School of Medicine and Health Sciences Poster Presentations

Document Type

Poster

Keywords

breast; cancer; specific; gamma; imaging

Publication Date

Spring 2017

Abstract

Background:

Breast Specific Gamma Imaging (BSGI) is increasingly being used as a diagnostic tool for the detection of breast cancer, using technetium 99m sestamibi to identify physiological differences between cancerous and normal breast tissue. Our study retrospectively evaluates pathologic correlates to positive BSGI findings in the detection of breast cancer.

Methods:

A retrospective review was performed of patients with positive BSGI examinations (200 total) during a 1-year period. Using biopsy/surgical pathology or 2 years mammography/ultrasound/MRI follow-up as correlation, we determined the positive predictive values of BSGI findings when categorized by: (i) character of suspicious region [mass, non-mass, asymmetric diffuse], (ii) character surrounding breast parenchymal tissue [homogeneous, heterogeneous], (iii) breast density [dense, non-dense], and (iv) likelihood of cancer based on degree of observable radiotracer uptake.

Results:

There were 200 patients with 276 positive BSGI lesions, of which 130 were true positives; true positive rate (TPR) = 47.1%. There were 154 mass-like lesions, 108 non-mass-like, and 14 asymmetric diffuse; TPR’s = 54.5%, 38.0%, and 35.7%, respectively. There were 149 findings with homogeneous parenchymal uptake and 127 with heterogeneous uptake; TPR’s = 53.7% and 39.4%, respectively. There were 71 findings from non-dense breasts, of which 39 were positive for cancer (TPR = 54.9%), and 189 findings from dense breasts, of which 82 were positive (TPR = 43.4%). There were 104 lesions with a likelihood of cancer score 1, of which 24 were true positives (TPR = 23.1%); 65 lesions with likelihood of cancer score 2, of which 17 were true positives (TPR = 26.2%); and 107 lesions with likelihood of cancer score 3, of which 88 were true positives (TPR = 82.2%).

Conclusion:

Understanding the positive predictive value of BSGI when categorized according to character of lesion, parenchyma, breast density, and degree of radiotracer uptake may improve early diagnosis of breast cancer. Variability in mass-like or non-mass-like character of positive BSGI findings are not useful determinants for probability of malignancy, while the degree of observable radiotracer uptake is. Therefore, subtle, small-area foci of radiotracer uptake should not be managed with less urgency than more obvious, large-area foci. Additionally, it is more difficult to detect cancerous lesions in women with heterogeneous parenchymal enhancement compared to homogeneous parenchymal enhancement. Lastly, detection of breast cancer with BSGI is not significantly affected by breast density, which makes it a promising modality for breast cancer screening.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Poster presented GW Annual Research Days 2017.

One image has been removed from the original poster.

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Breast Lesions Detected Via Breast Specific Gamma Imaging: Descriptor Characteristics and Positive Predictive Value

Background:

Breast Specific Gamma Imaging (BSGI) is increasingly being used as a diagnostic tool for the detection of breast cancer, using technetium 99m sestamibi to identify physiological differences between cancerous and normal breast tissue. Our study retrospectively evaluates pathologic correlates to positive BSGI findings in the detection of breast cancer.

Methods:

A retrospective review was performed of patients with positive BSGI examinations (200 total) during a 1-year period. Using biopsy/surgical pathology or 2 years mammography/ultrasound/MRI follow-up as correlation, we determined the positive predictive values of BSGI findings when categorized by: (i) character of suspicious region [mass, non-mass, asymmetric diffuse], (ii) character surrounding breast parenchymal tissue [homogeneous, heterogeneous], (iii) breast density [dense, non-dense], and (iv) likelihood of cancer based on degree of observable radiotracer uptake.

Results:

There were 200 patients with 276 positive BSGI lesions, of which 130 were true positives; true positive rate (TPR) = 47.1%. There were 154 mass-like lesions, 108 non-mass-like, and 14 asymmetric diffuse; TPR’s = 54.5%, 38.0%, and 35.7%, respectively. There were 149 findings with homogeneous parenchymal uptake and 127 with heterogeneous uptake; TPR’s = 53.7% and 39.4%, respectively. There were 71 findings from non-dense breasts, of which 39 were positive for cancer (TPR = 54.9%), and 189 findings from dense breasts, of which 82 were positive (TPR = 43.4%). There were 104 lesions with a likelihood of cancer score 1, of which 24 were true positives (TPR = 23.1%); 65 lesions with likelihood of cancer score 2, of which 17 were true positives (TPR = 26.2%); and 107 lesions with likelihood of cancer score 3, of which 88 were true positives (TPR = 82.2%).

Conclusion:

Understanding the positive predictive value of BSGI when categorized according to character of lesion, parenchyma, breast density, and degree of radiotracer uptake may improve early diagnosis of breast cancer. Variability in mass-like or non-mass-like character of positive BSGI findings are not useful determinants for probability of malignancy, while the degree of observable radiotracer uptake is. Therefore, subtle, small-area foci of radiotracer uptake should not be managed with less urgency than more obvious, large-area foci. Additionally, it is more difficult to detect cancerous lesions in women with heterogeneous parenchymal enhancement compared to homogeneous parenchymal enhancement. Lastly, detection of breast cancer with BSGI is not significantly affected by breast density, which makes it a promising modality for breast cancer screening.

 

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