铊-201闪烁扫描术在可触及和不可触及乳腺病变评估中的应用：与乳房X线摄影及超声检查的相关性

201Tl scintigraphy in the evaluation of palpable and nonpalpable breast lesions: correlation with mammography and ultrasonography.

作者信息

Vural G, Atasever T, Ozdemir A, Oznur I, Karabacak N I, Gökçora N, Işik S, Unlü M

机构信息

Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Tüirkiye.

出版信息

Nuklearmedizin. 1997 Dec;36(8):282-8.

PMID:17068879

Abstract

AIM

Our goal was to determine the clinical usefulness of Tl-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings.

METHODS

Tl-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of Tl-201. Visual and semiquantitative interpretation was performed.

RESULTS

Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. Tl-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by Tl-201 scintigraphy. The smallest mass lesion detected by Tl-201 measured 1.5 x 1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. Tl-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed Tl-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated Tl-201. Tl-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by Tl-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 +/- 0.38 (mean +/- SD) and 1.48 +/- 0.32 (p > 0.05), 1.87 +/- 0.65 and 1.34 +/- 0.20 (p < 0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p > 0.05).

CONCLUSION

Overall, Tl-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of Tl-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

摘要

目的

我们的目标是确定铊-201在临床检查有可疑乳腺病变和/或放射学（乳房X线摄影和/或超声检查）结果异常的患者中识别乳腺癌的临床实用性。

方法

对68例有70处乳腺异常（51处可触及，19处不可触及）的患者进行铊-201闪烁扫描，并与乳房X线摄影和超声检查进行比较。注射111MBq（3mCi）铊-201后获取乳房的早期（15分钟）和晚期（3小时）图像。进行视觉和半定量解读。

结果

最终诊断证实52处为恶性乳腺病变，18处为良性病变。铊-201显示了52处总体恶性病变中的47处（90%）。铊-201闪烁扫描检测到40处可触及乳腺癌中的38处（95%）和12处不可触及乳腺癌中的9处（75%）。铊-201检测到的最小肿块病变尺寸为1.5×1.0厘米。11处乳腺病变在乳房X线摄影和/或超声检查中被判定为不确定。铊-201闪烁扫描在8例被判定为不确定的良性乳腺病变患者中的7例（88%）中排除了恶性病变。18处良性乳腺病变中有5处（28%）显示铊-201摄取。纤维腺瘤和纤维囊性变均未积聚铊-201。铊-201闪烁扫描、乳房X线摄影和超声检查的总体敏感性分别为90%、92%、85%，总体特异性分别为72%、56%、61%。28处腋窝淋巴结转移部位中的21处（75%）也被铊-201检测到。在恶性和良性病变中，早期和晚期病变/对侧正常侧（L/N）比值分别为1.58±0.38（平均值±标准差）和1.48±0.32（p>0.05），1.87±0.65和1.34±0.20（p<0.05）。恶性和良性组的平均早期和晚期L/N比值未显示出统计学差异（p>0.05）。