventional planar SM and SPECT detected residual tumors in 23/28 (82%) and in 25/28 (89.2%) cases, respectively. Both procedures missed 2 multifocal, scattered microscopic residues, only evidenced at DBC. Conventional planar SM also missed 3 further macroscopic residues (15-20 mm), while SPECT only one of these, a mucinous BC, in which DBC was not performed. DBC correctly classified all other 12 patients in whom the procedure was performed. Both conventional planar SM and SPECT proved useful diagnostic tools in monitoring neoadjuvant chemo/hormono therapy response in LAPBC with SPECT appearing more sensitive; however, our data, although in a limited number of cases, suggest that sensitivity can further be increased using high resolution DBC, especially in detecting microscopic residual tumor foci.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Androstadienes; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Aromatase Inhibitors; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Female; Humans; Lymph Nodes; Mammography; Mass Screening; Middle Aged; Neoadjuvant Therapy; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

The purpose of this study was a retrospective survey of 40 patients with infiltrating ductal breast carcinoma to evaluate the relationships between the degree of accumulation of technetium-99m tetrofosmin (Tc-TF), multidrug resistance-related protein (MRP) expression and P-glycoprotein (Pgp) expression in breast cancer tissue. Immunohistochemical analysis (IHA) was performed on pathological specimens of the 40 breast cancers to determine Pgp and MRP expression. The results of IHA, were used as the basis for dividing the 40 breast cancers into four groups: A, 10 tumors with positive MRP and Pgp expressions; B, 10 tumors with positive MRP but negative Pgp expression; C, 10 tumors with negative MRP but positive Pgp expression; and D, 10 tumors with negative MRP and Pgp expression. All 40 patients had undergone Tc-TF mammoscintigraphy to calculate breast cancer uptake of Tc-TF to background uptake (T/B) ratios before IHA and surgery/biopsy. Of the four groups, group A had the lowest T/B ratios (1.15+/-0.10) and group D, the highest (2.19+/-0.15) (P<0.05). The T/B ratios in groups B (1.36+/-0.27) and C (1.37+/-0.26) were intermediate between those of groups A and D. In addition, the T/B ratios were statistically significantly lower in group A than in group B or C, and statistically significantly higher in groups D than in groups B or C (P<0.05). However, no significant difference in T/B ratio was found between groups B and C (P>0.05). Our results indicate that Tc-TF mammoscintigraphy is helpful for in vivo determination of Pgp and MRP expression in breast cancers.

Topics: Adult; Aged; ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Breast Neoplasms; Carcinoma, Ductal, Breast; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Female; Humans; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Random Allocation; Retrospective Studies

The aim of this study was to evaluate the usefulness of supine 99mTc-tetrofosmin SPECT in the detection of small size breast carcinomas (BC), for which planar scintimammography has showed a low sensitivity. We studied 93 patients with breast lesions

Topics: Adult; Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Male; Mammography; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

Topics: Breast Neoplasms, Male; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Exercise Test; Heart; Humans; Male; Mammary Neoplasms, Animal; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Thallium; Tomography, Emission-Computed, Single-Photon

We have investigated the usefulness of dual-isotope single photon emission computed tomography (SPECT) for predicting the response to chemotherapy in patients with breast cancer. Twenty-five patients with breast cancer were analyzed by SPECT using both 99m-technetium-tetrofosmin (99mTc-TF) and 201-thallium-chloride (201Tl). The relationship between response to chemotherapy and retention of each tracer was analyzed. 99mTc-TF retention was significantly higher in responders (42.0+/-37.9) than in non-responders (-11.3+/-34.6) (p=0.003). Ten of 13 patients (76.9%) with high 99mTc-TF retention (>15%) showed good response to chemotherapy, whereas 11 of 12 patients (91.7%) with low 99mTc-TF retention (<15%) did not respond to the therapy. The overall predictability to the response to chemotherapy was 84.0%. 201Tl retention (responders, 47.5+/-60.2% vs. non-responders, 55.8+/-45.0%; p=0.443) was not useful in therapeutic prediction, but was required to identify the lesion on the SPECT image. This is the first report to find that dual-isotope SPECT using 99mTc-TF and 201Tl is useful in predicting the response to chemotherapy in patients with breast cancer. Low 99mTc-TF retention is a strong predictor of therapeutic resistance, and high 99mTc-TF retention suggests a favorable response to chemotherapy.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Carcinoma, Ductal, Breast; Cyclophosphamide; Doxorubicin; Female; Humans; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiopharmaceuticals; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to assess the usefulness of techentium-99m tetrofosmin (Tc-TF) scintimammography to detect breast cancer in 32 female Taiwanese patients with indeterminate mammograpic probability of malignancy because of mammographyically dense breasts. All breast masses were removed and final histopathological diagnoses were obtained in all cases. The results showed that Tc-TF scintimammography findings were true-positive in 20 cases, false-positive in 1 case, true-negative in seven cases, and false-negative in four cases. The diagnostic sensitivity, specificity, and accuracy were 83, 88, and 84%, respectively, for detecting breast cancer in mammographically dense breasts. In conclusion, Tc-TF scintimammography is a useful tool for detecting breast cancer in patients with indeterminate mammograms because of mammographically dense breasts.

Topics: Adult; Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; False Negative Reactions; Female; Fibroadenoma; Humans; Mammography; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Papilloma, Intraductal; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

The aim of this study was to evaluate the usefulness of (99m)Tc-tetrofosmin single-photon emission tomography (SPET) in the detection of both primary breast cancer and axillary lymph node metastasis. We studied 192 consecutive patients in whom primary breast cancer was suspected on the basis of mammography and/or physical examination. After intravenous injection of 740 MBq (99m)Tc-tetrofosmin, both planar and SPET scintimammography was performed in all patients using a rectangular dual-head gamma camera equipped with low-energy, high-resolution, parallel-hole collimators. In 175 patients with breast cancer at histology, the per-lesion overall sensitivity of SPET and planar imaging for the detection of breast cancer was 95.8% and 75.9% (P<0.0005), respectively. The sensitivity of SPET and planar imaging was, respectively, 96.5% and 79.5% in palpable (P<0.0005) and 90% and 45% in non-palpable lesions (P<0.01). With regard to lesion size, the sensitivity of SPET and planar imaging was, respectively, 90.5% and 45.2% in lesions < or =10 mm ( P<0.0005), 95.3% and 81.4% in lesions of 11-20 mm (P<0.005), 100% and 84.6% in lesions of 21-30 mm (P<0.05) and 100% and 95.8% in lesions >30 mm (P>0.05). In the remaining 17 patients with benign mammary lesions at histology, per-lesion overall specificity of SPET and planar imaging was 76.2% and 85.7% (P>0.05), respectively. Neither SPET nor planar imaging showed false-positive results in non-palpable lesions or in those < or =10 mm. In 173 breast cancer patients submitted to axillary lymph node dissection (ALND), per-axilla overall sensitivity of SPET and planar imaging in the detection of axillary lymph node metastasis was 93% and 52.3% ( P<0.0005), respectively. The sensitivity of SPET and planar imaging was, respectively, 100% and 82.6% in palpable nodes (P>0.05), 90.5% and 41.3% in non-palpable nodes (P<0.0005), 92.8% and 35.7% in the presence of < or =3 nodes ( P<0.0005) and 93.2% and 68.2% in the presence of >3 nodes (P<0.005). The specificity of SPET and planar imaging was 91% and 100% (P<0.05), respectively. (99m)Tc-tetrofosmin SPET appears to be a reliable method for the detection of both primary BC and axillary lymph node metastasis, and its diagnostic accuracy exceeds that of (99m)Tc-tetrofosmin planar scintimammography. The use of SPET is particularly important in the identification of small non-palpable primary carcinomas and metastatic axillae with < or =3 non-palpable lymph nodes. More extensive use of SPE

Topics: Axilla; Breast Neoplasms; Breast Neoplasms, Male; Carcinoma, Ductal, Breast; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

We compared 99mTc-Tetrofosmin P-SPECT with radioguided SN biopsy in 101 T1/T2 BC pts to predict axillary lymph node status. The day before surgery all pts underwent lymphoscintigraphy (LS) to mark the SN, following subdermal injection of 99mTc-colloidal sulphur surrounding the breast lesion. LS was combined with pre and intraoperative gamma probe. Previously, all pts had also undergone P-SPECT. ALND was performed in all cases. The SN(s) was detected in 97/101 cases (96%) by LS and gamma probe; in the 4 missed cases P-SPECT predicted lymph node status. In the 97 comparable cases, radioguided SN biopsy showed a slightly higher accuracy than P-SPECT (94.8% vs 93.8%), but a higher false-negative rate (14.3% vs 8.6%); P-SPECT had a higher NPV (95.2% vs 92.5%). The two procedures when combined achieved 100% accuracy. Radioguided SN biopsy alone had 100% accuracy only in pts with BC < 15 mm. P-SPECT had 3 false negative cases, 2 of which were micrometastatic SNs, and 3 false positives. P-SPECT identified 81.2% of cases with a single node, determined the exact number of nodes in 82.6% of cases with 1 to 3 node and correctly classified 93.7% of pts as having < or = 3 or > 3 metastatic nodes. Radioguided SN biopsy seems indicated in selected, early stage, small BC pts, while P-SPECT shows a high sensitivity independent of primary tumor size, giving additional important preoperative prognostic information. The two procedures combined provided a better axillary lymph node status prediction in T1/T2 carcinomas, and could thus improve ALND pt selection.

Topics: Adult; Aged; Axilla; Biopsy, Needle; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Carcinoma, Medullary; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Tomography, Emission-Computed, Single-Photon

To assess the value of 99m-Tc-tetrofosmin (tetrofosmin) scintigraphy in patients with palpable and nonpalpable breast lesions.. Prospective, blinded trial. One hundred and fifty-nine consecutive patients with 163 breast lesions detected by clinical examination and mammography were included. Tetrofosmin scintigraphy of the breast was performed additionally to the regular diagnostic procedure. Using histologic assessment as the golden standard, sensitivity, specificity, positive and negative predictive value for tetrofosmin scintigraphy of the breast were assessed.. Overall sensitivity and specificity were 82% and 84%. The sensitivity for palpable tumors (65%) was 93% compared to 62% for non-palpable breast lesions. Malignant lesions were nearly twice as big as benign lesions (31.5 mm +/- 2.4 vs. 16.9 mm +/- 2.4). Specificity, positive and negative predictive value (84%, 89%, and 66%) did not differ significantly in palpable versus non-palpable tumors. Of malignant tumors 18% were found false negative by tetrofosmin scintigraphy.. The results suggest that tetrofosmin scintigraphy is a valuable tool for the evaluation of palpable breast cancer. In patients with non-palpable tumors, tetrofosmin scintigraphy may not add to the work-up of patients with breast cancer due to a low sensitivity rate.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Palpation; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Single-Blind Method

Breast cancer, the most common malignancy in women, still poses a challenge to diagnostic procedures and therapy. Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In the last years other additional diagnostic procedures such as high frequency ultrasonography (US) and especially magnetic resonance imaging (MRI) have improved breast cancer diagnosis. However, all these imaging methods are lacking in specificity which makes biopsy or surgery necessary. 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 in patients with suspicious mammographic lesions. One hundred and thirty seven patients in whom mammography and/or high resolution ultrasonography (10 MHz) revealed suspicious breast lesions were studied with Tc-99m tetrofosmin scintimammography. In 84 of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m tetrofosmin 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 (+2) or definitely (+3) positive. Planar scintimammography with Tc-99m tetrofosmin was negative in 46 patients (43 true negative-f.n; 3 false negative-f.n.) and positive in 38 patients (27 true positive-t.p.; 11 false positive-t.p.). Using SPECT imaging Tc-99m scintimammography was negative in 43 cases (41 t.n.; 2f.n.) and positive in 41 cases (28 t.p.; 13 t.p). Sensitivity of Tc-99m tetrofosmin scintimammography in this prospective study was 90%, specificity 80%, PPV 71% and NPV 93% for planar imaging and 93%, 76%, 68% and 95% for SPECT, respectively. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m tetrofosmin accumulates in breast cancer as well as in some fibroadenoma with high cellularity. However, the high NPV of 93 and 95% respectively excludes breast cancer in suspicious mammographic lesions to a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients.

Topics: Adenocarcinoma; Adult; Aged; Breast; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged; Neoplasms, Multiple Primary; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Mammary

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.. 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.. Fourtyeight patients in whom mammography and/or high resolution ultrasonography (10 MHz) 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 (+2) or definitely (+3) positive. Scintimammography with Tc-99m-tetrofosmin was negative in 18 patients (17 t.p., 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 results 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 mammographic lesions in a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients. 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.

Topics: Adult; Aged; Breast; Breast Diseases; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Fibrocystic Breast Disease; Humans; Mammography; Middle Aged; Necrosis; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Mammary