99mTc-sestamibi using a direct conversion molecular breast imaging system to assess tumor response to neoadjuvant chemotherapy in women with locally advanced breast cancer

David Mitchell, Carrie B Hruska, Judy C Boughey, Dietlind L. Wahner-Roedler, Katie N. Jones, Cindy Tortorelli, Amy Lynn Conners, Michael K. O'Connor

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

PURPOSE: The objective of this study was to determine the ability of breast imaging with Tc-sestamibi and a direct conversion-molecular breast imaging (MBI) system to predict early response to neoadjuvant chemotherapy (NAC). METHODS: Patients undergoing NAC for breast cancer were imaged with a direct conversion-MBI system before (baseline), at 3 to 5 weeks after onset, and after completion of NAC. Tumor size and tumor-to-background (T/B) uptake ratio measured from MBI images were compared with extent of residual disease at surgery using the residual cancer burden. RESULTS: Nineteen patients completed imaging and proceeded to surgical resection after NAC. Mean reduction in T/B ratio from baseline to 3 to 5 weeks for patients classified as RCB-0 (no residual disease), RCB-1 and RCB-2 combined, and RCB-3 (extensive residual disease) was 56% (SD, 0.20), 28% (SD, 0.20), and 4% (SD, 0.15), respectively. The reduction in the RCB-0 group was significantly greater than in RCB-1/2 (P = 0.036) and RCB-3 (P = 0.001) groups. The area under the receiver operator characteristic curve for determining the presence or absence of residual disease was 0.88. Using a threshold of 50% reduction in T/B ratio at 3 to 5 weeks, MBI predicted presence of residual disease at surgery with a diagnostic accuracy of 89.5% (95% confidence interval [CI], 0.64%-0.99%), sensitivity of 92.3% (95% CI, 0.74%-0.99%), and specificity of 83.3% (95% CI, 0.44%-0.99%). The reduction in tumor size at 3 to 5 weeks was not statistically different between RCB groups. CONCLUSIONS: Changes in T/B ratio on MBI images performed at 3 to 5 weeks following initiation of NAC were accurate at predicting the presence or absence of residual disease at NAC completion.

Original languageEnglish (US)
Pages (from-to)949-956
Number of pages8
JournalClinical Nuclear Medicine
Volume38
Issue number12
DOIs
StatePublished - Dec 2013

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Technetium Tc 99m Sestamibi
Molecular Imaging
Breast
Breast Neoplasms
Drug Therapy
Neoplasms
Confidence Intervals
Residual Neoplasm

Keywords

  • Tc- sestamibi
  • breast cancer
  • molecular breast imaging
  • neoadjuvant chemotherapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

99mTc-sestamibi using a direct conversion molecular breast imaging system to assess tumor response to neoadjuvant chemotherapy in women with locally advanced breast cancer. / Mitchell, David; Hruska, Carrie B; Boughey, Judy C; Wahner-Roedler, Dietlind L.; Jones, Katie N.; Tortorelli, Cindy; Conners, Amy Lynn; O'Connor, Michael K.

In: Clinical Nuclear Medicine, Vol. 38, No. 12, 12.2013, p. 949-956.

Research output: Contribution to journalArticle

Mitchell, David ; Hruska, Carrie B ; Boughey, Judy C ; Wahner-Roedler, Dietlind L. ; Jones, Katie N. ; Tortorelli, Cindy ; Conners, Amy Lynn ; O'Connor, Michael K. / 99mTc-sestamibi using a direct conversion molecular breast imaging system to assess tumor response to neoadjuvant chemotherapy in women with locally advanced breast cancer. In: Clinical Nuclear Medicine. 2013 ; Vol. 38, No. 12. pp. 949-956.
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AU - Mitchell, David

AU - Hruska, Carrie B

AU - Boughey, Judy C

AU - Wahner-Roedler, Dietlind L.

AU - Jones, Katie N.

AU - Tortorelli, Cindy

AU - Conners, Amy Lynn

AU - O'Connor, Michael K.

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N2 - PURPOSE: The objective of this study was to determine the ability of breast imaging with Tc-sestamibi and a direct conversion-molecular breast imaging (MBI) system to predict early response to neoadjuvant chemotherapy (NAC). METHODS: Patients undergoing NAC for breast cancer were imaged with a direct conversion-MBI system before (baseline), at 3 to 5 weeks after onset, and after completion of NAC. Tumor size and tumor-to-background (T/B) uptake ratio measured from MBI images were compared with extent of residual disease at surgery using the residual cancer burden. RESULTS: Nineteen patients completed imaging and proceeded to surgical resection after NAC. Mean reduction in T/B ratio from baseline to 3 to 5 weeks for patients classified as RCB-0 (no residual disease), RCB-1 and RCB-2 combined, and RCB-3 (extensive residual disease) was 56% (SD, 0.20), 28% (SD, 0.20), and 4% (SD, 0.15), respectively. The reduction in the RCB-0 group was significantly greater than in RCB-1/2 (P = 0.036) and RCB-3 (P = 0.001) groups. The area under the receiver operator characteristic curve for determining the presence or absence of residual disease was 0.88. Using a threshold of 50% reduction in T/B ratio at 3 to 5 weeks, MBI predicted presence of residual disease at surgery with a diagnostic accuracy of 89.5% (95% confidence interval [CI], 0.64%-0.99%), sensitivity of 92.3% (95% CI, 0.74%-0.99%), and specificity of 83.3% (95% CI, 0.44%-0.99%). The reduction in tumor size at 3 to 5 weeks was not statistically different between RCB groups. CONCLUSIONS: Changes in T/B ratio on MBI images performed at 3 to 5 weeks following initiation of NAC were accurate at predicting the presence or absence of residual disease at NAC completion.

AB - PURPOSE: The objective of this study was to determine the ability of breast imaging with Tc-sestamibi and a direct conversion-molecular breast imaging (MBI) system to predict early response to neoadjuvant chemotherapy (NAC). METHODS: Patients undergoing NAC for breast cancer were imaged with a direct conversion-MBI system before (baseline), at 3 to 5 weeks after onset, and after completion of NAC. Tumor size and tumor-to-background (T/B) uptake ratio measured from MBI images were compared with extent of residual disease at surgery using the residual cancer burden. RESULTS: Nineteen patients completed imaging and proceeded to surgical resection after NAC. Mean reduction in T/B ratio from baseline to 3 to 5 weeks for patients classified as RCB-0 (no residual disease), RCB-1 and RCB-2 combined, and RCB-3 (extensive residual disease) was 56% (SD, 0.20), 28% (SD, 0.20), and 4% (SD, 0.15), respectively. The reduction in the RCB-0 group was significantly greater than in RCB-1/2 (P = 0.036) and RCB-3 (P = 0.001) groups. The area under the receiver operator characteristic curve for determining the presence or absence of residual disease was 0.88. Using a threshold of 50% reduction in T/B ratio at 3 to 5 weeks, MBI predicted presence of residual disease at surgery with a diagnostic accuracy of 89.5% (95% confidence interval [CI], 0.64%-0.99%), sensitivity of 92.3% (95% CI, 0.74%-0.99%), and specificity of 83.3% (95% CI, 0.44%-0.99%). The reduction in tumor size at 3 to 5 weeks was not statistically different between RCB groups. CONCLUSIONS: Changes in T/B ratio on MBI images performed at 3 to 5 weeks following initiation of NAC were accurate at predicting the presence or absence of residual disease at NAC completion.

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