Spanu Angela, Schillaci Orazio, Meloni Giovanni Battista, Porcu Alberto, Cottu Pierina, Nuvoli Susanna, Falchi Antonio, Chessa Francesca, Solinas Maria Elisabetta, Madeddu Giuseppe
Department of Nuclear Medicine, University of Sassari, I-07100 Sassari, Italy.
Int J Oncol. 2002 Oct;21(4):831-40.
The aim of this study was to evaluate the usefulness of supine 99mTc-tetrofosmin SPECT in the detection of small size breast carcinomas (BC), for which planar scintimammography has showed a low sensitivity. We studied 93 patients with breast lesions </=10 mm, 69 with BC (14 T1a and 55 T1b, 39 palpable and 30 non-palpable) and 24 with benign lesions (16 palpable and 8 non-palpable). All patients had previously undergone clinical examination and mammography. Ten min after 740 MBq 99mTc-tetrofosmin i.v. injection, both planar and SPECT (360 degrees; angular step: 3 degrees; acquisition time/frame: 30 sec) scintimammography were performed in all patients using a rectangular dual head gamma camera equipped with HR parallel-hole collimators. In all patients the scintigraphic data were related to histology. In the 69 BC patients, SPECT showed a significantly higher overall sensitivity than planar (89.8% vs. 46.4%; p<0.0005). SPECT gave a higher sensitivity than planar in both T1a (71.4% vs. 35.7%) and T1b (94.5% vs. 49.1%) carcinomas, and in the latter the difference was statistically significant (p<0.0005). SPECT sensitivity was also significantly higher in palpable (94.9% vs. 48.7%; p<0.0005) and non-palpable (83.3% vs. 43.3%; p<0.005) carcinomas. SPECT and planar imaging showed the same specificity (95.8%). SPECT showed a significantly higher overall negative predictive value and accuracy than planar (76.7% vs. 38.3% and 91.4% vs. 59.1%, respectively; p<0.0005). In our series mammography sensitivity, specificity and accuracy were 94, 36.8 and 81.4%, respectively. 99mTc-tetrofosmin SPECT is a widely available diagnostic method and appears highly accurate in the detection of small size BC, improving the low sensitivity of planar scintimammography. In particular, SPECT seems indicated for T1b carcinoma detection, although its usefulness in T1a carcinomas should not be ignored. A larger clinical application of SPECT as complementary tool to mammography is suggested in small size primary BC diagnosis.
本研究的目的是评估仰卧位99mTc-替曲膦单光子发射计算机断层扫描（SPECT）在检测小尺寸乳腺癌（BC）方面的实用性，对于此类乳腺癌，平面乳腺闪烁显像已显示出较低的敏感性。我们研究了93例乳腺病变≤10 mm的患者，其中69例为乳腺癌（14例T1a期和55例T1b期，39例可触及和30例不可触及），24例为良性病变（16例可触及和8例不可触及）。所有患者之前均接受过临床检查和乳腺X线摄影。静脉注射740 MBq 99mTc-替曲膦10分钟后，使用配备高分辨率平行孔准直器的矩形双头γ相机对所有患者进行平面和SPECT（360度；角度步长：3度；采集时间/帧：30秒）乳腺闪烁显像。在所有患者中，闪烁显像数据均与组织学相关。在69例乳腺癌患者中，SPECT显示出的总体敏感性显著高于平面显像（89.8%对46.4%；p<0.0005）。在T1a期（71.4%对35.7%）和T1b期（94.5%对49.1%）乳腺癌中，SPECT的敏感性均高于平面显像，且在T1b期中差异具有统计学意义（p<0.0005）。在可触及（94.9%对48.7%；p<0.0005）和不可触及（83.3%对43.3%；p<0.005）乳腺癌中，SPECT的敏感性也显著更高。SPECT和平面显像显示出相同的特异性（95.8%）。SPECT显示出的总体阴性预测值和准确性显著高于平面显像（分别为76.7%对38.3%和91.4%对59.1%；p<0.0005）。在我们的系列研究中，乳腺X线摄影的敏感性、特异性和准确性分别为94%、36.8%和81.4%。99mTc-替曲膦SPECT是一种广泛可用的诊断方法，在检测小尺寸乳腺癌方面显示出高度准确性，提高了平面乳腺闪烁显像的低敏感性。特别是，SPECT似乎适用于T1b期乳腺癌的检测，尽管其在T1a期乳腺癌中的作用也不应被忽视。建议在小尺寸原发性乳腺癌诊断中更广泛地应用SPECT作为乳腺X线摄影的补充工具。
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