Azarpeikan Ali Reza, Omranipour Ramesh, Mahmoodzadeh Habibollah, Miri Seyed Rouhollah, Mohammadzadeh Narjes, Derakhshan Farhang, Farzanefar Saeed, Abbasi Mehrshad
Department of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Breast Disease Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Adv Biomed Res. 2023 Apr 25;12:86. doi: 10.4103/abr.abr_347_21. eCollection 2023.
The surgery for a breast imaging-reporting and data system (BIRADS) IV lesions needs imaging or pathology supporting data. The roll of breast scintigraphy for this purpose is unclear.
In a prospective design, 16 patients with 25 BIRADS IV lesions who were scheduled for surgery were included. Before the surgery, breast scintigraphy was done using a nondedicated dual head gamma camera in the prone position employing a shaped foam pad providing imaging at breast pendulous position. Twenty mCi Tc methoxy-isobutyl-isonitrile was injected and two 15 and 60-min delayed imaging were done (anterior, bilateral, and single photon emission computed tomography [SPECT] projections). Pathology reports were collected and tumor to nontumor uptake ratio (T/NT) was analyzed, accordingly.
Out of all lesions, 12 were malignant (invasive ductal and lobular carcinoma ductal carcinoma ). At 15 min, T/NT was insignificantly higher in the malignant compared to benign lesions (22.8 ± 23.9 vs. 10.1 ± 10.1; = 0.109). The optimal T/NT cutoff for discrimination of malignant and benign lesions was 20. Only 1 out of 13 benign lesions presented uptake >20 (7.7%; false-positive rate; = 0.047). The diagnostic accuracy, sensitivity, and specificity for T/NT calculated at 0.68, 0.42, and 0.92, respectively. The T/NT at 60 min remained unchanged for either benign or malignant lesions (22.3 ± 30.2 vs. 11.7 ± 17.1; = 0.296).
Breast scintigraphy with general purpose gamma camera employing SPECT imaging may assist the selection of BIRADS IV lesions in need for surgery. All uptake positive cases should undergo surgery and decision for uptake negative cases should be made based on other data.
乳腺影像报告和数据系统（BIRADS）IV类病变的手术需要影像学或病理学支持数据。乳腺闪烁扫描在此目的中的作用尚不清楚。
采用前瞻性设计，纳入16例计划手术的患有25个BIRADS IV类病变的患者。手术前，使用非专用双头伽马相机在俯卧位进行乳腺闪烁扫描，采用成型泡沫垫在乳房下垂位置进行成像。注射20mCi锝甲氧基异丁基异腈，并进行两次延迟15分钟和60分钟的成像（前位、双侧位和单光子发射计算机断层扫描[SPECT]投影）。收集病理报告并分析肿瘤与非肿瘤摄取比（T/NT）。
在所有病变中，12例为恶性（浸润性导管癌和小叶癌）。在15分钟时，恶性病变的T/NT略高于良性病变（22.8±23.9对10.1±10.1；P = 0.109）。区分恶性和良性病变的最佳T/NT临界值为20。13例良性病变中只有1例摄取>20（7.7%；假阳性率；P = 0.047）。T/NT的诊断准确性、敏感性和特异性分别计算为0.68、0.42和0.92。60分钟时，良性或恶性病变的T/NT均无变化（22.3±30.2对11.7±17.1；P = 0.296）。
使用SPECT成像的通用伽马相机进行乳腺闪烁扫描可能有助于选择需要手术的BIRADS IV类病变。所有摄取阳性的病例均应接受手术，对于摄取阴性的病例应根据其他数据做出决策。
