Breast cancer detection with 99m-Tc-sestamibi scintigraphy, mammography, and fine-needle aspiration cytology: Comparative study in 64 surgically treated patients

Background: In breast cancer, mammography (MG) fails to reveal malignancy i n 10% to 15% of patients, and its sensitivity is limited by dense breast ti ssue. The aim of this study was to evaluate the usefulness of 99m-Tc-sestam ibi scintimammography (SMM) in conjunction with MG and fine needle aspirati on (FNA) cytology in the detection of low-stage breast cancer. Methods: A total of 64 women (median age 58 years, range 32-86 years), 53 ( 82.8%) with palpable and 11 (17.2%) with nonpalpable breast mass, underwent SMM; 61 patients had MG and 62 underwent FNA cytology. At histological exa mination, breast cancer was found in 59 (92.2%) of the women (pTis = 2, pT1 a = 2, pT1b = 13, pT1c = 20, pT2 = 22). Results: Of the 61 patients who had MG, 45 (73.8%) showed signs of cancer o r abnormalities. Of the 62 patients who had FNA cytology, 55 (88.7%) showed malignancy. In 5 (8.1%) patients, atypical ductal hyperplasia or complex s clerosing lesions were found. MG, SMM, and FNA cytology were 80.4%, 78.0%, and 96.5% sensitive, respectively, and their positive predictive value was 97.8%, 100%, and 100%, respectively. In all patients, cancer was at least d etected by one of these three techniques. Conclusions: In women with suspicious MG or abnormal FNA cytology that requ ired further investigations, SMM may be helpful in surgical planning and sh ould be considered in most patients before biopsy as an additional noninvas ive procedure.