Jaukovic Ljiljana Dj, Ajdinovic Boris Z, Jankovic Zoran D, Strbac Miroslav
Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia and Montenegro.
Nucl Med Rev Cent East Eur. 2006;9(1):30-6.
The aim of this study was to evaluate the accuracy of breast cancer seeking agent Tc-99m-Tetrofosmin in the detection of breast malignancy and axillary lymph node metastases.
Twenty-eight female patients (mean age 52.4) with 30 breast lesions suspected of malignancy were enrolled in the study. All the patients underwent clinical investigation, Tc-99m Tetrofosmin scintimammography (SMM), mammography (MM) and biopsy/surgery for final histopathologic diagnosis. Patients were injected intravenously with 555 MBq of Tc-99m Tetrofosmin, cubitally, in the contralateral arm to the side of suspicious lesion. Seven minute static scans or at least 2.0 million counts were obtained using single head gamma camera (Orbiter 75, Siemens). Planar images were acquired in left and right prone lateral view as well as in the supine position for an anterior view of chest and axillary region.
SMM scans of 30 breast lesions were compared to the definitive histopathology findings (HP) using decision matrix. In the group of 23 patients with positive SMM scans 19 had breast malignancy: 15 infiltrating ductal cancer, three patients with one infiltrating lobular, one papillary, one colloidal cancer and one patient with cystosarcoma phyllodes-malignant type. SMM detected primary breast malignancy with 95% sensitivity, 60% specificity and 83% accuracy. Axillary dissection was performed in 19/20 with malignant disease. The number of lymph nodes extracted and HP evaluated varied from 4 to 23 per patient. Metastatic involvement was confirmed by HP in 9 out of 20 patients. SMM detected axillary metastases with 55% sensitivity and 80% accuracy.
Our results showed that SMM might be useful as a complementary test to improve the sensitivity and specificity of conventional imaging modalities, although SMM in the staging of breast carcinoma was less reliable. Further studies to evaluate the role of SMM in metastatic node involvement are necessary.
本研究的目的是评估乳腺癌寻靶剂锝-99m-替曲膦在检测乳腺恶性肿瘤及腋窝淋巴结转移方面的准确性。
28例女性患者（平均年龄52.4岁），共30处乳腺病变疑似为恶性，被纳入本研究。所有患者均接受了临床检查、锝-99m替曲膦乳腺闪烁显像（SMM）、乳腺X线摄影（MM）以及活检/手术以进行最终的组织病理学诊断。患者在对侧手臂肘前静脉注射555MBq的锝-99m替曲膦，该侧为可疑病变侧。使用单探头γ相机（Orbiter 75，西门子）进行7分钟静态扫描或至少采集200万计数。在左右俯卧侧位以及仰卧位采集胸部和腋窝区域的平面图像，以获得前位图像。
使用决策矩阵将30处乳腺病变的SMM扫描结果与最终组织病理学结果（HP）进行比较。在SMM扫描呈阳性的23例患者中，19例患有乳腺恶性肿瘤：15例浸润性导管癌、3例浸润性小叶癌、1例乳头状癌、1例胶样癌以及1例恶性叶状囊肉瘤患者。SMM检测原发性乳腺恶性肿瘤的敏感性为95%，特异性为60%，准确性为83%。19/20例患有恶性疾病的患者进行了腋窝清扫术。每位患者提取的淋巴结数量以及评估的HP各不相同，范围为4至23个。20例患者中有9例经HP证实有转移累及。SMM检测腋窝转移的敏感性为55%，准确性为80%。
我们的结果表明，SMM可能作为一种辅助检查手段，有助于提高传统成像方式的敏感性和特异性，尽管SMM在乳腺癌分期方面的可靠性较低。有必要进一步开展研究以评估SMM在转移淋巴结累及方面的作用。
