Sevim Süreyya ÇERÇİ, Celal ÇERÇİ, Bahattin BAYKAL, Mustafa YILDIZ, Feride Meltem ÖZBEK, F. Nilgün KAPICIOĞLU, Ahmet YEŞİLDAĞ, Hasan Erol EROĞLU

Meme kanserinin tespitinde Tc-99m MIBI meme sintigrafisi, mamografi ve ultrasonografi yöntemlerinin etkinliklerinin karşılaştırılması

Meme kanseri tüm dünya kadınları arasında en sık görülen kanser türü olmakla birlikte bu hastalığa bağlı mortalite oranı, erken tanı ve tedavideki gelişmeler sayesinde azalmıştır. Mamografi ve ultrasonografi meme kanseri taraması ve tanısında en sık kullanılan görüntüleme yöntemleri olmasına karşın her iki yöntemde de benign ve malign lezyonlar benzer görünümde olabilmekte ve bu da gereksiz fazla sayıda negatif biyopsi alınmasına sebep olmaktadır. Non-invaziv yöntemler kullanılarak, biyopsiden yararlanabilecek hastaların seçimi ve negatif sonuçlu biyopsi sayısının azaltılması önemlidir. Bu amaçla çeşitli radyonüklidler kullanılarak meme sintigrafisi ve pozitron emisyon tomografi yöntemleri uygulanmaktadır. Bu çalışmada memede ele gelen kitle nedeniyle kliniklere başvuran hastaların lezyonlarının benign, malign ayrımında mamografi, ultrasonografi ve Technetium-99m- hexakis-2-methoxy-isobutyl-isonitrile (Tc-99m MIBI) ile yapılan meme sintigrafisi bulguları retrospektif olarak değerlendirilmiş ve etkinliklerinin karşılaştırılması amaçlanmıştır. Bu amaçla biyopsi sonuçları mevcut olan 84 olgunun (yaş ortalaması 49.63±11.33 yıl) mamografi, ultrasonografi ve Tc-99m MIBI meme sintigrafisi sonuçları değerlendirildi. Elli dört hastanın histopatolojik incelemesi benign, 30 hastanın malign olarak tespit edildi. Meme sintigrafisinde malignite için sensitivite %93, spesifite %91, mamografide sensitivite %83, spesifite %85 ve ultrasonografide sensitivite %87, spesifite %89 olarak bulundu. Her üç yöntem kombine edildiğinde ise sensitivite ve spesifite değerlerinin, %97 ve %96. ya yükseldiği tespit edildi. Sonuç olarak meme sintigrafisinin palpabl meme kitlelerinin tespitinde şüpheli mamogram ve ultrasonografiye sahip, meme kanseri açısından yüksek risk taşıyan kadınlarda, lezyonun biyopsi öncesi malignite açısından natürünü ortaya koymak amacıyla kullanımı önerilebilir.

Anahtar Kelimeler:

Duyarlılık ve özgüllük, Meme neoplazmları, Tanı, Teknesyum Tc 99m sestamibi, Mammografi, Ultrasonografi, Geriyedönük çalışma

Comparison of Tc 99m MIBI scintomammography, mammography and ultrasonography in detection of breast carcinoma

However breast carcinoma is the most common neoplasm found among women, improvements in diagnostic and therapeutic methods decreased the mortality rates. Although, mammography and ultrasonography are the most widely used methods for screening and diagnosing breast cancer; images of benign and malignant lesions can be similar in both methods and frequently result in negative biopsies. It is important to reduce the negative result ratios by using non-invasive diagnostic methods. For this purpose scintomammography and PET scanning methods by using different radionuclides can be perform. The aim of this study was to compare the specificity and sensitivity of mammography, ultrasonography and Technetium-99m- hexakis- 2-methoxy-isobutyl-isonitrile (Tc-99m MIBI) scintomammography methods in patients with palpable breast mass in detection of benign and malignant lesions retrospectively. A total 84 patients (mean age of 49.63±11.33 years) with palpable breast masses were studied. Mammography, ultrasonography and Tc-99m MIBI scintomammography were performed to all patients. Histopathological examination revealed malignancy in 30 patients and benign disease in 54 patients. In the detection of malignancy; sensitivity and specificity of scintomammography, mammography and ultrasonography were 93% and 91%, 83% and 85%, 87% and 89% respectively. Using a combination of three tests, the combined sensitivity and specificity was increased to 97% and 96%. In conclusion scintomammography might be a complementary method for suspicious lesions in mammography and ultrasonography in deciding which lesions require a biopsy.

Keywords:

Sensitivity and Specificity, Breast Neoplasms, Diagnosis, Technetium Tc 99m Sestamibi, Mammography, Ultrasonography, Retrospective Studies,

PDF

___

1. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A al. Cancer statistics. CA Cancer J Clin. 2004; 54: 8-29.
2. Ursin G, Bernstein L, Pike MC. Breast cancer. Cancer Surv. 1994; 19-20: 21-264.
3. Sampalis FS, Denis R, Picard D, Fleiszer D, Martin G, Nassif E, et al. International prospective evaluation of scintimammography with technetium-99m sestamibi: interim results. Am J Surg. 2001; 182(4): 399-403.
4. Danielsson R, Sanchez-Crespo A, Pegerfalk A, Grabowska H, Larsson SA, Bone B, et al. 99mTc- sestamibi uptake and histological malignancy grade in invasive breast carcinoma. Eur J Nucl Med. 2003; 30: 662-6.
5. Bone B, Apselin P, Bronge L, Veress B. Contrast- enhanced MR imaging as a prognostic indicator of breast cancer. Acta Radiol. 1998; 39: 279-84.
6. Jackson VP. The role of US in breast imaging. Radiology. 1990; 177: 305-11.
7. Kopans DB. Sonography should not be used for breast cancer screening until its efficacy has been proven scientifically. AJR 2004; 182: 489-91.
8. Whole-breast US imaging: four-year follow-up. Radiology. 1985; 157(2): 505-7.
9. The role of sestamibi scintigraphy in the radioisotopic assessment of myocardial viability. J Nucl Med. 1992; 33(11):1925-30.
10. Hassan IM, Sahweil A, Constantinides C, Mahmoud A, Nair M, Omar YT, Abdeldayem HM. Uptake and kinetics of Tc99-m hexakis 2-methoxy isobutyl isonitrile in benign and malignant lesions in the lungs. Clin Nucl Med. 1989; 14:333-40 .
11. Palmedo H, Biersack HJ, Lastoria S, Maublant J, Prats E, Stegner HE, et al. Scintimammography with technetium-99m methoxyisobutylisonitrile: results of a prospective European multicentre trial. Eur J Nucl Med. 1998; 25(4):375-85.
12. Turkish Society of Nuclear Medicine Nuclear Oncology Task Group. Procedure guideline for breast scintigraphy. Turk J Nucl Med 2001; 4(S): 119-122.
13.Wolfe JN. Analysis of 462 breast carsinoma. AJR 1974; 121: 846-9.
14. Fletcher SW, Black W, Haris R. Report of the international workshop on screening for breast cancer. J Natl Cancer Inst 1993; 85: 1644-56.
15. Tabar L, Duffy SW, Krusemo UB. Detection method, tumor size and node metastases in breast cancer diagnosed during a trial of breast cancer screening. Eur J Cancer Clin Oncol 1987; 23: 959-62.
16. Andersson I. Mammographic screening and mortality from breast cancer: Malmö mammographic screening trial. Brit J Med.1998; 943-8.
17. Randomized study of mammography screening-- preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat. 1991 ;18(1):49-56.
18. Canada national breast screening study. Can Med Assoc J. 1992; 147:1459-76.
19. Reasons underlying negative mammography in patients with palpable breast cancer. Clin Radiol. 1994; 49(2):123-5.
20. Analysis of cancers missed at screening mammography. Radiology. 1992;184 (3):613-7.
21. Kopans DB. The positive predictive value of mammography. Am J Roentgenol. 1992; 158 (3): 521-6.
22. Comparison of quantitative and visual analysis of Tc- 99m MIBI scintimammography for detection of primary breast cancer. Eur J Radiol. 2005;53(2):192-8.
23. Bird RE, Wallace TW, Yankaskas BC. Analysis o f cancers missed at screening mammography. Radiology 1992; 184:613-7.
24. Holland R, Jan HC, Hendricks L, Mravunac M. Mammographically occult breast cancers:a pathological and radiologic study. Cancer 1983; 52: 1810-19.
25. Schillaci O, Buscombe JR. Breast scintigraphy t o d a y : i n d i c a t i o n s a n d l i m i t a t i o n s . Eur J Nucl Med Mol Imaging. 2004;31 Suppl 1:S35-S45. Epub 2004 Apr 23.
26. Palpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions. Radiology. 1988; 166(2): 435-9.
27. Breast cancer detection with sonography and mammography: comparison using state-of-the-art equipment. Am J Roentgenol. 1983;140(5):843-5.
28. Prone scintimammography in patients with suspicion o f c a r c i n o m a o f t h e b r e a s t . J Am Coll Surg. 1994;178(5):491-7.
29. Breast cancer diagnosis by scintimammography: a meta-analysis and review of the literature. Breast Cancer Res Treat. 2003;80(1):115-26.
30. Sampalis FS, Denis R, Picard D, Fleiszer D, Martin G, Nassif E, et al. International prospective evaluation of scintimammography with (99m)technetium sestamibi. Am J Surg 2003; 185: 544-9.
31. Uptake of Tc-99m MIBI related to tumour size and type. Anticancer Res. 1997; 17(B): 1693-4.
32. A three center study on the diagnostic accuracy of 99mTc-MIBI scintimammography. Anticancer Res. 1997;17(3B):1631-4.
33. Diagnostic accuracy of 99mTc-sestamibi breast imaging: multicenter trial results. J Nucl Med. 2000;41(12):1973-9.
34. Gupta P, Waxman A, Nguyen K. Correlation of Tc- 99m sestamibi uptake with histopathologic characteristics in patients with breast disease. J Nucl Med 1996; 37: 250.