top
 
More Languages
     
Latest News
View All


  
 

 
 
 
 
 
 

 BSGI / Molecular Breast Imaging References  

Breast-specific gamma imagnig as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade.

Breast-specific gamma imaging or BSGI (Dilon) complements mammography and ultrasound. After intravenous injection of 99m Technetium sestamibi, images of both breasts are obtained using a gamma camera with a small field of view device which is able to detect cancers greater than 3 mm. Positron emission mammography or PEM (Naviscan) involves intravenously injecting a glucose-containing radiopharmaceutical fluordexoyglucose (FDG) and imaging with a high-resolution, organ- specific PET scanner. Since both sestamibi and glucose uptake is greater in cancerous cells, BSGI and PEM demonstrate many of the same advantages as MRI including for presurgical planning and in differentiating a scar from a recurrent cancer. Image acquisition is made with the patient in a seated position so that claustrophobia is not an issue and being able to obtain the standard mammographic views makes it easy to compare modalities. Interpretation of the BSGI and PEM is much faster than with MRI since the number of images obtained is significantly less.  Both modalities achieve high sensitivity for the detection of breast cancer and higher specificity than mammography with no difference noted between the detection of cancer in the fatty and dense breast. False positives such as fibroadenomas, fibrocystic changes and fat necrosis are seen on BSGI and PEM but less frequently than with MRI.  PEM can be followed with whole body PET imaging to evaluate for metastatic disease. It should be noted that, the radiotracer and procedure cost is higher for PEM than BSGI. PEM also requires patient to fast for imaging to begin one hour after the injection, and with the patient needing to maintain a distance from others for 45 minutes after the procedure. In addition, PEM studies are only reimbursed in those patients with known cancer while with BSGI reimbursement is for both pre and post diagnosis of breast cancer. Similar to MRI, these techniques require image specific biopsy capabilities, so that when a suspicious lesion is visualized it can be sampled using that modality. The BSGI guided biopsy device is currently not FDA approved.

 The indications for BSGI include;
-Complements mammography and ultrasound for patients who are difficult to image such as those with dense breast tissue, breast implants, in the post surgical breast and for those women who have had silicone and paraffin injections.
-In patients with known cancer to determine the extent of the disease, evaluate for multifocal, multicentric and bilateral disease.
-In those patients with questionable areas seen on mammography or breast ultrasound to reassure probably benign lesions or BI-RADS 3.
-Palpable abnormality or nipple discharge with a normal mammogram and breast ultrasound.
-To differentiate a scar from a recurrent cancer.
-Evaluating the axillary regions for lymph node status in breast cancer patients.
-Predicting chemotherapeutic response,
-Monitoring primary tumor response to neoadjuvant therapy.
-Evaluation of multiple lesions or clusters or microcalcifications to aid in the biopsy targeted selection.
-Evaluation in women with indeterminate or malignant type cluster of  microcalcifications prior to stereotactic core biopsy.
-Patients in which an MRI of the breast is indicated and in those where MRI is not technically possible due to the presence of ferromagnetic implants, body habitus, obesity or patient claustrophobia.
-In high risk patients similar to the MRI screening criteria; personal history, parent, child or sibling with BRCA1 or BRCA 2 mutations, established lifetime risk of 20-25% or history of chest radiation between the ages of 10-30 years of age.

In our practice, we found that BSGI is helpful in evaluating those patients who have a palpable mass but with a negative mammogram and ultrasound. Traditionally, these patients would have been sent to a breast surgeon for management.

Our results show that if the BSGI is normal in this group of patients, the negative predictive value is 95%.  That is to say we can reassure these patients that there is less than 5% chance she does has an invasive cancer.  

In those patients with a positive BSGI, the abnormality was usually identified on a second look targeted ultrasound and subsequent biopsies were positive in 27% of the cases.

 
References:

1. Sampalis, F.S., International Prospective Evaluation of Scintinmammography with 99mTechnetium Sestamibi. Amer Journ Surg 2003; 185 544-549.
2. Brem R, Floerke A, Rapelyea J. TealC, Kelley T, Mathur V. Breast Specific Gamma imaging as an Adjunct Modality for the Diagnosis of Breast cancer. Radiology 2008; 247 (3): 651-57.
3. Zhou M, Johnson N, Blanchard D, Bryn S, Nelson J. Real-world application of breast-specific gamma imaging, initial experience at a community breast center and its potential impact on clinical care. The American Journal of Surgery 2008; 195, 631-635.
4. Zhou M, Johnson N, Gruner S, Ecklund GW, Muenier P, Bryan S, Green G, et al. Clinical Utility of Breast Speicific Imaging for Evaluating Disease in the Newly Diagnosed Breast Cancer Patient. The American Journal of Surgery 2009, Vol 197, No 2.
5. Brem R, Fishman M, Rapelyea JA. Detection of Ductal Carcinoma in-situ with Mammography, Breast-Specific Gamma Imaging and MRI: a comparative study. Academic Radiology. August 2007; Volume 14, Issue 8; 945-950.

6. Brem R, Ioffe M, Rapelyea JA, et al. Invasive Lobular Carcinoma: Detection with Mammography, Sonography, MRI and Breast Specific Gamma Imaging. AJR 2009;192:379-383
7. Brem R, Petrovich R, Rapelyea J et al. Breast- Specific Gamma Imaging with 99m Tc-sestamibi and MRI in the Diagnosis of Breast Cancer- A Comparative Study. The Breast Journal . September 2007; Volume 13 Issue 5; 465-469
8. Bekis R, Derebek E, Balci P, Kodor MA et al. Screening mammographic non-palpable suspicious breast lesions: preliminary results. Nuklearmedizin 2004 Feb; 43 (1): 16-20.
9. Bongers V, Perre C, deHooge P. The use of scintimammography for detecting the recurrence of loco-regional breast cancer: histolopathologically proven results. Nucl Med Commun 2004Feb; 25(2): 145-9.
10. Coover LR, Caravaglia G, Kuhn P. Scintimammography with dedicated breast camera detects and localizes occult carcinoma. J Nucl Med 2004 April; 45(4):553-8.
11.Scillaci O, Buscombe JR. Breast scintigraphy today: indications and limitations. Eur J Nucl Med Mol Imaging 2004 June; 31 Suppl 1:S35-45.
12. Rhodes DJ, O’Connor MK, Phillips SW, Smith RL, Collins DA. Molecular breast imaging: a new technique using technetium Tc 99m scintimammography to detect small tumors of the breast. Mayo Clin Proc 2005; 80:24-30.
13. Tallefer R, et al Clinical Applications of Scintimammography. Sem Nuc Med 2005; 35:100-15.
14. Dunnwald LK, Gralow JR, Ellis GK, Livingston RB et al. Residual tumor uptake of Tc99m sestamibi after neodjuvant chemotherapy for locally advanced breast carcinoma predicts survival. Cancer 2005Feb; 103(4): 680-8.
15. Hussain R, Buscombe JR. A meta-analysis of scintimammography: an evidence-based approach to its clinical utility. Nucl Med Commun 2006 Jul; 27(7):589-94.
16. O’Connor MK, Phillips SW, Hruska CB, Rhodes DJ, Collins DA. Molecular Breast Imaging: advantages and limitations of a scintimammographic technique in patients with small breast tumors. Breast J 2007 JN-Feb; 13 (1):3-11.
17. Orazio S, Buscombe JR. Breast Scintigraphy Today: indications and limitations. European Journal of Nuclear Medicine and Molecular Imaging June 2004, Volume 31, Supple 1.

 

Molecular Breast Imaging:  the Sensitivity of Breast-Specific Gamma Imaging as a Diagnostic Adjunct to Mammography and Ultrasound in a Triple Assessment Protocol

Molecular Breast Imaging:  A Multicenter Clinical registry to Compare Breast-Specifc Gamma Imaging and Breast MRI in the Detection of Breast Carcinoma

Bibliography for Molecular Breast Imaging

Summary Bullets

 
 
 
 
 
 
 

How Does BSGI Affect the Mangement of Patients with Newly Diagnosed Breast Cancer?
 

 

 

 

     
 
Copyright 2004-17  Weinstein Imaging Associates, Pittsburgh, PA       North Hills 412-630-2649  •  Shadyside 412-441-1161  •  South Hills 412-440-6999
Home  |  About Us  |  Services  |  For Patients  |  For Doctors  |  News / Events  |  Links  |  FAQ  |  Contact Us