Khalkhali I, Mena I, Jouanne E, Diggles L, Venegas R, Block J, Alle K, Klein S
Department of Radiology, Harbor-UCLA Medical Center, Torrance, California.
J Am Coll Surg. 1994 May;178(5):491-7.
Mammography and physical examination have a sensitivity of 85 percent for detection of carcinoma of the breast. Mammography also has a positive predictive value of 15 to 30 percent. The aim of this study was to evaluate the usefulness of scintimammography (SMM) as a screening technique for the detection of carcinoma of the breast and compare the test's sensitivity and specificity with that of mammography. We conducted SMM on 59 female patients in whom abnormal mammogram and physical examination warranted biopsy of the breast or fine needle aspiration cytology of the breast, or both. Each patient received 20 millicuries of 99mTc Sestamibi intravenously. Five and sixty minutes postinjection, planar breast images in lateral and posterior oblique views were obtained. In 23 patients with biopsy-confirmed carcinoma of the breast, the SMM result was positive. In 33 patients with benign breast lesions, no increased uptake of Sestamibi was noted in the breast. Five other patients with benign lesions of the breast had false-positive scans. There was one patient with an intraductal carcinoma and a cluster of microcalcifications on mammography without an associated mass, for whom the 99mTc Sestamibi scan was negative. In the group of patients studied, the sensitivity of SMM was 95.8 percent, specificity was 86.8 percent, positive predictive value was 82.1 percent and, most importantly, the negative predictive value for the detection of carcinoma of the breast was 97.1 percent. We conclude in this pilot study that SMM is a highly sensitive test that improves the specificity of conventional mammography for the detection of carcinoma of the breast and deserves further study as a screening technique to potentially reduce the number of mammographically "indicated" biopsies of the breast that yield negative results for carcinoma.
乳房X线摄影和体格检查对乳腺癌的检测灵敏度为85%。乳房X线摄影的阳性预测值也为15%至30%。本研究的目的是评估乳腺闪烁显像（SMM）作为乳腺癌检测筛查技术的有效性，并将该检查的灵敏度和特异性与乳房X线摄影的进行比较。我们对59名女性患者进行了SMM检查，这些患者的乳房X线摄影和体格检查结果异常，需要进行乳房活检或乳房细针穿刺细胞学检查，或两者都做。每位患者静脉注射20毫居里的99mTc司他米比。注射后5分钟和60分钟，获取乳房外侧和后斜位的平面图像。在23例经活检证实为乳腺癌的患者中，SMM结果为阳性。在33例乳房良性病变患者中，未发现乳房对司他米比的摄取增加。另外5例乳房良性病变患者扫描结果为假阳性。有1例导管内癌患者，乳房X线摄影显示有一簇微钙化但无相关肿块，其99mTc司他米比扫描结果为阴性。在所研究的患者组中，SMM的灵敏度为95.8%，特异性为86.8%，阳性预测值为82.1%，最重要的是，检测乳腺癌的阴性预测值为97.1%。我们在这项初步研究中得出结论，SMM是一种高度灵敏的检查，可提高传统乳房X线摄影检测乳腺癌的特异性，作为一种筛查技术，有望减少乳房X线摄影“提示”的乳房活检中结果为阴性的癌灶数量，值得进一步研究。
