TECHNETIUM-99M-MIBI SCINTIGRAPHY IN THE ASSESSMENT OF NEOADJUVANT CHEMOTHERAPY IN BREAST-CARCINOMA

Presurgical neoadjuvant chemotherapy (PSNC) is the treatment of choice for patients with locally advanced breast carcinoma (LABC). Accurate assessment of tumor response is important in planning subsequent treat ments. Conventional response assessment by mammography and clinical ev aluation is not fully reliable, This study evaluates the diagnostic yi eld of serial Tc-99m-MIBI scintigraphy in the assessment of LABC respo nse to PSNC, Methods: Twenty-nine patients affected by LABC underwent clinical, mammographic and Tc-99m-MIBI scintigraphy before and after 3 cycles of FEC (500 mg/m(2) 5-fluorouracil, 50 mg/m(2) epirubicin and 400 mg/m(2) cyclophosphamide) on Days 1 and 8, Surgery was planned for 15 days after the third cycle of chemotherapy, Pathological status wa s obtained after surgery in all patients, Results: Sensitivities (i.e. , true-positive ratios) for a correct prediction of tumor presence aft er PSNC were 65% for scintigraphy, 35% for clinical evaluation and 69% for mammography, Specificities (i.e., true-negative ratios) for a cor rect prediction of tumor absence after PSNC were 100% for scintigraphy , 67% for clinical evaluation and 33% for mammography, Technetium-99m- MIBI uptake in this series did not correlate with P-170 expression, pr oliferating cell nuclear antigen, Her-2/neu oncogene protein, antihuma n endothelial cell CD31 antigen and estrogenic and progestinic recepto r status, Conclusion: Technetium-99m-MIBI scintigraphy is effective in monitoring the response to PSNC in LABC patients, Its diagnostic yiel d is clearly superior to clinical evaluation alone, Scintigraphy perfo rms as does mammography in patients with negative response, but it is clearly superior in patients with positive response.