Comparison of 99mTc-sestamibi molecular breast imaging and breast MRI in patients with invasive breast cancer receiving neoadjuvant chemotherapy

Katie N. Hunt, Amy Lynn Conners, Matthew Philip Goetz, Michael K. O’Connor, Vera Jean Suman, Krishna R Kalari, Richard M Weinshilboum, Liewei M Wang, Jodi Carter, Sarah McLaughlin, Alvaro Moreno Aspitia, Richard Gray, Donald W Northfelt, Judy C Boughey

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Abstract

OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. SUBJECTS AND METHODS. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) 99mTc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. RESULTS. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. CONCLUSION. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.

Original languageEnglish (US)
Pages (from-to)932-943
Number of pages12
JournalAmerican Journal of Roentgenology
Volume213
Issue number4
DOIs
StatePublished - Jan 1 2019

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Technetium Tc 99m Sestamibi
Molecular Imaging
Breast
Breast Neoplasms
Drug Therapy

Keywords

  • Tc-sestamibi
  • Breast cancer
  • Molecular breast imaging
  • MRI
  • Neoadjuvant chemotherapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{e02e43d6bd7e4a6c85dd7a46dcd9a0fb,
title = "Comparison of 99mTc-sestamibi molecular breast imaging and breast MRI in patients with invasive breast cancer receiving neoadjuvant chemotherapy",
abstract = "OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. SUBJECTS AND METHODS. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) 99mTc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. RESULTS. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3{\%} of cases before NAC and 70.1{\%} of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7{\%} of breast MRI cases and 59.6{\%} of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9{\%}) cases were negative at MRI and 23 (41.1{\%}) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4{\%}) at MRI and uptake in six cases (17.6{\%}) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8{\%}, 69.4{\%}, 81.4{\%}, and 71.4{\%}, respectively, for MRI and 58.9{\%}, 82.4{\%}, 84.6{\%}, and 54.9{\%}, respectively, for MBI. CONCLUSION. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.",
keywords = "Tc-sestamibi, Breast cancer, Molecular breast imaging, MRI, Neoadjuvant chemotherapy",
author = "Hunt, {Katie N.} and Conners, {Amy Lynn} and Goetz, {Matthew Philip} and O’Connor, {Michael K.} and Suman, {Vera Jean} and Kalari, {Krishna R} and Weinshilboum, {Richard M} and Wang, {Liewei M} and Jodi Carter and Sarah McLaughlin and {Moreno Aspitia}, Alvaro and Richard Gray and Northfelt, {Donald W} and Boughey, {Judy C}",
year = "2019",
month = "1",
day = "1",
doi = "10.2214/AJR.18.20628",
language = "English (US)",
volume = "213",
pages = "932--943",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "4",

}

TY - JOUR

T1 - Comparison of 99mTc-sestamibi molecular breast imaging and breast MRI in patients with invasive breast cancer receiving neoadjuvant chemotherapy

AU - Hunt, Katie N.

AU - Conners, Amy Lynn

AU - Goetz, Matthew Philip

AU - O’Connor, Michael K.

AU - Suman, Vera Jean

AU - Kalari, Krishna R

AU - Weinshilboum, Richard M

AU - Wang, Liewei M

AU - Carter, Jodi

AU - McLaughlin, Sarah

AU - Moreno Aspitia, Alvaro

AU - Gray, Richard

AU - Northfelt, Donald W

AU - Boughey, Judy C

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. SUBJECTS AND METHODS. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) 99mTc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. RESULTS. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. CONCLUSION. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.

AB - OBJECTIVE. The purpose of this study is to prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. SUBJECTS AND METHODS. Women with invasive breast cancer greater than or equal to 1.5 cm were enrolled to compare the longest dimension before and after NAC at MRI and MBI. MBI was performed on a dual-detector cadmium zinc telluride system after administration of 6.5 mCi (240 MBq) 99mTc-sestamibi. The accuracy of MRI and MBI in assessing residual disease (invasive disease or ductal carcinoma in situ) was determined relative to pathologic examination. RESULTS. The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. CONCLUSION. Breast MRI and MBI showed similar disease extent before NAC. MBI may be an alternative to breast MRI in patients with a contraindication to breast MRI. Neither modality showed sufficient accuracy after NAC in predicting breast pathologic complete response to obviate tissue diagnosis to assess for residual invasive disease. Defining the extent of residual disease compared with pathologic evaluation was also limited after NAC for both breast MRI and MBI.

KW - Tc-sestamibi

KW - Breast cancer

KW - Molecular breast imaging

KW - MRI

KW - Neoadjuvant chemotherapy

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U2 - 10.2214/AJR.18.20628

DO - 10.2214/AJR.18.20628

M3 - Article

C2 - 31166752

AN - SCOPUS:85070313942

VL - 213

SP - 932

EP - 943

JO - American Journal of Roentgenology

JF - American Journal of Roentgenology

SN - 0361-803X

IS - 4

ER -