Breast scintigraphy evaluation with technetium 99m sestamibi.

Geyer, René
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Forty (40) female patients with breast masses underwent Technetium 99m Sestamibi scintigraphy in order to evaluate its usefulness in differentiating benign from malignant breast disease and to compare scintigraphy to mammography. Informed consent was obtained from each patient. Scintigraphy consisted of anterior chest and lateral and oblique breast planar images, obtained 5 minutes after intravenous injection of 20 rnecuries (740 MBq) Technetium 99m Sestamibi. Eleven (11) of the 40 patients also had Technetium 99m Methylene Diphosponate breast scintigraphy for comparison. Four nuclear medicine physicians of who three also graded the MDP images performed grading of the Sestamibi scintigraphic images. The grading method, although focussing on the absence (0) or presence (>0) of uptake of isotope, was also designed for comparison of the Sestamibi and MDP images. Statistical analysis showed good correlation between observer grading. Breast scintigraphy was compared to mammography in 27 ofthe 40 patients. Of the 26 malignant breast masses confirmed on histology, 19 were positively identified on Sestamibi scanning giving a sensitivity of 73%, 2 results were inconclusive (grading (0·1) and 5 had a grading 0, of the 8 patients with confirmed lymph node metastases, only 2 were positive on the Sestamibi scans, with 1 inconclusive result. Of the 19 benign breast masses, 9 were visible on Sestamibi scans with additional 3 inconclusive results (grading of 0-1). Statistical analysis showed no significant difference in the Sestamibi and MDP grading. In comparison to mammography, breast scintigraphy was less accurate in distinguishing benign from malignant breast masses. Mammography identified 85.7% of the malignant breast masses and 72.7% of the benign breast masses. Sestamibi scintigraphy identified 76.2% of the malignant breast masses and only 36.4% of the benign breast masses.
A research report submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Nuclear Medicine.
Breast Diseases diagnosis., Breast Diseases radionuclide imaging.