Can Molecular Breast Imaging With Tc-99m Sestamibi Safely Rule Out Malignancy in Pathologic Nipple Discharge?

Area of Science:

• Radiology and Imaging
• Oncology
• Breast Health

Background:

• Pathologic nipple discharge (PND) is a common breast complaint, necessitating the exclusion of malignancy.
• Conventional diagnostic (CD) imaging, including mammography and ultrasound, are standard initial evaluations.
• Molecular breast imaging (MBI) presents a potential alternative or complementary tool for evaluating PND.

Purpose of the Study:

• To assess the diagnostic role of MBI in identifying breast cancer (BC) in patients presenting with PND.
• To evaluate MBI's effectiveness in cases where conventional diagnostic (CD) imaging yields negative or indeterminate results.
• To compare the performance of MBI against CD imaging for PND.

Main Methods:

• A retrospective, single-center cohort study was conducted.
• Included patients with PND evaluated by both CD imaging and MBI between 2012 and 2020.
• Pathology reports served as the gold standard for diagnosis; follow-up was used for cases without pathology.

Main Results:

• Of 96 PND cases, 18 (20%) were diagnosed as breast cancer (BC).
• MBI detected BC in cases missed by CD imaging alone, highlighting its complementary value.
• MBI demonstrated superior sensitivity (83% vs. 33%) and negative predictive value (96% vs. 86%) compared to CD imaging.

Conclusions:

• Molecular breast imaging (MBI) exhibits significant diagnostic accuracy for detecting breast cancer (BC) in patients with PND.
• MBI is particularly valuable when conventional diagnostic (CD) imaging results are negative or indeterminate.
• The findings suggest MBI can aid in preventing unnecessary surgical interventions by improving diagnostic certainty.