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Molecular Breast Imaging in Patients with Suspicious Calcifications.

Katie N Hunt1, Carrie B Hruska1, Matthew P Johnson2

  • 1Mayo Clinic, Department of Radiology, Rochester, MN.

Journal of Breast Imaging
|March 1, 2024
PubMed
Summary

Molecular breast imaging (MBI) is not accurate enough to avoid biopsies for suspicious calcifications. However, MBI can detect additional mammographically occult breast cancers in women undergoing biopsy.

Keywords:
breast cancercalcificationsductal carcinoma in situmammographymolecular breast imaging

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Area of Science:

  • Nuclear medicine
  • Breast imaging
  • Oncology

Background:

  • Mammography is standard for detecting breast calcifications.
  • Molecular breast imaging (MBI) uses radiopharmaceuticals to visualize functional uptake in the breast.
  • Accuracy of MBI for suspicious calcifications requires evaluation.

Purpose of the Study:

  • To assess the accuracy of MBI in patients with suspicious mammographic calcifications.
  • To determine if MBI can help avoid unnecessary biopsies.

Main Methods:

  • Prospective enrollment of women scheduled for stereotactic biopsy of mammographic calcifications.
  • Prebiopsy MBI performed using Tc-99m sestamibi and a cadmium zinc telluride gamma camera.
  • Biopsy of positive findings on either mammography or MBI; excision of malignant findings.

Main Results:

  • Of 76 calcifications biopsied, 24 (32%) were malignant (20 DCIS, 4 invasive).
  • MBI was positive in 17% of calcifications, detecting 50% of DCIS and 50% of invasive cancers.
  • MBI identified additional occult cancers in 2 of 6 patients (33%), including contralateral DCIS.

Conclusions:

  • MBI has insufficient negative predictive value to avoid biopsies for suspicious calcifications.
  • MBI can detect mammographically occult breast cancer in women undergoing biopsy.
  • Negative MBI findings should not be used to avoid biopsy of suspicious calcifications.