Brem Rachel F, Floerke Angelique C, Rapelyea Jocelyn A, Teal Christine, Kelly Tricia, Mathur Vivek
Departments of Radiology and Surgery, George Washington University, 2150 Pennsylvania Ave NW, Washington, DC 20037, USA.
Radiology. 2008 Jun;247(3):651-7. doi: 10.1148/radiol.2473061678.
To retrospectively determine the sensitivity and specificity of breast-specific gamma imaging (BSGI) for the detection of breast cancer by using pathologic results as the reference standard.
This study was Institutional Review Board approved and Health Insurance Portability and Accountability Act compliant. Informed consent was obtained for participants who were not imaged as part of their clinical protocol but were participating in other Institutional Review Board-approved studies that used BSGI. A retrospective review of 146 women (aged 32-98 years) undergoing BSGI and breast biopsy was performed. Patients underwent BSGI with intravenous injection of 30 mCi (1110 MBq) of technetium 99 ((99m)Tc)-sestamibi and were imaged in craniocaudal and mediolateral oblique projections. Study images were assigned scores, and scores were classified as positive (focal increased radiotracer uptake) or negative (no uptake or scattered heterogeneous physiologic uptake) and compared with biopsy results. The sensitivity, specificity, and positive and negative predictive values were determined.
In 146 patients, 167 lesions underwent biopsy, of which 83 (16 ductal carcinoma in situ [DCIS] and 67 invasive cancers) were malignant. Of 84 nonmalignant lesions, 82 were benign and two showed atypical histologic results (one atypical lobular hyperplasia and one lobular carcinoma in situ). BSGI helped detect cancer in 80 of 83 malignant lesions with a sensitivity of 96.4% (95% confidence interval [CI]: 92%, 99%) and correctly identified 50 of 84 nonmalignant lesions as negative for cancer with a specificity of 59.5% (95% CI: 49%, 70%). The positive predictive value for 80 of 114 malignant lesions with a BSGI examination with findings positive for cancer was 68.8% (95% CI: 60%, 78%) and the negative predictive value for 50 of 53 nonmalignant lesions was 94.3% (95% CI: 88%, 99%). The smallest invasive cancer and DCIS detected were both 1 mm. BSGI helped detect occult cancer not visualized at mammography or ultrasonography in six patients.
BSIG has high sensitivity (96.4%) and moderate specificity (59.5%) helping detect breast cancers.
以病理结果作为参考标准，回顾性确定乳腺特异性γ成像（BSGI）检测乳腺癌的敏感性和特异性。
本研究经机构审查委员会批准，并符合《健康保险流通与责任法案》。对于未作为其临床方案一部分进行成像，但参与其他使用BSGI的机构审查委员会批准研究的参与者，均获得了知情同意。对146例接受BSGI和乳腺活检的女性（年龄32 - 98岁）进行回顾性研究。患者静脉注射30 mCi（1110 MBq）的锝99（99mTc）- 甲氧基异丁基异腈进行BSGI检查，并在头尾位和内外斜位进行成像。对研究图像进行评分，评分分为阳性（局灶性放射性示踪剂摄取增加）或阴性（无摄取或散在不均匀的生理性摄取），并与活检结果进行比较。确定敏感性、特异性以及阳性和阴性预测值。
146例患者中，167个病灶接受了活检，其中83个（16个原位导管癌[DCIS]和67个浸润性癌）为恶性。84个非恶性病灶中，82个为良性，2个显示非典型组织学结果（1个非典型小叶增生和1个小叶原位癌）。BSGI在83个恶性病灶中的80个中检测到癌症，敏感性为96.4%（95%置信区间[CI]：92%，99%），并将84个非恶性病灶中的50个正确鉴定为癌症阴性，特异性为59.5%（95% CI：49%，70%）。114个经BSGI检查发现癌症阳性的恶性病灶中，80个的阳性预测值为68.8%（95% CI：60%，78%），53个非恶性病灶中50个的阴性预测值为94.3%（95% CI：88%，99%）。检测到的最小浸润性癌和DCIS均为1毫米。BSGI帮助在6例患者中检测到乳腺X线摄影或超声检查未发现的隐匿性癌症。
BSIG具有高敏感性（96.4%）和中度特异性（59.5%），有助于检测乳腺癌。
