Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial
Identifieur interne : 003D40 ( Pmc/Checkpoint ); précédent : 003D39; suivant : 003D41Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial
Auteurs : Teresa Massardo [Chili] ; Omar Alonso [Uruguay] ; Augusto Llamas-Ollier [Colombie] ; Levin Kabasakal [Turquie] ; Uma Ravishankar [Inde] ; Rossana Morales [Pérou] ; Lucía Delgado [Uruguay] ; Ajit K. Padhy [Autriche]Source :
- BMC Nuclear Medicine [ 1471-2385 ] ; 2005.
Abstract
Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was performed.
One hundred and forty-nine female patients were included prospectively from different regions. Their mean age was 55.1 ± 11.9 years. Histological report was obtained from 2.987 excised lymph nodes from 150 axillas. An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients, all images performed with 740–925 MBq dose of Tc99m sestamibi. Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla. Diagnostic values, 95% confidence intervals [CI] and also likelihood ratios (LR) were calculated.
Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes. Sestamibi was positive in 30 axillas (25 true-positive) and negative in 120 (only 55 true-negative). The sensitivity corresponded to 27.8% [CI = 18.9–38.2] and specificity to 91.7% [81.6–97.2]. The positive and negative LR were 3.33 and 0.79, respectively. There was no difference between early and delayed images. Sensitivity was higher in patients with palpable lesions.
This work confirmed that non tomographic Tc99m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer.
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DOI: 10.1186/1471-2385-5-4
PubMed: 16048648
PubMed Central: 1199526
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Santiago</wicri:regionArea><wicri:noRegion>Santiago</wicri:noRegion></affiliation></author><author><name sortKey="Alonso, Omar" sort="Alonso, Omar" uniqKey="Alonso O" first="Omar" last="Alonso">Omar Alonso</name><affiliation wicri:level="1"><nlm:aff id="I2">Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo, Uruguay</nlm:aff><country xml:lang="fr">Uruguay</country><wicri:regionArea>Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo</wicri:regionArea><wicri:noRegion>Montevideo</wicri:noRegion></affiliation></author><author><name sortKey="Llamas Ollier, Augusto" sort="Llamas Ollier, Augusto" uniqKey="Llamas Ollier A" first="Augusto" last="Llamas-Ollier">Augusto Llamas-Ollier</name><affiliation wicri:level="1"><nlm:aff id="I3">Nuclear Medicine Department, National Cancer Institute, Bogotá, Colombia</nlm:aff><country xml:lang="fr">Colombie</country><wicri:regionArea>Nuclear Medicine Department, National Cancer Institute, Bogotá</wicri:regionArea><wicri:noRegion>Bogotá</wicri:noRegion></affiliation></author><author><name sortKey="Kabasakal, Levin" sort="Kabasakal, Levin" uniqKey="Kabasakal L" first="Levin" last="Kabasakal">Levin Kabasakal</name><affiliation wicri:level="1"><nlm:aff id="I4">Nuclear Medicine Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey</nlm:aff><country xml:lang="fr">Turquie</country><wicri:regionArea>Nuclear Medicine Department, Cerrahpasa Medical Faculty, Istanbul University</wicri:regionArea><wicri:noRegion>Istanbul University</wicri:noRegion></affiliation></author><author><name sortKey="Ravishankar, Uma" sort="Ravishankar, Uma" uniqKey="Ravishankar U" first="Uma" last="Ravishankar">Uma Ravishankar</name><affiliation wicri:level="1"><nlm:aff id="I5">Nuclear Medicine Department, Indraprastha Apollo Hospitals, New Delhi, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Nuclear Medicine Department, Indraprastha Apollo Hospitals, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author><author><name sortKey="Morales, Rossana" sort="Morales, Rossana" uniqKey="Morales R" first="Rossana" last="Morales">Rossana Morales</name><affiliation wicri:level="1"><nlm:aff id="I6">Department of Nuclear Medicine, Neoplastic Disease Institute and Peruvian Institute of Nuclear Energy, Lima, Peru</nlm:aff><country xml:lang="fr">Pérou</country><wicri:regionArea>Department of Nuclear Medicine, Neoplastic Disease Institute and Peruvian Institute of Nuclear Energy, Lima</wicri:regionArea><wicri:noRegion>Lima</wicri:noRegion></affiliation></author><author><name sortKey="Delgado, Lucia" sort="Delgado, Lucia" uniqKey="Delgado L" first="Lucía" last="Delgado">Lucía Delgado</name><affiliation wicri:level="1"><nlm:aff id="I2">Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo, Uruguay</nlm:aff><country xml:lang="fr">Uruguay</country><wicri:regionArea>Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo</wicri:regionArea><wicri:noRegion>Montevideo</wicri:noRegion></affiliation></author><author><name sortKey="Padhy, Ajit K" sort="Padhy, Ajit K" uniqKey="Padhy A" first="Ajit K" last="Padhy">Ajit K. Padhy</name><affiliation wicri:level="3"><nlm:aff id="I7">Medicine Section, Department of Human Health, International Atomic Energy Agency, Vienna, Austria</nlm:aff><country xml:lang="fr">Autriche</country><wicri:regionArea>Medicine Section, Department of Human Health, International Atomic Energy Agency, Vienna</wicri:regionArea><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author></analytic><series><title level="j">BMC Nuclear Medicine</title><idno type="eISSN">1471-2385</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was performed.</p></sec><sec sec-type="methods"><title>Methods</title><p>One hundred and forty-nine female patients were included prospectively from different regions. Their mean age was 55.1 ± 11.9 years. Histological report was obtained from 2.987 excised lymph nodes from 150 axillas. An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients, all images performed with 740–925 MBq dose of Tc99m sestamibi. Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla. Diagnostic values, 95% confidence intervals [CI] and also likelihood ratios (LR) were calculated.</p></sec><sec><title>Results</title><p>Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes. Sestamibi was positive in 30 axillas (25 true-positive) and negative in 120 (only 55 true-negative). The sensitivity corresponded to 27.8% [CI = 18.9–38.2] and specificity to 91.7% [81.6–97.2]. The positive and negative LR were 3.33 and 0.79, respectively. There was no difference between early and delayed images. Sensitivity was higher in patients with palpable lesions.</p></sec><sec><title>Conclusion</title><p>This work confirmed that non tomographic Tc99m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Nucl Med</journal-id><journal-title>BMC Nuclear Medicine</journal-title><issn pub-type="epub">1471-2385</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">16048648</article-id><article-id pub-id-type="pmc">1199526</article-id><article-id pub-id-type="publisher-id">1471-2385-5-4</article-id><article-id pub-id-type="doi">10.1186/1471-2385-5-4</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial</article-title></title-group><contrib-group><contrib id="A1" corresp="yes" contrib-type="author"><name><surname>Massardo</surname><given-names>Teresa</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>tmassardo@redclinicauchile.cl</email></contrib><contrib id="A2" contrib-type="author"><name><surname>Alonso</surname><given-names>Omar</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>oalonso@hc.edu.uy</email></contrib><contrib id="A3" contrib-type="author"><name><surname>Llamas-Ollier</surname><given-names>Augusto</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>allamas14@epm.net.co</email></contrib><contrib id="A4" contrib-type="author"><name><surname>Kabasakal</surname><given-names>Levin</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>lkabasakal@tsnm.org</email></contrib><contrib id="A5" contrib-type="author"><name><surname>Ravishankar</surname><given-names>Uma</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>umaravi@vsnl.com</email></contrib><contrib id="A6" contrib-type="author"><name><surname>Morales</surname><given-names>Rossana</given-names></name><xref ref-type="aff" rid="I6">6</xref><email>cmn@amauta.rcp.net.pe</email></contrib><contrib id="A7" contrib-type="author"><name><surname>Delgado</surname><given-names>Lucía</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>ldelgado@hc.edu.uy</email></contrib><contrib id="A8" contrib-type="author"><name><surname>Padhy</surname><given-names>Ajit K</given-names></name><xref ref-type="aff" rid="I7">7</xref><email>ajitpadhy@hotmail.com</email></contrib></contrib-group><aff id="I1"><label>1</label>Nuclear Medicine, University of Chile Clinical Hospital, Santiago, Chile</aff><aff id="I2"><label>2</label>Nuclear Medicine Centre and Medical Oncology Department, Hospital de Clínicas, University of La República, Montevideo, Uruguay</aff><aff id="I3"><label>3</label>Nuclear Medicine Department, National Cancer Institute, Bogotá, Colombia</aff><aff id="I4"><label>4</label>Nuclear Medicine Department, Cerrahpasa Medical Faculty, Istanbul University, Turkey</aff><aff id="I5"><label>5</label>Nuclear Medicine Department, Indraprastha Apollo Hospitals, New Delhi, India</aff><aff id="I6"><label>6</label>Department of Nuclear Medicine, Neoplastic Disease Institute and Peruvian Institute of Nuclear Energy, Lima, Peru</aff><aff id="I7"><label>7</label>Medicine Section, Department of Human Health, International Atomic Energy Agency, Vienna, Austria</aff><pub-date pub-type="collection"><year>2005</year></pub-date><pub-date pub-type="epub"><day>27</day><month>7</month><year>2005</year></pub-date><volume>5</volume><fpage>4</fpage><lpage>4</lpage><ext-link ext-link-type="uri" xlink:href="http://www.biomedcentral.com/1471-2385/5/4"></ext-link><history><date date-type="received"><day>29</day><month>12</month><year>2004</year></date><date date-type="accepted"><day>27</day><month>7</month><year>2005</year></date></history><permissions><copyright-statement>Copyright © 2005 Massardo et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2005</copyright-year><copyright-holder>Massardo et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0"></ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p><pmc-comment>
Massardo
Teresa
tmassardo@redclinicauchile.cl
Planar Tc99m – sestamibi scintimammography should be considered cautiously in the axillary evaluation of breast cancer protocols: Results of an international multicenter trial
2005 BMC Nuclear Medicine 5(1): 4-. (2005) 1471-2385(2005)5:1<4> urn:ISSN:1471-2385
</license></permissions><abstract><sec><title>Background</title><p>Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion. As a part of an interregional protocol using scintimammography with Tc99m compounds, the value of planar Tc99m sestamibi scanning for axillary lymph node evaluation is presented. Since there is a wide range of reported values, a standardized protocol of planar imaging was performed.</p></sec><sec sec-type="methods"><title>Methods</title><p>One hundred and forty-nine female patients were included prospectively from different regions. Their mean age was 55.1 ± 11.9 years. Histological report was obtained from 2.987 excised lymph nodes from 150 axillas. An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients, all images performed with 740–925 MBq dose of Tc99m sestamibi. Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla. Diagnostic values, 95% confidence intervals [CI] and also likelihood ratios (LR) were calculated.</p></sec><sec><title>Results</title><p>Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes. Sestamibi was positive in 30 axillas (25 true-positive) and negative in 120 (only 55 true-negative). The sensitivity corresponded to 27.8% [CI = 18.9–38.2] and specificity to 91.7% [81.6–97.2]. The positive and negative LR were 3.33 and 0.79, respectively. There was no difference between early and delayed images. Sensitivity was higher in patients with palpable lesions.</p></sec><sec><title>Conclusion</title><p>This work confirmed that non tomographic Tc99m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer.</p></sec></abstract></article-meta></front></pmc><affiliations><list><country><li>Autriche</li><li>Chili</li><li>Colombie</li><li>Inde</li><li>Pérou</li><li>Turquie</li><li>Uruguay</li></country><region><li>Vienne (Autriche)</li></region><settlement><li>Vienne (Autriche)</li></settlement></list><tree><country name="Chili"><noRegion><name sortKey="Massardo, Teresa" sort="Massardo, Teresa" uniqKey="Massardo T" first="Teresa" last="Massardo">Teresa Massardo</name></noRegion></country><country name="Uruguay"><noRegion><name sortKey="Alonso, Omar" sort="Alonso, Omar" uniqKey="Alonso O" first="Omar" last="Alonso">Omar Alonso</name></noRegion><name sortKey="Delgado, Lucia" sort="Delgado, Lucia" uniqKey="Delgado L" first="Lucía" last="Delgado">Lucía Delgado</name></country><country name="Colombie"><noRegion><name sortKey="Llamas Ollier, Augusto" sort="Llamas Ollier, Augusto" uniqKey="Llamas Ollier A" first="Augusto" last="Llamas-Ollier">Augusto Llamas-Ollier</name></noRegion></country><country name="Turquie"><noRegion><name sortKey="Kabasakal, Levin" sort="Kabasakal, Levin" uniqKey="Kabasakal L" first="Levin" last="Kabasakal">Levin Kabasakal</name></noRegion></country><country name="Inde"><noRegion><name sortKey="Ravishankar, Uma" sort="Ravishankar, Uma" uniqKey="Ravishankar U" first="Uma" last="Ravishankar">Uma Ravishankar</name></noRegion></country><country name="Pérou"><noRegion><name sortKey="Morales, Rossana" sort="Morales, Rossana" uniqKey="Morales R" first="Rossana" last="Morales">Rossana Morales</name></noRegion></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Padhy, Ajit K" sort="Padhy, Ajit K" uniqKey="Padhy A" first="Ajit K" last="Padhy">Ajit K. Padhy</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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