Pre-operative diagnosis and staging of symptomatic breast disease using ^99mtechnitium scintimammography

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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 740 MBq ^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 four axillary masses) without complication. SMM accurately predicted the nature of disease (sensitivity 90%, specificity 92%, PPV 90%, NPV 92%) and reporting was not improved by knowledge of TA. Axillary node histology from 52 patients with malignancy showed SMM sensitivity 19%, specificity 100%, PPV 100% and NPV 65%. SMM detected two occult bilateral cancers (6%) and multifocality in three 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.