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. 2005 Jul 27:5:4.
doi: 10.1186/1471-2385-5-4.

Planar Tc99m--sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: results of an international multicenter trial

Teresa Massardo  1 , Omar Alonso, Augusto Llamas-Ollier, Levin Kabasakal, Uma Ravishankar, Rossana Morales, Lucía Delgado, Ajit K Padhy
Affiliations

Planar Tc99m--sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: results of an international multicenter trial

Teresa Massardo et al. BMC Nucl Med. .

Abstract

Background: Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was performed.

Methods: One hundred and forty-nine female patients were included prospectively from different regions. Their mean age was 55.1 +/- 11.9 years. Histological report was obtained from 2.987 excised lymph nodes from 150 axillas. An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients, all images performed with 740-925 MBq dose of Tc99m sestamibi. Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla. Diagnostic values, 95% confidence intervals [CI] and also likelihood ratios (LR) were calculated.

Results: Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes. Sestamibi was positive in 30 axillas (25 true-positive) and negative in 120 (only 55 true-negative). The sensitivity corresponded to 27.8% [CI = 18.9-38.2] and specificity to 91.7% [81.6-97.2]. The positive and negative LR were 3.33 and 0.79, respectively. There was no difference between early and delayed images. Sensitivity was higher in patients with palpable lesions.

Conclusion: This work confirmed that non tomographic Tc99m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer.

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Figures

Figure 1
Figure 1
Tc99m sestamibi performance according to axillary status.
Figure 2
Figure 2
Comparison between axillary results in early and delayed Tc99m sestamibi in 95 patients.
See this image and copyright information in PMC

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