Comparison of 99mTc-Sestamibi Scintimammography and Dynamic MR Imaging as Adjuncts to Mammography in the Diagnosis of Breast Cancer


Correspondence: Beata Boné, Department of Diagnostic Radiology, The Karolinska Institute, Huddinge University Hospital, SE-141 86, Stockholm, Sweden.
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Purpose:  To compare the diagnostic accuracy of planar 99mTc-sestamibi scintimammography with dynamic contrast-enhanced MRI (CE-MRI) on the basis of histopathologic results, and to determine the clinical value of these methods as adjuncts to mammography.

Material and Methods:  A total of 90 consecutive women with 111 histopathologically verified breast lesions were enrolled in the study. Patients underwent scintimammography and CE-MRI in addition to mammography. Each finding was classified on a BI-RADS-like five-point rating scale describing the degree of suspicion for malignancy, and all findings were correlated with the histopathological results.

Results:  The overall sensitivity/specificity/accuracy was 85%/59%/78% for mammography, 94%/47%/80% for CE-MRI, and 82%/75%/80% for scintimammography, respectively. CE-MRI showed higher sensitivity ( p = 0.008), but its specificity was lower than scintimammography ( p = 0.049). Using ROC analysis, significant improvement ( p = 0.034) was found between mammography and the combination of mammography + CE-MRI, while mammography + scintigraphy showed no higher diagnostic accuracy than mammography alone.

Conclusion:  If high sensitivity and spatial resolution are needed, CE-MRI is to be preferred in clinical practice as an adjunct to mammography, rather than scintigraphy.