Usefulness of 99m-Tc-sestamibi scintimammography in suspected breast cancer and in axillary lymph node metastases detection

Aims: To evaluate the usefulness of 99m-Tc-sestamibi scintimammography (SSM ) in the detection of T1-2, N0-1, MO breast cancer (BC) and axillary node ( AN) metastases. Patients and methods: A series of 239 women (median age 55 years) who had a lready been selected for breast biopsy underwent both mammography (MG) and SSM before surgery. The final diagnosis confirmed in 207 (86.6%) patients, and benign breast lesions in 32 (13.4%). Results: Sensitivity, specificity, positive predictive value, negative pred ictive value, and accuracy of MG and SSM in BC detection were 88.9% vs 87.9 %, 62.5% vs 93.8% (P<0.01), 93.9% vs 98.9%, 46.5% vs 54.5%, and 85.4% vs 88 .7%, respectively. Age did not affect (P = NS) SSM sensitivity, and in prem enopausal patients (n = 80 (33.5%)) its specificity was 100%. Overall sensi tivity and specificity of SSM for assessing AN involvement were 82.3% and 9 4.1%, respectively. In patients with <3 AN metastases (n = 33 (53.2%)) SSM sensitivity was 69.7%, and only one out of six patients with a single AN me tastasis had a positive scan. Conclusions: In patients with suspicious MG undergoing biopsy, SSM should b e considered before surgery because of its high specificity, especially in younger patients. At present, its usefulness in detection of AN metastases is still modest and does not allow a correct pre-operative staging of patie nts with BC. (C) 2001 Harcourt Publishers Ltd.