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Vaz SC, Corion CLS, Goeman J, Zeillemaker AM, Hezemans R, de Geus-Oei LF, Pereira Arias-Bouda LM. Can Molecular Breast Imaging With Tc-99m Sestamibi Safely Rule Out Malignancy in Pathologic Nipple Discharge? Clin Nucl Med 2025:00003072-990000000-01693. [PMID: 40302123 DOI: 10.1097/rlu.0000000000005851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 02/18/2025] [Indexed: 05/01/2025]
Abstract
PURPOSE Nipple discharge is the third most common breast-related complaint. It is recommended to exclude malignancy in pathologic nipple discharge (PND). Mammography and ultrasound are the first-line conventional diagnostic (CD) imaging. Although magnetic resonance is often used as a complementary modality, molecular breast imaging (MBI) with Tc-99m sestamibi may be a suitable alternative. Considering the lack of information on this subject and its clinical importance, this study aimed to evaluate the role of MBI in ruling out malignancy in patients with PND and negative/indeterminate CD. PATIENTS AND METHODS Retrospective cohort single-center study including all patients with PND evaluated by CD and MBI between 2012 and 2020. Pathology was considered the gold standard. Follow-up was used when pathology was not available. RESULTS Of the 96 cases of PND included, 78 were benign, and 18 (20%) corresponded to breast cancer (BC). Although CD and MBI were concordant in the BIRADS classification in 81% (78/96), half of BC were detected by MBI only. BC was located directly behind the nipple in a minority of patients (11%), meaning that MBI could significantly prevent futile central ductal excision. MBI presented higher sensitivity (83% vs. 33%) and negative predictive value (96% vs. 86%) than CD alone, with similar specificity (89% vs. 92%) and positive predictive value (63% vs. 50%). The area under the curve of MBI and CD was 0,86 (P-value<0.001 [95% CI: 0.75-0.97]) and 0.63 (P-value=0.091 [95% CI: 0.47-0.79]), respectively. CONCLUSIONS MBI showed good diagnostic accuracy for detecting BC in patients with PND with negative/indeterminate findings on CD imaging.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
- Department of Radiology, Leiden University Medical Center, Leiden
| | | | - Jelle Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden
| | | | - Rachel Hezemans
- Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden
- Biomedical Photonic Imaging Group, University of Twente, Enschede
- Department of Radiation Science & Technology, Delft University of Technology, Delft
| | - Lenka M Pereira Arias-Bouda
- Department of Radiology, Leiden University Medical Center, Leiden
- Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp
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Patel MM, Adrada BE, Guirguis MS, Whitman G, Moseley TW, Rauch GM. Current Concepts in Molecular Breast Imaging. JOURNAL OF BREAST IMAGING 2025; 7:104-118. [PMID: 39692400 PMCID: PMC11918265 DOI: 10.1093/jbi/wbae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 12/19/2024]
Abstract
Molecular breast imaging (MBI) is a functional imaging modality that utilizes technetium 99m sestamibi radiotracer uptake to evaluate the biology of breast tumors. Molecular breast imaging can be a useful tool for supplemental screening of women with dense breasts, for breast cancer diagnosis and staging, and for evaluation of treatment response in patients with breast cancer undergoing neoadjuvant systemic therapy. In addition, MBI is useful in problem-solving when mammography and US imaging are insufficient to arrive at a definite diagnosis and for patients who cannot undergo breast MRI. Based on the BI-RADS lexicon, a standardized lexicon has been developed to aid radiologists in MBI reporting. In this article, we review MBI equipment, procedures, and lexicon; clinical indications for MBI; and the radiation dose associated with MBI.
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Affiliation(s)
- Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary S Guirguis
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tanya W Moseley
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gaiane M Rauch
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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van de Burgt A, van Velden FHP, Corion CLS, Collarino A, Olmos RAV, Smit F, de Geus-Oei LF, Arias-Bouda LMP. Comparison Between Prone SPECT-Based Semi-Quantitative Parameters and MBI-Based Semi-Quantitative Parameters in Patients with Locally Advanced Breast Cancer. Mol Imaging Biol 2024; 26:926-933. [PMID: 39516430 PMCID: PMC11634910 DOI: 10.1007/s11307-024-01959-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/16/2024] [Accepted: 10/10/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE This study evaluates the semi-quantitative single-photon emission computed tomography (SPECT) parameters of prone SPECT using [99mTc]Tc-sestamibi and compares them with Molecular Breast Imaging (MBI)-derived semi-quantitative parameters for the potential use of response prediction in women with locally advanced breast cancer (LABC). PROCEDURES Patients with proven LABC with a tumor ≥ 2 cm on mammography and an indication for MBI using [99mTc]Tc-sestamibi were prospectively enrolled. All patients underwent a prone SPECT/CT at 5 min (early exam) and an additional scan at 90 min (delayed exam) after injection of 600 MBq [99mTc]Tc-sestamibi to compose wash-out rates (WOR). All patients underwent MBI after early SPECT/CT. Volumes of interest of the primary tumor were drawn semi-automatically on early and delayed SPECT images. Semi-quantitative analysis included maximum and mean standardized uptake values (SUVmax, SUVmean,), functional tumor volume (FTVSPECT), total lesion mitochondrial uptake (TLMU), tumor-to-background ratios (TBRmax and TBRmean), WOR and coefficient of variation (COVSPECT). Subsequently, the FTVSPECT, TBRSPECT and COVSPECT were compared to FTVMBI, TBRMBI and COVMBI. RESULTS Eighteen patients were included. Early SUVmax, and TBRmax showed significantly higher interquartile range (IQR) compared to SUVmean and TBRmean, respectively 2.22 (2.33) g/mL, 6.86 (8.69), 1.29 (1.39) g/mL and 3.99 (5.07) (median (IQR), p < 0.05). WOR showed a large IQR (62.28), indicating that there is WOR variation among the LABC patients. FTV showed no difference between MBI and early SPECT semi-quantitative parameter (p = 0.46). CONCLUSIONS In LABC patients it is feasible to obtain semi-quantitative parameters from prone SPECT/CT. The FTV derived from early prone SPECT/CT is comparable with MBI-based FTV. Studies with comprehensive clinical parameters are needed to establish the clinical relevance of these semi-quantitative parameters, including WOR, for response prediction before its use in clinical routine.
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Affiliation(s)
- Alina van de Burgt
- Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp, The Netherlands.
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Floris H P van Velden
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Renato A Valdés Olmos
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Frits Smit
- Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
| | - Lenka M Pereira Arias-Bouda
- Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Abstract
There is growing interest in application of functional imaging modalities for adjunct breast imaging due to their unique ability to evaluate molecular/pathophysiologic changes, not visible by standard anatomic breast imaging. This has led to increased use of nuclear medicine dedicated breast-specific single photon and coincidence imaging systems for multiple indications, such as supplemental screening, staging of newly diagnosed breast cancer, evaluation of response to neoadjuvant treatment, diagnosis of local disease recurrence in the breast, and problem solving. Studies show that these systems maybe especially useful for specific subsets of patients, not well served by available anatomic breast imaging modalities.
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Affiliation(s)
- Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA.
| | - Beatriz Elena Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA
| | - Amy M Fowler
- Department of Radiology, Section of Breast Imaging and Intervention, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Medical Physics, University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Gaiane M Rauch
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1473, Houston, TX 77030, USA; Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1473, Houston, TX 77030, USA
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Hruska CB, Corion C, de Geus-Oei LF, Adrada BE, Fowler AM, Hunt KN, Kappadath SC, Pilkington P, Pereira Arias-Bouda LM, Rauch GM. SNMMI Procedure Standard/EANM Practice Guideline for Molecular Breast Imaging with Dedicated γ-Cameras. J Nucl Med Technol 2022; 50:103-110. [PMID: 40168518 DOI: 10.2967/jnmt.121.264204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Christinne Corion
- Department of Surgery, Haaglanden Medical Center, The Hague, Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
| | - Beatriz E Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Katie N Hunt
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - S Cheenu Kappadath
- Department of Medical Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick Pilkington
- Department of Nuclear Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Lenka M Pereira Arias-Bouda
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Nuclear Medicine, Alrijne Hospital, Leiderdorp, Netherlands
| | - Gaiane M Rauch
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands
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Hunt KN. Molecular Breast Imaging: A Scientific Review. JOURNAL OF BREAST IMAGING 2021; 3:416-426. [PMID: 38424795 DOI: 10.1093/jbi/wbab039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Indexed: 03/02/2024]
Abstract
Molecular breast imaging (MBI) is a nuclear medicine technique that has evolved considerably over the past two decades. Technical advances have allowed reductions in administered doses to the point that they are now acceptable for screening. The most common radiotracer used in MBI, 99mTc-sestamibi, has a long history of safe use. Biopsy capability has become available in recent years, with early clinical experience demonstrating technically successful biopsies of MBI-detected lesions. MBI has been shown to be an effective supplemental screening tool in women with dense breasts and is also utilized for breast cancer staging, assessment of response to neoadjuvant chemotherapy, problem solving, and as an alternative to breast MRI in women who have a contraindication to MRI. The degree of background parenchymal uptake on MBI shows promise as a tool for breast cancer risk stratification. Radiologist interpretation is guided by a validated MBI lexicon that mirrors the BI-RADS lexicon. With short interpretation times, a fast learning curve for radiologists, and a substantially lower cost than breast MRI, MBI provides many benefits in the practices in which it is utilized. This review will discuss the current state of MBI technology, clinical applications of MBI, MBI interpretation, radiation dose associated with MBI, and the future of MBI.
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Affiliation(s)
- Katie N Hunt
- Mayo Clinic, Department of Radiology, Rochester, MN, USA
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Adrada BE, Moseley T, Kappadath SC, Whitman GJ, Rauch GM. Molecular Breast Imaging-guided Percutaneous Biopsy of Breast Lesions: A New Frontier on Breast Intervention. JOURNAL OF BREAST IMAGING 2020; 2:484-491. [PMID: 33015619 DOI: 10.1093/jbi/wbaa057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 01/29/2023]
Abstract
Molecular breast imaging (MBI) is an increasingly recognized nuclear medicine imaging modality to detect breast lesions suspicious for malignancy. Recent advances have allowed the development of tissue sampling of MBI-detected lesions using a single-headed camera (breast-specific gamma imaging system) or a dual-headed camera system (MBI system). In this article, we will review current indications of MBI, differences of the two single- and dual-headed camera systems, the appropriate selection of biopsy equipment, billing considerations, and radiation safety. It will also include practical considerations and guidance on how to integrate MBI and MBI-guided biopsy in the current breast imaging workflow.
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Affiliation(s)
- Beatriz E Adrada
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - S Cheenu Kappadath
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Gary J Whitman
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
| | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
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Urbano N, Scimeca M, Bonanno E, Schillaci O. 99mTc sestamibi SPECT: a possible tool for early detection of breast cancer lesions with high bone metastatic potential. Future Oncol 2019; 15:455-457. [PMID: 30618271 DOI: 10.2217/fon-2018-0735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nicoletta Urbano
- Nuclear Medicine, Policlinico "Tor Vergata", viale Oxford, 81, 00133, Rome, Italy
| | - Manuel Scimeca
- Department of Biomedicine & Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy.,IRCCS San Raffaele, Rome, Italy
| | - Elena Bonanno
- IRCCS San Raffaele, Rome, Italy.,Department of Experimental Medicine & Surgery, University of Rome "Tor Vergata", Via Montpellier, 1, 00133 Rome, Italy.,IRCCS Neuromed Lab. "Diagnostica Medica" & "Villa dei Platani", Avellino, Italy
| | - Orazio Schillaci
- Department of Biomedicine & Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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