Huppe Ashley I, Mehta Anita K, Brem Rachel F
George Washington University, Comprehensive Breast Care Center, Washington, DC.
George Washington University, Comprehensive Breast Care Center, Washington, DC.
Semin Ultrasound CT MR. 2018 Feb;39(1):60-69. doi: 10.1053/j.sult.2017.10.001. Epub 2017 Oct 20.
Molecular breast imaging (MBI), also called breast-specific gamma imaging (BSGI), has been an integral component of our breast imaging practice for over a decade. Unlike mammography and ultrasound that are based on anatomy, MBI is a physiologic approach to breast cancer detection. MBI detects additional foci of occult breast cancer in 9.0% of women with newly diagnosed breast cancer, has a high sensitivity for detecting high-risk lesions, and detects 98% of invasive breast cancer and 91.0% of ductal carcinoma in situ. Furthermore, in surveillance of high-risk women, BSGI/MBI detects occult cancer in up to 16.5 per 1000 women. This modality is increasingly being used to assess response to treatment in women undergoing neo-adjuvant chemotherapy and for adjunct screening in women with dense breasts. It has been shown to influence surgical management in nearly a quarter of women with newly diagnosed breast cancer. The Society of Nuclear Imaging has established clinical indications and The American College of Radiology has established appropriateness criteria as well as an accreditation program for MBI. A BIRADS-like lexicon for MBI has also been described. Initially, MBI utilized 10-20mCi of 99mTc sestamibi, however, recent studies have reported the use of 5-10mCi with equal sensitivity to the higher dose of radiotracer. There are over 300 studies in the literature about MBI/BSGI with increasing integration of MBI into clinical practice. This chapter will describe the history, current literature and indications, clinical use, approach to biopsy and integration of MBI into clinical practice.
分子乳腺成像（MBI），也称为乳腺特异性γ成像（BSGI），十多年来一直是我们乳腺成像实践的一个组成部分。与基于解剖结构的乳腺X线摄影和超声不同，MBI是一种用于检测乳腺癌的生理学方法。MBI在9.0%新诊断为乳腺癌的女性中检测到隐匿性乳腺癌的额外病灶，对检测高危病变具有高敏感性，能检测出98%的浸润性乳腺癌和91.0%的原位导管癌。此外，在对高危女性的监测中，BSGI/MBI每1000名女性中可检测出多达16.5例隐匿性癌症。这种检查方法越来越多地用于评估接受新辅助化疗的女性的治疗反应，以及用于乳腺致密女性的辅助筛查。已证明它会影响近四分之一新诊断为乳腺癌的女性的手术治疗决策。核医学成像协会已制定了临床适应症，美国放射学会已制定了适用性标准以及MBI认证计划。还描述了一种类似BIRADS的MBI术语表。最初，MBI使用10 - 20mCi的99mTc司他米比，然而，最近的研究报告使用5 - 10mCi，其敏感性与更高剂量的放射性示踪剂相同。文献中有300多项关于MBI/BSGI的研究，MBI越来越多地融入临床实践。本章将描述MBI的历史、当前文献和适应症、临床应用、活检方法以及MBI融入临床实践的情况。
