Molecular scintigraphy (BSGI, Gammagram) for primary breast lesions – pro
Breast-specific -imaging (BSGI), also known as molecular breast imaging, is breast scintigraphy using a small-field-of-view -camera and 99mTc-sestamibi. Teh technology, especially the types of camers, continues to evolve. Although it is specific, 86%–89%, it has a relatively low positive predictive value, especially in dense breast tissue. In addition, correlation of the scintimammography images with ta mammogram is challenging.
BSGI can be used in patients who have radiodense breast tissue, breast implants, or unexplained architectural distortion or in whom MRI is indicated but not possible. Other uses include evaluation of indeterminate areas identified by mammography or ultrasound, evaluation of multiple lesions or clusters of microcalcifications to aid in biopsy target selection, evaluation of the axillary region for node status in breast cancer patients, and postsurgical or posttherapeutic evaluation of mammographic tissue changes. In addition, BSGI can be used to investigate a palpable mass not demonstrated on mammogram or ultrasound, detect multicentric and multifocal disease or bilateral disease, determine the extent of the primary lesion, and screen a high-risk However, the indications have not been fully defined and guideliens have not been issued. Although some comparative studies have been published, they are limited by the retrospective nature of most study designs, small sample sizes, patient populations with mixed indications for imaging, and a high prevalence of cancer.
Ferrara A. Nuclear imaging in breast cancer. Radiol Technol 2010 Jan-Feb;81(3):233-46.
Brem RF, Floerke A, Rapelyea J, Teal C, Kelly T, Mathur V. Breast specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radiology. 2008;247:651–657.
Zhou M, Johnson N, Gruner S, et al. Clinical utility of breast specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient. Am J Surg. 2009;197:159–163.
Zhou M, Johnson N, Gruner S Ecklund, GW, Meunier, P, Bryn S, Glissmeyer, M, Steinbock,K.
The clinical utility of breast specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient. Am J Surg 2009;197:159-163.
Killelea B, Gillego, A, Kirstein LJ, et al. George Peters Award: How does breast-specific gamma imaging affect the management of patients with newly diagnosed breast cancer? The American Journal of Surgery 2009;198:470 – 474.
Hussain R, Buscombe J. A meta-analysis of scintimammography: an evidence-based approach to its clinical utility. Nucl Med Comm 2006;27:589-594
SNG 2010 guideline: http://www.gammagram.com/docs/BreastScintigraphyGuidelines.pdf