Rationale and Objectives
To evaluate the sensitivity of high-resolution breast-specific gamma imaging (BSGI) for the detection of ductal carcinoma in situ (DCIS) based on histopathology and to compare the sensitivity of BSGI with mammography and magnetic resonance imaging (MRI) for the detection of DCIS.
Materials and Methods
Twenty women, mean 55 years (range 34–76 years), with 22 biopsy-proven DCIS were retrospectively reviewed. After injection of 25–30 mCi (925–1,110 MBq) technetium 99m-sestamibi, patients had BSGI with a high-resolution, small-field-of-view gamma camera in craniocaudal and mediolateral oblique projections. BSGI studies were prospectively classified according to focal radiotracer uptake using a 1 to 5 scale, as normal 1), with no focal or diffuse uptake; benign 2), with minimal patchy uptake; probably benign 3), with scattered patchy uptake; probably abnormal 4), with mild focal radiotracer uptake; and abnormal 5), with marked focal radiotracer uptake. Imaging findings were compared to findings at biopsy or surgical excision. The sensitivity of BSGI, mammography, and when performed, MRI were determined for the detection of DCIS. Breast MRI was performed on seven patients with eight biopsy-proven foci. The sensitivities were compared using a two-tailed t -test and confidence intervals were determined.
Results
Pathologic tumor size of the DCIS ranged from 2 to 21 mm (mean 9.9 mm). Of 22 cases of biopsy-proven DCIS in 20 women, 91% were detected with BSGI, 82% were detected with mammography, and 88% were detected with magnetic resonance imaging. BSGI had the highest sensitivity for the detection of DCIS, although this small sample size did not demonstrate a statistically significant difference. Two cases of DCIS (9%) were diagnosed only after BSGI demonstrated an occult focus of radiotracer uptake in the contralateral breast, previously undetected by mammography. There were two false-negative BSGI studies
Conclusions
BSGI has higher sensitivity for the detection of DCIS than mammography or MRI and can reliably detect small, subcentimeter lesions.
Ductal carcinoma in situ (DCIS) occurs in approximately 28% or more than 58,000 cases of breast cancer in the United States ( ). Mammography, the only accepted screening tool for breast cancer, detects the majority of clinically occult DCIS as microcalcifications, the hallmark mammographic finding of DCIS ( ). Yet, the diagnosis of DCIS remains difficult because mammography is unreliable in predicting the histology and extent of DCIS (2–5).
Breast MRI has been shown to have a sensitivity of 73%–89% for DCIS, but a limited specificity (58%–89%) and variable positive predictive value (25%–84%) ( ). As with mammography, small foci of DCIS are difficult to detect on magnetic resonance imaging (MRI), particularly lesions smaller than 5 mm ( ). In addition, MRI may overestimate DCIS extent in as many as 50% of cases and often cannot distinguish benign from malignant lesions, high-grade from low-grade DCIS, or detect an invasive component concurrent with the DCIS (3–5). As a result, MRI remains a secondary study with limitations in DCIS detection and evaluation.
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Materials and methods
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Results
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BSGI versus Mammography
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BSGI versus MRI
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Table 1
Two-Tailed t -test Evaluating Sensitivity of Breast-Specific Gamma Imaging (BSGI) to Mammography and Magnetic Resonance Imaging (MRI)
Contrast Value of Contrast Standard Error_t_ df_P_ Value (BSGI to mammography) 0.09 0.105 0.864 49 .392 (BSGI to MRI) 0.03 0.144 0.237 49 .814
Table 2
Confidence Intervals
Imaging Modality 95% Confidence Intervals Breast-specific gamma imaging (n = 22) 0.78–1.04 Mammography (n = 22) 0.64–0.99 Magnetic resonance imaging (n = 8) 0.58–1.17
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Discussion
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Acknowledgments
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