Some researchers tried to use Tc-99m MIBI scintigraphy for evaluating breast cancer patients Early reports revealed that Tc-99m MIBI breast scintigraphy is useful in distinguishing malignancies from benign masses in patients who have difficulty in mammographic evaluation. Further studies suggested that the functional imaging with Tc-99m MIBI in breast cancer seems to be correlated with levels of P-glycoprotein (Pgp) expression and angiogenesis in cancer tissues. So we evaluated whether there is an actually significant relationship between the pattern of Tc-99m MIBI uptake in tumor tissue and tumoric factors including Pgp expression and angiogenesis. Thirty one untreated breast cancer patients (pathologically proved to invasive ductal carcinoma later) were prospectively studied by both Tc-99m MIBI scintigraphy and immunohistochemical analysis of angiogenesis and Pgp expression on sugically removed tumor tissues. Both lateral and anterior planar images were obtained at 10 minutes and 3 hours after intravenous injection of 740 MBq Tc-99m MIBI. Tumor-to-normal breast ratio(T/N) and washout index (WI, early T/N minus late T/N divided by early T/N) were calcuated. The results were follows; A significant correlation was found between T/N at early and late images(r=0.54, p=0.002 on early images, r=0.47, p=0.008 on late images). T/N of early images were not different among different groups of Pgp expression(p=0.3696), while those of late images were significantly different among groups(p=0.0276). Even more significant difference of WI among the groups were noted (p=0.0015). A significant negative correlation was noted between T/N of late images and Pgp expression (p=0.00276). A even stronger correlation was found between WI and Pgp expression (r=0.68, p=0.001). In conclusion, the tumoral uptake and washout of Tc-99m MIBI can be used as a simple functional test for angiogenesis and P-glycoprotein expression in untreated breast cancer.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Humans ; Injections, Intravenous ; P-Glycoprotein ; Population Characteristics* ; Prospective Studies ; Radionuclide Imaging*

BACKGROUND: Some researchers have tried to use Tc-99m MIBI (2-methoxyisobutyl isonitril) scintigraphy to evaluate breast-cancer patients. Early reports revealed that Tc-99m MIBI breast scintigraphy was useful in distinguishing malignancies from benign masses in patients for whom mammographic evaluations were difficult. Further studies suggested that functional imaging with Tc-99m MIBI in breast cancer seemed to be correlated with the levels of P-glycoprotein (Pgp) expression and angiogenesis in cancer tissues. For that reason, we evaluated whether significant relationship actually existed between the pattern of Tc-99m MIBI uptake in tumor tissue and tumoric factors including Pgp expression and angiogenesis. METHODS: Thirty-one untreated breast-cancer patients (later pathologically proved to have had invasive ductal carcinomas) were prospectively studied by using both Tc-99m MIBI scintigraphy on and immunohistochemical analyses of angiogenesis and Pgp expression in sugically removed tumor tissues. Both lateral and anterior planar images were obtained at 10 minutes and 3 hours after intravenous injection of 740 MBq Tc-99m MIBI. The tumor-to-normal breast ratio (T/N) and the washout index (WI, early T/N minus late T/N divided by early T/N) were calculated. RESULTS: A significant correlation was found between the T/N's at early and late images (r=0.54, p=0.002 on early images; r=0.47, p=0.006 on late images). The T/N's of early images were not different among the different groups of Pgp expression (p=0.3696) while those of late images were significantly different among the groups (p=0.0276). An even more significant difference was noted in the WI's among the groups (p=0.0015). A significant negative correlation was noted between the T/N of late images and Pgp expression (p=0.0276). An even stronger correlation was found between WI and Pgp expression (r=0.668, p=0.001). CONCLUSIONS: The tumoral uptake and washout of Tc-99m MIBI can be used as a simple functional test for angiogenesis and P-glycoprotein expression in untreated breast cancer.
Breast Neoplasms* ; Breast* ; Humans ; Injections, Intravenous ; P-Glycoprotein ; Population Characteristics* ; Prospective Studies ; Radionuclide Imaging*

Early detection of neoplastic disese and metastatic spred is very important. Carcinoma of the breast is knownto readily metastasize to the bone. The use of Tc-99m-phophate as bone imaging agent has been shown to demonstrate early evidence of bone metastasis well before radiographic evidence is visualized and as thus become a very usefultechnique for establishing and monitoring the bony metastatic element of breast cancer. In this study, serial boneimaging studies were performed to monitor the management of 84 breast cancer patients before and after mastectomyand biopsy. We attempted to analyse bone scans of breast cancer and to correlated the scan findings with theclinical stage, status of lymphnodes, distanat metastasis, bone pain, and laboratory datas. The following useful patterns were emerged: 1. Postive bone scan rate was definitely higher in clinical stage III and IV (42, 57%) thatin stage I and II(4, 18%) in initital studies. However, no correlation between positive bone scan rate andclinical stage was found in follow up studies. 2. Positive bone scan rate was high in both groups with locallyadvanced tumor(T3 & T4) and distant metastasis. 3. No correlation between postive bone scan and status oflymphnode involvement was noted. 4. Positive bone scan rate was also very high in patients with bone pain andabnomral laboratory data.
Biopsy ; Breast Neoplasms ; Breast ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radionuclide Imaging

We present an interesting case of incidental diffuse fluorodeoxyglucose (FDG) uptake at PET in her left breast, related to atypical breastfeeding practice. Clinically, differential diagnoses of diffuse intense FDG uptake in unilateral breast include advanced breast cancer, breast lymphoma and inflammatory condition. However, normal physiologic lactation may also show increased FDG uptake in the breasts. Therefore, if we encounter that finding in daily practice, we should question the patient regarding unilateral breastfeeding. In addition, mammography and ultrasound would be helpful to confirm the diagnosis.
Adult ; Breast/*metabolism/radionuclide imaging ; Breast Feeding/*methods ; Breast Neoplasms/radionuclide imaging ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18/diagnostic use/*pharmacokinetics ; Humans ; Lactation/metabolism ; Lymphoma/radionuclide imaging ; Mammography ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use/*pharmacokinetics ; Ultrasonography, Mammary

PURPOSE: To assess the diagnostic usefulness of multimodality study in the diagnosis of breast cancer. MATERIALS AND METHODS: Eighty-one patients between January 1998 to December 1999 were involved in this study, and who underwent mammography, breast ultrasonography, and 99mTc-MIBI scintimammography in all cases the findings were retrospectively reviewed. Each modality was graded by two physicians specializing in nuclear medicine and two radiologists, all unaware of the pathologic results. A four-grade system(1=definitely benign, 2=probably benign, 3=probably malignant, 4=definitely malignant) was applied to those ofbreast ultrasonography and 99m Tc-MIBI scintimammography and BIRADS was applied to those ofmammography. All breast masses were confirmed by surgery (n=67) or FNA (n=14). Findings of grade 3 or 4 the four-grade system, BIRADS category 4 or 5, or positive coincidence in double and triple combination studies were defined as positive results, and on the basis of the data thus obtained, the sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were calculated for each modality and for multimodality studies. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 99mTc-MIBI scintimammography were 83.6%, 88.5%, 93.9%, 71.9% and 85.2%, respectively. For ultrasonography, the corresponding figure were 94.5%, 65.3%, 85.2%, 85.0%, and 85.2%, and these for mammography, they were 87.3%, 69.2%, 87.3%, 81.8% and 80.2%. For the ultrasonography and mammography combination, the figures were 83.6%, 50.0%, 93.9%, 100.0% and 95.2%, respectively, and for 99mTc-MIBI scinti-mammography and mammography, the corresponding findings were 72.7%, 69.2%, 95.2%, 100.0% and 96.7%. For the 99mTc-MIBI scintimammography and ultrasonography combination, respective findings of were 80.0%, 61.5%, 95.7%, 94.1% and 95.2%, respectively, and in the triple modality study, respective findings of 70.9%, 50.0%, 97.5%, 100.0% and 98.1% were recorded. CONCLUSION: Among multimodality studies, sensitivity was greatest in the ultrasonography and mammography combination, which is thus extremely suitable for the diagnosis of breast cancer. The findings of two series suggest that in equivocal cases, 99mTc-MIBI scintimammography with its higher specificity and positive predictive value, is a useful adjunctive tool.
Breast Neoplasms* ; Breast* ; Diagnosis ; Humans ; Mammography* ; Nuclear Medicine ; Radionuclide Imaging ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography ; Ultrasonography, Mammary

PURPOSE: It has been reported that the sodium/iodide symporter (NIS) gene is expressed in several breast cancer tissues, suggesting the possibility of radionuclide imaging and therapy. However, the regulatory mechanism of NIS gene expression in breast cancer is not yet understood. To assess the relationship between the hormonal status and the NIS expression in breast cancer tissue, we investigated the NIS expression and correlated it to the expression of the thyrotropin receptor (thyroid stimulating hormone receptor, TSH-R), the estrogen receptor (ER) and the progesterone receptor (PR) in human breast cancer tissues. MATERIALS AND METHODS: Breast cancer tissues were obtained from 44 patients. Pathological examination showed 2 cases of Grade I, 17 of Grade II, 22 of Grade III, and 3 of unknown grade. We measured the expression of NIS and TSH-R genes by using RT-PCR and we measured the status of ER and PR by using immunohisto-chemistry. RESULTS: The NIS gene was expressed in 15 (34%) of the 44 breast cancer tissues. The NIS gene was expressed in 32% of the cases with TSH-R gene expression. The NIS gene was expressed in 40% of the breast cancer tissues with a positive PR and in 31% with a negative PR (p>0.05). It was positive for PR in 18% of the cases and negative for PR in 39% of the cases (p>0.05). CONCLUSION: The NIS gene is expressed in approximately one-third of the human breast cancer tissues. Its expression was not related to the presence of the TSH-R gene or hormonal receptors, ER and PR.
Breast Neoplasms* ; Breast* ; Estrogens ; Gene Expression ; Humans* ; Ion Transport* ; Radionuclide Imaging ; Receptors, Estrogen ; Receptors, Progesterone ; Receptors, Thyrotropin

OBJECTIVETo test the clinical value of using Tc-99m MIBI scintimammography (Tc-99m MIBI SMM) to differentiate nodular lesions in breasts and detect axillary lymph node metastases of breast cancer.

METHODSThe subjects consisted of sixty female patients exhibiting unilateral palpable breast mass. The early and delay static acquisitions were undertaken in all subjects at 10 and 90 min after injection with Tc-99m MIBI. The acquisition included three positions: anterior supine, left lateral prone and right lateral prone. A special device for SMM which was developed by our laboratory was used. The ratio of [(T-B)/(NT-B)] was calculated as radioactivity of mass to that of opposite corresponding tissue, and [(T-B)/(NT-B)] > or = 1.21 was used as the cut-off for semi-quantitative discrimination of malignancy from benignity in semi-quantitative analysis. The final diagnosis was obtained from histology examination in all subjects.

RESULTSUsing Tc-99m MIBI SMM to differentiate between nodular lesions in breasts, the diagnostic sensitivity and specificity were 92.9% and 90.6% respectively, the positive predictive value 89.7%, the negative predictive value 93.5%, and the accuracy 91.7%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained with Tc-99m MIBI SMM for detecting axillary lymph node metastases were 83.3%, 86.1%, 80%, 88.6% and 85% respectively.

CONCLUSIONSIt is suggested that Tc-99m MIBI SMM may be not only valuable in differentiating malignant lesions from benign nodular masses of breast, but also helpful in detecting axillary lymph node metastases of breast cancer.

Adolescent ; Adult ; Aged ; Axilla ; Breast ; diagnostic imaging ; Breast Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Middle Aged ; Radionuclide Imaging ; Technetium Tc 99m Sestamibi

Technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) uptake is known to be increased in breast cancer because of increased blood flow from angiogenesis and heightened metabolism. We performed a 99mTc-MIBI scan in a patient with mammary Paget's disease. The patient had underlying invasive cancer in the same side of the breast. 99mTc-MIBI scan exhibited a scintigraphic image of the uptake from the invasive cancer lesion located deeply in the breast toward the epidermis. 99mTc-MIBI showed an uptake in the deeply located invasive cancer lesion as well as nipple lesion. Especially, the delayed phase of Tc-MIBI scan demonstrated the tumor site more accurately. In conclusion, 99mTc-MIBI scan could be a useful adjunct to clinical decision making in the management of Paget's disease of the breast.
Breast Neoplasms/radionuclide imaging* ; Breast Neoplasms/pathology ; Case Report ; Female ; Human ; Middle Age ; Nipples/pathology ; Paget's Disease, Mammary/radionuclide imaging* ; Paget's Disease, Mammary/pathology ; Skin/pathology ; Technetium Tc 99m Sestamibi/diagnostic use*

A 66-year-old woman was transferred to our hospital due to her right breast cancer. Preoperative breast MRI shows 1.9 cm malignancy on her right breast (cT1N0M0) and incidentally found osteosclerotic change of left coststernoclavicular region. Bone scintigraphy showed hot uptake and the possibility of bone metastasis was not excluded. However, because the bone metastasis is not common in early stage cancer and the costosternoclavicular region is not common site, other possibility should be considered. SAPHO syndrome can be diagnosed even in the absence of dermatosis when there is an axial or appendicular osteitis and hyperostosis, especially in costosternoclavicular region. Though breast imaging specialists are not accustomed to this disease entity, awareness and diagnosis of the SAPHO syndrome can help differentiate bone metastasis.
Acquired Hyperostosis Syndrome* ; Aged ; Breast Neoplasms* ; Breast* ; Diagnosis ; Female ; Humans ; Hyperostosis ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Osteitis ; Radionuclide Imaging ; Skin Diseases ; Specialization

PURPOSE: Holmium-166(H0-166) is a potent beta-emitter with a short half-life(26.83 hours) and high betaenergy(1.85MeV), and its necrotic effect on breast carcinoma has been proved. In cases of hepatocellularcarcinoma, Ho-166 can therefore be used for internal radiation therapy. The purpose of this study is to evaluatethe therapeutic effect of Ho-166 on hepatocellular carcinomas and to estimate the required dosage, according totheir size. MATERIALS AND METHODS: Tumor cells of hepatocellular carcinomas(SK-HEP1) were subcutaneouslyheterotransplanted into 71 nude mice and 71 hepatocellular carcinomas less than 2cm in diameter were grown. Ho-166was directly injected into a tumor at a dosage of between 0.5mCi(18.5MBq) and 3.0mCi(11MBq). After initialinjection of Ho-166, tumor uptake and radioactivity were indicated by gamma camera scanning. Hepatocellularcarcinomas in a control group of 20 mice were injected with 0.025ml of normal saline(n=10) and chitosansolution(n=10). Pathologic examination was performed and the necrotic tumor area was measured with an imageanalyzer. RESULTS: All specimens of Ho-166-injected hepatocellular carcinomas showed coagulation necrosisconsistent with radiation effect, while the control group did not show necrosis. As the injected dosage of Ho-166was increased, the necrotic area extended proportionally and the dosage required for total necrosis was calculatedaccording to tumor size. Gamma scintigraphy showed that injected Ho-166 had accumulated within the tumor, withoutthe accumulation of radioactivity in other organs ; the required dosage could be predicted on the basis ofradioactivity count indicated by a gamma camera. CONCLUSION: High-energy beta radiation emitted by Ho-166 can besufficient to kill tumor tissue without associated radiation damage to neighboring organs; intratumoral injectionis thought to be a promising therapeutic approach and a new method for the treatment of hepatocellular carcinoma.
Animals ; Beta Particles ; Breast Neoplasms ; Carcinoma, Hepatocellular* ; Gamma Cameras ; Mice* ; Mice, Nude ; Necrosis ; Radiation Effects ; Radioactivity ; Radionuclide Imaging