Role of 99mTc-sestamibi scintimammography in reducing the number of breast biopsies in patients with mammograms suggesting breast cancer.

F Lumachi, MD,a, SMM Basso, MD, a, MC Marzola, MD, b, P Zucchetta, MD, b, AA Brandes, MD, c, F. Bui, MD, b

Department of Surgical & Gastroenterological Sciences, University of Padua, School of Medicine, 35128 Padova, Italy

Background: Since several patients with suspicious mammograms do not have breast cancer (BC), additional imaging tests are necessary to avoid invasive procedures. The aim of this study was to analyze whether the use of 99mTc-sestamibi scintimammography (SSM) in conjunction with X-ray mammography (MG) may improve the results obtained using a single test. Methods: A series of 102 women (median age 51 years, range 32-86) who underwent both MG and SSM prior to surgery was reviewed. At histological examination 75 (73.5%) patients (median age 52 years, range 32-86) had BC: pT1a=1 (1.4%), pT1b=16 (21.3%9, pT1c=31 (41.3%), pT2=27 (36.0%). Moreover, 27 (27.5%) patients (median age 51 years, range 37-79) had benign breast lesions. Results: There was no difference (p=NS) in the age of the patients between the two subgroups. Sensitivity, negative predictive value (NPV) and accuracy were 85.3%, 60.7% and 79.4% for MG, and 80.0%, 63.4% and 84.3% for SSM (p=NS). Both the specificity and the positive predictive value (PPV) of SSM were significantly (p<0.05) higher in respect of MG (96.3% vs 62.9%, and 98.4% vs 86.5%, respectively). The sensitivity of MG and SSM together was 94.7%, significantly (p<0.05) improving the sensitivity of single tests. Conclusions: The combination of MG and SSM may potentially reduce unnecessary surgical procedures by more than 35% in patients with mammograms suggesting BC who had been selected for open breast biopsy. Thus, SSM should be considered complementary to MG as an additional noninvasive imaging test.

KEY WORDS: Breast cancer diagnosis, Scintimammography, Mammography.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Diagnostic Markers.