Triple Assessment (TA) may fail to distinguish benign from malignant disease, underestimate locoregional spread or miss occult multifocal disease. This study evaluated complementary Scintimammography (SMM) in the pre-operative diagnosis and staging of symptomatic breast disease.
Patients underwent initial TA followed by planar SMM of both breasts using 740MBq 99mTechnitium Sestamibi injected into a pedal vein. Ten-minute acquisition images were graded both blindly and with knowledge of TA as either normal, benign, equivocal, suspicious or malignant.
SMM was performed in 75 patients (45 palpable lumps, 26 impalpable and 4 axillary masses) without complication. SMM accurately predicted the nature of disease (Sens. 90%, Spec. 92%, PPV 90%, NPV 92%) and reporting was not improved by knowledge of TA. Axillary node histology from 52 patients with malignancy showed SMM Sens. 19%, Spec. 100%, PPV 100% and NPV 65%. SMM detected 2 occult bilateral cancers (6%) and multifocality in 3 patients (9%) missed by TA. Consequently, SMM altered the management of 14 breasts from 12 patients (19%).
Complementary SMM after TA improves the accuracy of pre-operative diagnosis and staging of symptomatic breast disease. SMM may improve the management of breast cancer, particularly when planning breast conservation or management of regional nodes.
Bradford IMJ, Mackie A, McCauley E, Cadigan P, Cook AIM. Pre-Operative Diagnosis and Staging of Symptomatic Breast Disease using 99m-Technetium Scintimammography. Oral presentation at Symposium Mammographicum, York, 9th October 2000. To be published in Breast Cancer Research during 2001.
Dr. Alison Mackie, Durham Unit, Durham. Tel: +44 (0)191-333-2219.
Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK.
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