Papantoniou V, Christodoulidou J, Papadaki E, Valotassiou V, Souvatzoglou M, Louvrou A, Feida H, Sotiropoulou M, Pampouras G, Michalas S, Zerva C
Department of Nuclear Medicine, Alexandra Hospital, University of Athens, Greece.
Nucl Med Commun. 2002 May;23(5):461-7. doi: 10.1097/00006231-200205000-00006.
This study was performed to investigate the relationship between histological type and grade, with the uptake and washout of 99mTc-hexakis-2-methoxyisobutylisonitrile (99mTc-sestamibi, 99mTc-MIBI) and 99mTcV-dimercaptosuccinic acid (99mTcV-DMSA) in breast cancer. Forty-five patients with histologically proven breast cancer had previously been referred for 99mTcV-DMSA and/or 99mTc-MIBI scintimammography. Twenty-five of them underwent both 99mTcV-DMSA and 99mTc-MIBI scintigraphy in a double phase study. Lateral prone and anterior supine images were acquired at 15 and 60 min after administration of 740-925 MBq of each radiotracer. Uptake ratios and retention index were calculated and correlated with histology and grade of malignancy. Histology showed eight different histotypes: 77.7% were infiltrating ductal or lobular carcinomas. Mammography was definitely positive in 32/45, indeterminate in 10 and negative in three cases (sensitivity 71%). 99mTcV-DMSA was true positive in 37/40 (sensitivity 92.5%) and 99mTc-MIBI in 28/30 (sensitivity 93.3%) breast cancers. Uptake ratios were significantly higher in ductal than in lobular carcinomas on 99mTcV-DMSA and 99mTc-MIBI scintigrams at early and delayed phases. Grade II carcinomas had significantly lower values of retention index (rapid washout) than grade III carcinomas. This finding was statistically significant only on 99mTc-MIBI scans and was observed in ductal and lobular carcinomas. The retention index did not show any significant difference between ductal and lobular carcinomas. Uptake ratios were also not statistically different between grade II and III cancers. It is concluded that 99mTc-MIBI and 99mTcV-DMSA uptake in breast cancer is probably related to histological type and may distinguish ductal from lobular carcinomas. To a certain degree, the washout rate may reflect the histological grade, but since grade is not the only factor influencing this phenomenon it should be explored further in conjunction with other parameters by multivariate analysis in order to clarify eventual indirect correlations.
本研究旨在探讨乳腺癌的组织学类型和分级与99m锝-六甲基异丁基异腈（99mTc-甲氧基异丁基异腈，99mTc-MIBI）及99m锝-二巯基丁二酸（99mTcV-DMSA）摄取和洗脱之间的关系。45例经组织学证实的乳腺癌患者此前已被转诊接受99mTcV-DMSA和/或99mTc-MIBI乳腺闪烁显像检查。其中25例患者在双时相研究中同时接受了99mTcV-DMSA和99mTc-MIBI闪烁扫描。在给予每种放射性示踪剂740 - 925MBq后15分钟和60分钟采集侧卧位俯卧位和仰卧位前位图像。计算摄取率和滞留指数，并将其与组织学和恶性程度分级相关联。组织学显示有八种不同的组织学类型：77.7%为浸润性导管癌或小叶癌。乳腺X线摄影在32/45例中明确为阳性，10例为不确定，3例为阴性（敏感性71%）。99mTcV-DMSA在40例乳腺癌中真阳性为37例（敏感性92.5%），99mTc-MIBI在30例中真阳性为28例（敏感性93.3%）。在99mTcV-DMSA和99mTc-MIBI闪烁扫描的早期和延迟期，导管癌的摄取率显著高于小叶癌。II级癌的滞留指数值（洗脱快）显著低于III级癌。这一发现仅在99mTc-MIBI扫描中具有统计学意义，且在导管癌和小叶癌中均观察到。导管癌和小叶癌之间的滞留指数未显示出任何显著差异。II级和III级癌之间的摄取率在统计学上也无差异。结论是，乳腺癌中99mTc-MIBI和99mTcV-DMSA摄取可能与组织学类型有关，并且可能区分导管癌和小叶癌。在一定程度上，洗脱率可能反映组织学分级，但由于分级不是影响这一现象的唯一因素，因此应通过多变量分析结合其他参数进一步探索，以阐明最终的间接相关性。
