Nuclear imaging of the breast: translating achievements in instrumentation into clinical use

Abstract

Approaches to imaging the breast with nuclear medicine and∕or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed.

Figure 1

A cadmium zinc telluride (CZT)-based detector. Collimator and cover plate have been removed to show the 5 × 5 array of CZT modules giving a 20 × 20 cm imaging detector. Each CZT module comprises 16 × 16 array of 2.5 × 2.5 mm pixels.

Figure 2

Lateral view of a benign breast cyst with inflammation. Images were acquired using a conventional gamma camera (scintimammography) (left) and a dedicated breast imaging gamma camera (right).

Figure 3

Dilon 6800 gamma camera for breast specific gamma imaging (BSGI). (courtesy of Dilon Diagnostics)

Figure 4

(a) Gamma Medica Lumagem 3200s system (courtesy of Gamma Medica, Inc.). (b) GE Discovery NM750b system (courtesy of GE Healthcare).

Figure 5

Naviscan PEM-FLEX Solo II system (courtesy of Naviscan).

Figure 6

Oncovision Mammi-PEM system. Cover has been removed to show the 12 detector modules in a ring geometry (courtesy of Oncovision).

Figure 7

Multimodality single-photon systems. (a) Dual-modality breast tomosynthesis (DMT) system combining digital x-ray tomosynthesis and limited-angle SPECT. A small high-resolution gamma camera is mounted on a translation stage attached to the gantry arm. The configuration during gamma imaging is shown here. The camera is positioned anteriorly out of the x-ray beam during x-ray imaging. Image courtesy of Dr. Mark Williams, University of Virginia. (b) Combined SPECT/CT system developed at Duke University. Patient is positioned prone and breast is imaged with a small CZT based detector and CT system. Image courtesy of Dr. Martin Tornai, Duke University Medical Center.

Figure 8

Images of a patient with an invasive ductal carcinoma with lobular features obtained using a dedicated LYSO PET/CT system. The contrast enhanced CT, shown at top (coronal view at left and axial view at right), has been window to enhance appearance of benign cysts. The fused PET/CT image, at bottom, demonstrates F-18 FDG uptake in the extensive tumor. Image courtesy of Dr. Ramsey Badawi, University of California Davis.

Figure 9

A patient with a 2.2 cm invasive breast cancer was imaged with MBI prior to initiation of neoadjuvant chemotherapy (panel a) and again at 3 weeks after initiation (panel b). MBI performed at 3 weeks showed nearly complete resolution of the tumor, indicating a functional response to neoadjuvant chemotherapy. Surgery performed after four months of therapy showed complete pathological response (pCR), i.e., no residual in situ or invasive disease.

Figure 10

Two separate MBI studies performed in the same patient with a 10-mm invasive ductal carcinoma. MBI was performed using 150 MBq with a resolution recovery algorithm applied (panel a) and 300 MBq (panel b) Tc-99m sestamibi on a dual-head CZT-based gamma camera.

Figure 11

Images from a patient with two areas of confirmed ductal carcinoma in situ who had MBI performed with 300 MBq Tc-99m sestamibi (panel a) and 300 MBq Tc-99m alphaV beta 3 integrin (panel b).