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

24 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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