A. Tofani et al., Tc-99(m)-MIBI scintimammography in 300 consecutive patients: Factors that may affect accuracy, NUCL MED C, 20(12), 1999, pp. 1113-1121
We evaluated the diagnostic yield of Tc-99(m)-MIBI scintimammography in a r
elatively large series of consecutive patients referred for breast surgery
on the basis of physical examination or mammogram. Tc-99(m)-MIBI uptake was
correlated to tumour size, receptor status, neovascularity, proliferating
activity, P-170 glycoprotein expression and the patient's gonadal state. Th
ree hundred consecutive patients referred to our institution, with either a
positive mammogram or a palpable mass, were entered into the study. All pa
tients underwent Tc-99(m)-MIBI scintimammography. Pathological status was o
btained after surgery in all patients. Breast cancer was diagnosed in 218 (
73%) patients. The MIBI scan was positive in 89% (194/218) cancer patients
and in 17% (14/82) of patients with benign masses (false-positives); the sc
an was negative in 24 (11%) cancer patients (false-negatives). The sensitiv
ity of MIBI scintigraphy was higher for tumours >1 cm (95 vs 48% in lesions
less than or equal to 1 cm) and in pre-menopausal women (95 vs 85%). Conve
rsely, the specificity was better for lesions <1 cm (100%) and in post-meno
pausal women (89%). The positive predictive value of MIBI scan was good bot
h in small (<1 cm) and large tumours (100% and 93%, respectively) and sligh
tly modified by gonadal state (89% and 96% in pre- and post-menopausal stat
e). The negative predictive value was unsatisfactory, especially in small t
umours and in older patients. The diagnostic performance increased stratify
ing data for tumour size, indicating that lesion size is a major determinan
t in the diagnostic accuracy of MIBI scintimammography. We conclude that 99
Tcm-MIBI scintimammography is useful in the diagnostic evaluation of young
patients, because it can select patients for further invasive diagnostic pr
ocedures. In older patients, a positive 99Tcm-MIBI scan is highly suggestiv
e of malignancy and might be an indication for surgery. In the case of a ne
gative scan, biopsy is advisable given the poor negative predictive value.
Small tumour size and a well-differentiated histotype characterize false-ne
gative cases. (C) 1999 Lippincott Williams & Wilkins).