Clifford E J, Lugo-Zamudio C
Department of Surgery, St. Paul Medical Center, Dallas, Texas 75235, USA.
Am J Surg. 1996 Nov;172(5):483-6. doi: 10.1016/S0002-9610(96)00225-5.
Mammography has a positive predictive value in the detection of breast cancer of 15% to 25%. Ten percent of patients with breast cancer present with normal mammograms; however, the false negative rate is increased in younger patients. The purpose of this study was to evaluate the effectiveness of Tc-99m Sestamibi imaging in the diagnosis of breast disease.
Images were collected on 147 women. Patients were evaluated with a combination of physical examination, sonography, and mammography. Each patient received 20 millicuries of Tc-99m Sestamibi intravenously. Anterior and lateral images were obtained, the latter with the patient prone and the breast in the dependent position.
One hundred seven patients showed no enhancement (negative scan). Seven of these patients were found at biopsy to have carcinoma. Five had ductal carcinoma in-situ (DCIS) with no associated mass, 1 had an incidental 3 mm focus of invasive ductal carcinoma (IDC), and 1 had a 5-cm cystic lesion with IDC. Forty-one patients showed focal enhancement on their scans (positive scan). Thirty-six were found to have either invasive or in-situ cancer. Four of the 5 patients with benign findings had sclerosing adenosis. The positive and negative predictive values for scintimammography in this group of patients were 88% and 93%, respectively. The sensitivity and specificity were 84% and 95%, respectively.
We conclude that scintimammography is a highly specific test that deserves study as a modality to further refine the indications for breast surgery.
乳腺钼靶摄影在乳腺癌检测中的阳性预测值为15%至25%。10%的乳腺癌患者乳腺钼靶摄影结果正常；然而，年轻患者的假阴性率会增加。本研究的目的是评估锝-99m甲氧基异丁基异腈（Tc-99m Sestamibi）显像在乳腺疾病诊断中的有效性。
对147名女性进行了影像采集。通过体格检查、超声检查和乳腺钼靶摄影相结合的方式对患者进行评估。每位患者静脉注射20毫居里的Tc-99m Sestamibi。获取了前后位和侧位影像，侧位影像采集时患者俯卧，乳房处于下垂位置。
107名患者显示无强化（扫描阴性）。活检发现其中7名患者患有癌症。5名患者为导管原位癌（DCIS）且无相关肿块，1名患者偶然发现有3毫米的浸润性导管癌（IDC）病灶，1名患者有一个5厘米的囊性病变伴IDC。41名患者的扫描显示有局灶性强化（扫描阳性）。其中36名患者被发现患有浸润性或原位癌。5名检查结果为良性的患者中有4名患有硬化性腺病。在这组患者中，乳腺闪烁显像的阳性和阴性预测值分别为88%和93%。敏感性和特异性分别为84%和95%。
我们得出结论，乳腺闪烁显像为一项高度特异的检查，值得作为一种进一步完善乳腺手术适应证的检查方法进行研究。
