Performance of Molecular Breast Imaging as an Adjunct Diagnostic Tool
DOI:
https://doi.org/10.46570/utjms.vol6-2019-333Keywords:
breast, invasive carcinomas, molecular imaging, diagnostic toolAbstract
Purpose: The aim was to retrospectively assess the performance of molecular breast imaging (MBI) as an adjunct diagnostic tool when symptoms could not be explained by conventional imaging, or when mammography or ultrasound findings were equivocal.
Methods: The analysis was comprised of women who underwent further testing with MBI after diagnostic mammography and/or targeted ultrasound. Outcome measures included sensitivity, specificity, and positive and negative predictive values. Receiver-operating characteristic (ROC) curve was constructed and analyzed as a performance measure.
Results: In 301 women with a complete reference standard, 18 (6.0%) were diagnosed with cancer. MBI detected cancer in 16 subjects; two interval cancers occurred. 15 of the 16 cancers detected by MBI were invasive. Overall sensitivity of MBI in this sample was 88.9 % (95% CI 65.6 – 98.6), with 97.5% specificity (95% CI 95.0 – 99.0). Positive predictive value (PPV) was 69.6%, while negative predictive value for recall (NPV) was calculated as 99.3%. ROC curves demonstrated excellent performance (area under the curve = 0.933).
Conclusions: MBI is a valuable diagnostic tool for further evaluation or to guide management when conventional imaging is incomplete. The majority of tumors in this study were invasive carcinomas with node negative status, important for timely treatment.
References
Bjurstam N, Bjorneld L, Duffy SW, et al. The Gothenburg Breast Cancer Screening Trial: preliminary results on breast cancer mortality for women aged 39-49. Journal of the National Cancer Institute. Monographs. 1997(22):53-55. DOI: https://doi.org/10.1093/jncimono/1997.22.53
Bjurstam N, Bjorneld L, Duffy SW, et al. The Gothenburg breast screening trial: first results on mortality, incidence, and mode of detection for women ages 39-49 years at randomization. Cancer. 1997;80(11):2091-2099. DOI: https://doi.org/10.1002/(SICI)1097-0142(19971201)80:11<2091::AID-CNCR8>3.0.CO;2-#
Jonsson H, Nystrom L, Tornberg S, Lenner P. Service screening with mammography of women aged 50-69 years in Sweden: effects on mortality from breast cancer. Journal of medical screening. 2001;8(3):152-160. DOI: https://doi.org/10.1136/jms.8.3.152
Krecke KN, Gisvold JJ. Invasive lobular carcinoma of the breast: mammographic findings and extent of disease at diagnosis in 184 patients. AJR. American journal of roentgenology. 1993;161(5):957-960. DOI: https://doi.org/10.2214/ajr.161.5.8273634
Jones EA, Phan TD, Blanchard DA, Miley A. Breast-specific gamma-imaging: molecular imaging of the breast using 99mTc-sestamibi and a small-field-of-view gamma-camera. Journal of nuclear medicine technology. 2009;37(4):201-205. DOI: https://doi.org/10.2967/jnmt.109.063537
Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology. 2012;265(1):59-69. DOI: https://doi.org/10.1148/radiol.12120621
Sickles EA. The use of breast imaging to screen women at high risk for cancer. Radiologic clinics of North America. 2010;48(5):859-878. DOI: https://doi.org/10.1016/j.rcl.2010.06.012
Flobbe K, Bosch AM, Kessels AG, et al. The additional diagnostic value of ultrasonography in the diagnosis of breast cancer. Archives of internal medicine. 2003;163(10):1194-1199. DOI: https://doi.org/10.1001/archinte.163.10.1194
Duijm LE, Guit GL, Zaat JO, Koomen AR, Willebrand D. Sensitivity, specificity and predictive values of breast imaging in the detection of cancer. British journal of cancer. 1997;76(3):377-381. DOI: https://doi.org/10.1038/bjc.1997.393
Mendelson EB, Tobin CE. Critical pathways in using breast US. Radiographics : a review publication of the Radiological Society of North America, Inc. 1995;15(4):935-945. DOI: https://doi.org/10.1148/radiographics.15.4.7569138
Wernli KJ, DeMartini WB, Ichikawa L, et al. Patterns of breast magnetic resonance imaging use in community practice. JAMA internal medicine. 2014;174(1):125-132. DOI: https://doi.org/10.1001/jamainternmed.2013.11963
Kriege M, Brekelmans CT, Boetes C, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. The New England journal of medicine. 2004;351(5):427-437. DOI: https://doi.org/10.1056/NEJMoa031759
Warner E, Plewes DB, Hill KA, et al. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. Jama. 2004;292(11):1317-1325. DOI: https://doi.org/10.1001/jama.292.11.1317
Leach MO, Boggis CR, Dixon AK, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet. 2005;365(9473):1769-1778. DOI: https://doi.org/10.1016/S0140-6736(05)66481-1
Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA: a cancer journal for clinicians. 2007;57(2):75-89. DOI: https://doi.org/10.3322/canjclin.57.2.75
Maublant J, de Latour M, Mestas D, et al. Technetium-99m-sestamibi uptake in breast tumor and associated lymph nodes. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 1996;37(6):922-925.
Maublant JC, Zhang Z, Rapp M, Ollier M, Michelot J, Veyre A. In vitro uptake of technetium-99m-teboroxime in carcinoma cell lines and normal cells: comparison with technetium-99m-sestamibi and thallium-201. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 1993;34(11):1949-1952.
Cordobes MD, Starzec A, Delmon-Moingeon L, et al. Technetium-99m-sestamibi uptake by human benign and malignant breast tumor cells: correlation with mdr gene expression. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 1996;37(2):286-289.
Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V. Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radiology. 2008;247(3):651-657. DOI: https://doi.org/10.1148/radiol.2473061678
Hruska CB, Boughey JC, Phillips SW, et al. Scientific Impact Recognition Award: Molecular breast imaging: a review of the Mayo Clinic experience. American journal of surgery. 2008;196(4):470-476. DOI: https://doi.org/10.1016/j.amjsurg.2008.06.005
Rhodes DJ, Hruska CB, Conners AL, et al. Journal club: molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts. AJR. American journal of roentgenology. 2015;204(2):241-251. DOI: https://doi.org/10.2214/AJR.14.13357
Shermis RB, Wilson KD, Doyle MT, et al. Supplemental Breast Cancer Screening With Molecular Breast Imaging for Women With Dense Breast Tissue. AJR. American journal of roentgenology. 2016:1-8. DOI: https://doi.org/10.2214/AJR.15.15924
Conners AL, Hruska CB, Tortorelli CL, et al. Lexicon for standardized interpretation of gamma camera molecular breast imaging: observer agreement and diagnostic accuracy. European journal of nuclear medicine and molecular imaging. 2012;39(6):971-982. DOI: https://doi.org/10.1007/s00259-011-2054-z
Conners AL, Maxwell RW, Tortorelli CL, et al. Gamma camera breast imaging lexicon. AJR. American journal of roentgenology. 2012;199(6):W767-774. DOI: https://doi.org/10.2214/AJR.11.8298
van Erkel AR, Pattynama PM. Receiver operating characteristic (ROC) analysis: basic principles and applications in radiology. European journal of radiology. 1998;27(2):88-94. DOI: https://doi.org/10.1016/S0720-048X(97)00157-5
Obuchowski NA. Receiver operating characteristic curves and their use in radiology. Radiology. 2003;229(1):3-8. DOI: https://doi.org/10.1148/radiol.2291010898
Rhodes DJ, Hruska CB, Phillips SW, Whaley DH, O'Connor MK. Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts. Radiology. 2011;258(1):106-118. DOI: https://doi.org/10.1148/radiol.10100625
Hruska CB, Conners AL, Jones KN, et al. Diagnostic workup and costs of a single supplemental molecular breast imaging screen of mammographically dense breasts. AJR. American journal of roentgenology. 2015;204(6):1345-1353. DOI: https://doi.org/10.2214/AJR.14.13306
Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. Jama. 2012;307(13):1394-1404. DOI: https://doi.org/10.1001/jama.2012.388
Meissnitzer T, Seymer A, Keinrath P, et al. Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI. The British journal of radiology. 2015;88(1051):20150147. DOI: https://doi.org/10.1259/bjr.20150147
Skaane P, Engedal K. Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma. AJR. American journal of roentgenology. 1998;170(1):109-114. DOI: https://doi.org/10.2214/ajr.170.1.9423610
Zanello PA, Robim AF, Oliveira TM, et al. Breast ultrasound diagnostic performance and outcomes for mass lesions using Breast Imaging Reporting and Data System category 0 mammogram. Clinics. 2011;66(3):443-448. DOI: https://doi.org/10.1590/S1807-59322011000300014
Kim BS. Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast: a comparative study with MRI. Annals of nuclear medicine. 2012;26(2):131-137. DOI: https://doi.org/10.1007/s12149-011-0544-5
Edwards C, Williams S, McSwain AP, et al. Breast-specific gamma imaging influences surgical management in patients with breast cancer. The breast journal. 2013;19(5):512-519. DOI: https://doi.org/10.1111/tbj.12147
Johnson N, Sorenson L, Bennetts L, et al. Breast-specific gamma imaging is a cost effective and efficacious imaging modality when compared with MRI. American journal of surgery. 2014;207(5):698-701; discussion 701. DOI: https://doi.org/10.1016/j.amjsurg.2013.12.015
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
