Clinical value of hybrid imaging for staging breast cancer in a district general hospital

Introduction

Hybrid imaging, integrating anatomical computed tomography (CT) with functional single-photon emission computed tomography (SPECT), has emerged as a powerful diagnostic tool in breast cancer imaging. This dual modality increases the specificity of skeletal scintigraphy in detecting bony metastases and achieves accurate sentinal lymph node mapping, directly influencing the surgical approach. For patients with high-grade breast cancer, hybrid SPECT/CT provides the opportunity for a ‘one-stop shop’ with important implications for patient care, cost-effectiveness and follow-up.

Methods

We included 50 women with >15 mm grade 2 or grade 3 invasive breast cancer attending our imaging department over 6 months. Each underwent SPECT/CT imaging protocol using a 16-slice Phillips Precedence. A questionnaire assessed type/number of imaging visits and perceived anxiety levels. Change to patient management, radiation dose and estimated costs were also collected from the trust patient and imaging information systems and multidisciplinary notes, to assess overall value.

Results

One-third of patients underwent significant change in medical or surgical management based on hybrid imaging. Overall, >90% of patients surveyed reported higher satisfaction following a ‘one-stop’ visit. Cost and total radiation dose of combined imaging were more favourable than for single visits.

Conclusions

Whilst hybrid SPECT/CT in breast imaging remains in its infancy, its potential to add value for the clinician and patient is clear. The positive advantages for patient management and convenience/cost suggested in our pilot study suggest it is likely to influence future breast cancer management protocols.