The purpose of this study was to investigate the correlations between tumor-to-background ratio (TBR) obtained from breast-specific gamma imaging (BSGI) and the prognostic factors of breast cancer. Sixty-seven patients with invasive ductal carcinoma who underwent preoperative BSGI were enrolled. The BSGI images were visually scored from 1 to 5 according to a breast imaging reporting and data system (BIRADS). The TBR results obtained from positive BSGI images were compared according to the following prognostic factors: tumor size; axillary lymph node metastasis; nuclear grade (NG); histologic grade (HG); subtype; Ki-67; and the expression profile of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Among 67 images, 60 were classified as a positive finding (sensitivity 89.6%). A higher TBR value was significantly correlated with tumor size ≥ 2 cm (P = 0.001), axillary lymph node metastasis (P = 0.007), high HG (P = 0.029), negative PR status (P = 0.036), and Ki-67 ≥ 14% (P = 0.007). The TBR showed a significant difference between the luminal A and non-luminal A subtypes (P = 0.007). On multivariate analysis, TBR had a high correlation with tumor size ≥ 2 cm, axillary lymph node metastasis, and negative PR status (P = 0.003, 0.048, and 0.030, respectively). A high TBR on BSGI was significantly correlated with poor prognostic factors of breast cancer. Luminal A subtype, a breast cancer subtype with more favorable prognosis, was associated with a low TBR on BSGI.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Estrogens ; Humans ; Information Systems ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Phenobarbital ; Prognosis ; Radionuclide Imaging ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

We report a rare case of distant subcutaneous parathyroid carcinoma recurrence. A 50-year-old woman was referred to our hospital because of sustained hypercalcemia despite surgical removal of a parathyroid carcinoma. A focal uptake in the upper mediastinal area was detected in a 99mTc-sestamibi scan, and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging demonstrated a subcutaneous mass. She underwent tumor resection, and the pathological findings were consistent with a parathyroid carcinoma. The postoperative serum parathyroid hormone (PTH) level remained within normal limits. However, a new palpable solitary mass was identified in the upper portion of the left breast 1 year postoperatively. Both a 99mTc-sestamibi scan and 18F-FDG PET/CT imaging revealed an abnormal lesion in the upper breast, and subsequent pathology reports confirmed parathyroid carcinoma metastasis. Serum PTH and calcium levels fell within normal ranges after tumor resection. Two subcutaneous recurrent lesions appeared likely due to tumor seeding during the previous endoscopic operation at a local hospital.
Biological Markers/blood ; Breast Neoplasms/blood/radiography/*radionuclide imaging/*secondary/surgery ; Carcinoma/blood/radiography/*radionuclide imaging/*secondary/surgery ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Middle Aged ; Multimodal Imaging ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*pathology/surgery ; *Positron-Emission Tomography ; Predictive Value of Tests ; Radiopharmaceuticals/*diagnostic use ; Technetium Tc 99m Sestamibi/*diagnostic use ; Time Factors ; *Tomography, X-Ray Computed ; Treatment Outcome

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

OBJECTIVETo explore the effects of different injection techniques of radiotracer on the visualization rate of internal mammary sentinel lymph nodes (IMSLN) in breast cancer patients.

METHODSA series of 137 consecutive breast cancer patients was included in this prospective study. Fifty-eight patients (group A) received the radiotracer (99)Tc(m)-sulphur colloid injected only into 1-2 points in the breast parenchyma in one quadrant, and seventy-nine patients (group B) received the radiotracer injection into the breast parenchyma in two quadrants of the breast. The differences of IMSLN visualization rates of the two groups were compared and the relevant affecting factors were analyzed.

RESULTSThe IMSLN visualization rate of the group B (70.9%, 56/79) was significantly higher than that of the group A (13.8%, 8/58) (P < 0.001). Both techniques seemed to be reliable to identify sentinel lymph node in the axilla (98.7% vs. 98.3%, P = 0.825). In addition, the visualization rate of internal mammary hotspots (82.2%) was more commonly seen in patients receiving injection of a larger volume of radiotracer ( ≥ 0.5 ml/point) than those receiving a smaller volume of radiotracer (<0.5 ml/point, 55.9%, P = 0.011).

CONCLUSIONSThe modified injection technique (two quadrants, large volume radiotraver, and ultrasound guidance) can significantly improve the visualization rate of IMSLN. Our findings should make the biopsy of IMSLN widely implemented and provide an effective and minimally invasive technique to evaluate the internal mammary lymph node status.

Adult ; Aged ; Axilla ; diagnostic imaging ; pathology ; Breast Neoplasms ; diagnostic imaging ; pathology ; surgery ; Female ; Humans ; Injections ; Lymph Nodes ; diagnostic imaging ; pathology ; Middle Aged ; Prospective Studies ; Radionuclide Imaging ; Radiopharmaceuticals ; administration & dosage ; Sentinel Lymph Node Biopsy ; methods ; Technetium Tc 99m Sulfur Colloid ; administration & dosage

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

OBJECTIVETo investigate the value of technetium-99m methoxyisobutylisonitrile ((99)Tc(m)-MIBI) imaging in predicting the efficacy of neoadjuvant chemotherapy (NCT) and prognosis in patients with operable breast cancer.

METHODSSixty five patients with breast cancer underwent (99)Tc(m)-MIBI scintimammography before NCT, and static planar images were taken at 10 min and 180 min after scintimammography. The clearance rate was calculated in each patient, correlation between the clearance rate and efficacy of NCT, and the disease free survival rate were analyzed.

RESULTSThe mean clearance rate of 65 patients was (17.4 ± 6.8)%. The efficacy of NCT was 86.2% (CR 4 cases, PR 52 cases, SD 8 cases, and PD 1 case), and the mean clearance rate of patients with good response or poor response of chemotherapy were (15.5 ± 5.0)% and (29.2 ± 3.2)%, respectively. There was a significant difference between the two groups. The average disease free survival rate in the group with low clearance rate was (75.8%, P = 0.046), significantly higher than that in the group with high clearance rate (53.1%).

CONCLUSIONScintimammography of (99)Tc(m)-MIBI may be used to evaluate the efficacy and prognosis of NCT for patients with operable breast cancer.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; Carcinoma, Ductal, Breast ; diagnostic imaging ; drug therapy ; Carcinoma, Lobular ; diagnostic imaging ; drug therapy ; Chemotherapy, Adjuvant ; Cyclophosphamide ; therapeutic use ; Disease-Free Survival ; Epirubicin ; therapeutic use ; Etoposide ; therapeutic use ; Female ; Fluorouracil ; therapeutic use ; Follow-Up Studies ; Humans ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Predictive Value of Tests ; Radionuclide Imaging ; Radiopharmaceuticals ; Remission Induction ; Taxoids ; therapeutic use ; Technetium Tc 99m Sestamibi

Positron emission tomography combined with computed tomography (PET/CT) has been receiving increasing attention during the recent years for making the diagnosis, for determining the staging and for the follow-up of various malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34-79 years old, mean age: 50 years) were retrospectively compared with the PET or CT scans alone. PET/CT was found to be better than PET or CT alone for detecting small tumors or multiple metastases, for accurately localizing lymph node metastasis and for monitoring the response to chemotherapy in breast cancer patients.
Adult ; Aged ; Bone Neoplasms/*diagnosis/pathology/secondary ; Breast/pathology/radionuclide imaging ; Breast Neoplasms/*diagnosis/pathology/radionuclide imaging ; Carcinoma, Ductal, Breast/diagnosis/pathology ; Carcinoma, Intraductal, Noninfiltrating/*diagnosis/pathology/radionuclide imaging ; Contrast Media/administration & dosage ; Female ; Humans ; Lymphatic Metastasis ; Mammography/methods ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis/pathology ; Neoplasm Staging/methods ; Positron-Emission Tomography/*methods ; Radiographic Image Enhancement/methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ultrasonography, Mammary

PURPOSE: Sentinel lymph node biopsy (SLNB) has been developed to accurately assess the axillary lymph node status accurately without having to remove most of the axillary contents in node negative early breast cancer patients. The aims of this study were to evaluate the accuracy, the false negative rate and the advantage of additional axillary sampling for SLNB with using radioisotope. METHODS: Between December 2003 and June 2005, we carried out SLNB for 574 breast cancer patients who were diagnosed and had operation at Asan Medical Center. For detection of the sentinel lymph node (SLN), radioisotope was injected into the periareolar area on the operating day, breast scintigraphy was performed and finally the biopsy was done using a gamma-detection probe in the operating room. If the SLN turned out to be positive for metastatic malignancy according to the frozen section histology, then additional axillary lymph nodes (LN) dissection was performed. But, if it was free of metastasis, then only axillary node sampling (n< or =5) or no further treatment was done. RESULTS: The mean number of resected SLNs was 2.67+/-0.98 (1-7) and the mean number of total LN was 8.5+/-5.0 (1-38). The SLN was detected 82.8% of the time on lymphoscintigraphy and 98.4% of the time with the gamma probe. Axillary metastasis was founded in 118 cases (20.9%). The accuracy was 98.2%, and the false negative rate was 7.89%. For the SLN positive cases, there were 73/78 cases (93.6%) of 1st SLN metastasis, there were 75/78 cases (93.6%) of 1st and 2nd SLN metastasis, and 75/78 (93.6%) of 1st to 3rd SLN metastasis. The false negative rate of the alternative frozen section was 40% and that of the full frozen section was 24.1%. The difference was statistically significant. CONCLUSION: SLNB using (99m)Tc-antimony trisulfide colloid (0.5 mCi) showed a high detection rate and a low false negative rate. The false negative rate was decreased by using full section H&E staining and at least 3 SLNs showed the exact LN status. Even if the SLN was free of metastasis, additional sampling may decrease the false negative rate.
Biopsy ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Colloids ; Frozen Sections ; Humans ; Lymph Nodes* ; Lymphoscintigraphy ; Neoplasm Metastasis ; Operating Rooms ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy*

OBJECTIVETo investigate an optimal examination method to detect micrometastases in sentinel lymph nodes (SLNs) of breast cancer.

METHODSFirstly, the SLNs of breast cancer were found by 99mTc-DX isotope method. Secondly, all the SLNs which were negative by routine HE examination were serially sectioned at a 100 microm interval and stained by both HE and immunohistochemistry for detecting micrometastases. All tumor tissue paraffin blocks were also sectioned and stained with HE and immunohistochemistry as control.

RESULTSTotally, 121 SLNs and 44 tumors of 59 patients were examined. Micrometastasis was found to be positive in 17 SLNs (14.0%) of 14 patients (23.7%). When examined number of sections was increased from one to three, more positive micrometastatic SLNs were detected by HE staining only (3, 7, 10 for 1, 2, 3 sections, respectively). When HE staining was combined with immunohistochemical staining for AE1/3 or CK19 or muc1, much more positive micrometastatic SLNs were found (14, 12, 16 for 1, 2, 3 sections, respectively). The more sections were examined, the more micrometastases in SLNs were found. Furthermore, micrometastasis was also found to be positively correlated with the tumor size and the expression of c-erbB2, MMP-2, VEGF. The larger the tumor size was or the stronger expression of the above mentioned biomarkers, the more micrometastases in SLNs could be found.

CONCLUSIONSerially sections at a 100 microm interval and staining with both HE and immunohistochemical technique using muc1 antibody may be the best way to detect micrometastases in sentinel lymph nodes in breast cancer patients.

Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; metabolism ; pathology ; Dextrans ; Female ; Humans ; Immunohistochemistry ; Lymph Nodes ; diagnostic imaging ; metabolism ; pathology ; Lymphatic Metastasis ; Matrix Metalloproteinase 2 ; metabolism ; Middle Aged ; Organotechnetium Compounds ; Radionuclide Imaging ; Receptor, ErbB-2 ; metabolism ; Sentinel Lymph Node Biopsy ; methods ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo develop a new imaging agent, (99m)Tc-Rituximab, for sentinel lymphoscinti-graphy and investigate its feasibility in detecting the sentinel lymph node (SLN) for breast cancer patient.

METHODS(99m)Tc-Rituximab was prepared by introducing (99m)Tc directly into the mclecule of Rituximab, thus a new kind of lymphoscintigraphy agent ((99m)Tc-Rituximab) was produced. Five Bal b/c mice and ten breast cancer patients underwent dynamic SLN mapping procedures using (99m)Tc-Rituximab. Axillary lymph node status in breast cancer patients were evaluated with the fusion images, which was processed by computer software. With ROI technique, SLN/background ratio and the rate of SLN uptake were calculated and the dynamic curve of SLN uptake was drawn. The other 61 breast carcinoma patients underwent routine lymphatic mapping. Sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) were both performed in all 71 patients. Fresh SLNs and all axillary nodes were sent for pathological examination using hematoxylin and eosin (H&E) staining.

RESULTS(99m)Tc-Rituximab, with a yield of about 95.0%, can show SLN status in both mice and patients. The fusion image showed SLNs clearly, even the depth of SLNs in the axilla. The results of dynamic SLN mapping showed visible SLN starting from 10 min, up to 16 h after injecting tracer, however, secondary lymph nodes were not detectable at all. In mice, the ratio of SLN/background was 2.1, the rate of uptake was about 3.0% to 3.5%, and the equation of the curve was produced as: y = 0.036x + 2.7875, r(2) = 0.9787. For breast cancer patients, the uptake rate was different from case to case, but the cure seemed to be consistent with logarithm. The result of SLNB and ALND showed that the sensitivity and accuracy of SLNB was both 100.0%. The average number of SLNs found in each case was 2.6. Of nineteen breast cancer patients (26.8%) with lymph node metastasis, 11 were found to only have SLN metastasis.

CONCLUSION(99m)Tc-Rituximab, as a new tracer to mapping sentinel lymph node for breast cancer patient, is able to show the status of sentinel lymph node reliably. The fusing image is easy to obtain and be interpreted by the clinician.

Adult ; Aged ; Animals ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Axilla ; Breast Neoplasms ; diagnostic imaging ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; pathology ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Mice ; Mice, Inbred BALB C ; Middle Aged ; Organotechnetium Compounds ; Radionuclide Imaging ; Random Allocation ; Sentinel Lymph Node Biopsy ; methods