Unit of Nuclear Medicine, University of Sassari, Sassari, Italy.
Int J Oncol. 2012 Aug;41(2):483-9. doi: 10.3892/ijo.2012.1495. Epub 2012 May 24.
We investigated the clinical impact of breast scintigraphy acquired with a breast specific γ-camera (BSGC) in the diagnosis of breast cancer (BC) and assessed its incremental value over mammography (Mx). A consecutive series of 467 patients underwent BSGC scintigraphy for different indications: suspicious lesions on physical examination and/or on US/MRI negative at Mx (BI-RADS 1 or 3), characterization of lesions suspicious at Mx (BI-RADS 4), preoperative staging in lesions highly suggestive of malignancy at Mx (BI-RADS 5). Definitive histopathological findings were obtained in all cases after scintigraphy: 420/467 patients had BC, while 47/467 patients had benign lesions. The scintigraphic data were correlated to Mx BI-RADS category findings and to histology. The incremental value of scintigraphy over Mx was calculated. Scintigraphy was true-positive in 97.1% BC patients, detecting 96.2% of overall tumor foci, including 91.5% of carcinomas ≤10 mm, and it was true-negative in 85.1% of patients with benign lesions. Scintigraphy gave an additional value over Mx in 141/467 cases (30.2%). In particular, scintigraphy ascertained BC missed at Mx in 31 patients with BI-RADS 1 or 3, including 26 patients with heterogeneously/high dense breast (19/26 with tumors ≤10 mm) and detected additional clinically occult ipsilateral or controlateral tumor foci (all <10 mm) or the in situ component sited around invasive tumors in 77 BC patients with BI-RADS 4 or 5, changing surgical management in 18.2% of these cases; moreover, scintigraphy ruled out malignancy in 33 patients with BI-RADS 4. BSGC scintigraphy proved a highly sensitive diagnostic tool, even in small size carcinoma detection, while maintaining a high specificity. The procedure increased both the sensitivity of Mx, especially in dense breast and in multifocal/multicentric disease, and the specificity as well as it better defined local tumor extension, thus guiding the surgeon to a more appropriate surgical treatment.
我们研究了专用乳腺γ相机（BSGC）进行乳腺摄影（Mx）诊断乳腺癌（BC）的临床影响，并评估了其优于 Mx 的附加值。连续系列的 467 例患者因不同原因接受 BSGC 闪烁照相术：体检可疑病变和/或 Mx 阴性的 US/MRI 检查（BI-RADS 1 或 3），Mx 可疑病变的特征（BI-RADS 4），术前分期在 Mx 高度提示恶性的病变（BI-RADS 5）。在所有病例中，在闪烁照相术之后都获得了明确的组织病理学发现：420/467 例患者患有 BC，而 47/467 例患者患有良性病变。闪烁照相术的数据与 Mx BI-RADS 类别发现和组织学相关。计算了闪烁照相术优于 Mx 的附加值。闪烁照相术在 97.1%的 BC 患者中为真阳性，检测到 96.2%的总体肿瘤病灶，包括 91.5%的≤10mm 的癌，在 85.1%的良性病变患者中为真阴性。在 141/467 例（30.2%）中，闪烁照相术优于 Mx。特别是，闪烁照相术在 31 例 BI-RADS 1 或 3 的患者中确定了 Mx 遗漏的 BC，包括 26 例异质性/高密度乳腺（19/26 例肿瘤≤10mm），并在 77 例 BI-RADS 4 或 5 的患者中检测到了额外的临床隐匿性同侧或对侧肿瘤病灶（均<10mm）或位于侵袭性肿瘤周围的原位成分，改变了这些病例中的 18.2%的手术管理；此外，闪烁照相术排除了 33 例 BI-RADS 4 的恶性肿瘤。BSGC 闪烁照相术证明是一种高度敏感的诊断工具，即使在小尺寸癌的检测中，也保持了高特异性。该程序提高了 Mx 的敏感性，特别是在致密乳腺和多灶性/多中心疾病中，以及特异性，并更好地定义了局部肿瘤的扩展，从而指导外科医生进行更适当的手术治疗。
