SCINTIMAMMOGRAPHY WITH TC-99M SESTAMIBI

Mammography and physical breast examination are currently the most fre quently and recognized screening tools for detection of breast carcino ma. These methods have been proved successful for early detection of b reast cancer. Considering the 85% sensitivity associated with combined mammography and physical examination and a low positive predictive va lue of 20%-30% for diagnosis of breast carcinoma, there is a critical need for a more accurate, noninvasive imaging test to improve the sens itivity and specificity of mammography (7, 19, 20). Since early 1992, we have studied over 1200 women with clinically and/or mammographic ab normalities prior to breast biopsy and/or fine needle aspiration cytol ogy of the breast. We have evaluated the role of Tc 99m Sestamibi as a complimentary procedure to conventional mammography in detection of b reast carcinoma. The preliminary results of our studies have been publ ished elsewhere (14, 17, 18). DuPont Merck Pharmaceutical Company in t he USA on that basis, determined to conduct a multicenter clinical tri al for the role of this radiopharmaceutical for the diagnosis of breas t carcinoma in women with mammographically and/or clinically palpable abnormalities. This study was conducted at 42 institutions throughout the United States and Canada enrolling 673 women who where otherwise s cheduled for breast biopsy and/or mastectomy. The preliminary results of this trial in both palpable and nonpalpable breast abnormalities ar e encouraging (24). Our most recent study on 157 women (mean age 47.9 years +/- 10.2) with 164 lesions with indications for histologic and c ytologic analysis who underwent scintimammography with Tc 99m Sestamib i demonstrated the sensitivity of 92.3% and the specificity 87.5% (15) . We have concluded that scintimammography with Tc 99m Sestamibi can b e used in conjunction with mammography to improve its specificity.