Research article

Imaging in situ breast carcinoma (with or without an invasive component) with technetium-99m pentavalent dimercaptosuccinic acid and technetium-99m 2-methoxy isobutyl isonitrile scintimammography

Vassilios Papantoniou¹ , Spyridon Tsiouris¹ , Ekaterini Mainta¹ , Varvara Valotassiou¹, Michael Souvatzoglou¹ , Maria Sotiropoulou² , Lydia Nakopoulou³ , Dimitrios Lazaris⁴ , Androniki Louvrou⁴ , Maria Melissinou⁵ , Artemis Tzannetaki⁶, Ioannis Pirmettis⁷ , John Koutsikos¹ and Cherry Zerva¹

¹Department of Nuclear Medicine, 'Alexandra' University Hospital, Athens, Greece

²Department of Pathology, 'Alexandra' University Hospital, Athens, Greece

³Department of Pathology, University of Athens School of Medicine, Athens, Greece

⁴Department of Obstetrics and Gynecology, 'Alexandra' University Hospital, Athens, Greece

⁵Department of Internal Medicine, 'Metropolitan' Hospital, Athens, Greece

⁶Department of Radiology, 'Alexandra' University Hospital, Athens, Greece

⁷Institute of Radioisotopes – Radiodiagnostic Products, National Center for Scientific Research 'Demokritos', Athens, Greece

author email corresponding author email

Breast Cancer Res 2005, 7:R33-R45doi:10.1186/bcr948

Published:	8 November 2004

Abstract

Introduction

The aim of the study was to retrospectively define specific features of the technetium-99m pentavalent dimercaptosuccinic acid (^99mTc-(V)DMSA) and technetium-99m 2-methoxy isobutyl isonitrile (^99mTc-Sestamibi [^99mTc-MIBI]) distribution in ductal breast carcinoma in situ and lobular breast carcinoma in situ (DCIS/LCIS), in relation to mammographic, histological and immunohistochemical parameters.

Materials and methods

One hundred and two patients with suspicious palpation or mammographic findings were submitted preoperatively to scintimammography (a total of 72 patients with ^99mTc-(V)DMSA and a total of 75 patients with ^99mTc-Sestamibi, 45 patients receiving both radiotracers). Images were acquired at 10 min and 60 min, and were evaluated for a pattern of diffuse radiotracer accumulation. The tumor-to-background ratios were correlated (T-pair test) with mammographic, histological and immunohistochemical characteristics.

Results

Histology confirmed malignancy in 46/102 patients: 20/46 patients had DCIS/LCIS, with or without coexistent invasive lesions, and 26/46 patients had isolated invasive carcinomas. Diffuse ^99mTc-(V)DMSA accumulation was noticed in 18/19 cases and ^99mTc-Sestamibi in 6/13 DCIS/LCIS cases. Epithelial hyperplasia demonstrated a similar accumulation pattern. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for each tracer were calculated. Solely for ^99mTc-(V)DMSA, the tumor-to-background ratio was significantly higher at 60 min than at 10 min and the diffuse uptake was significantly associated with suspicious microcalcifications, with the cell proliferation index ≥ 40% and with c-erbB-2 ≥ 10%.

Conclusion

^99mTc-(V)DMSA showed high sensitivity and ^99mTc-Sestamibi showed high specificity in detecting in situ breast carcinoma (^99mTc-(V)DMSA especially in cases with increased cell proliferation), and these radiotracers could provide clinicians with preoperative information not always obtainable by mammography.