Comparative Study Of ^99mTc-HL91 With ^99mTc-MIBI Double-phase Mammoscintigraphy In Breast Carcinoma And Axillary Lymph Node Metastases

Objective: To compare the diagnostic value of double-phase ^99mTc-HL91 hypoxia imaging and ^99mTc-MIBI tumor imaging in differentiation of breast lesions and detection of axillary lymph node metastases from breast cancer and to preliminarily assess the clinical value of the two methods in judging the degree of malignancy and prognosis of breast carcinoma.Methods: 39 patients with palpable breast masses confirmed by operation and pathology ( including 27 patients with breast carcinoma and 12 with benign disease ) underwent double-phase ^99mTc-HL91 hypoxia imaging (1h, 4h) and ^99mTc-MIBI imaging (10min, 2h) before surgery. The uptake of ^99mTc-HL91 and ^99mTc-MIBI at the region of interest (ROI) was evaluated as tumor to normal background (T/N) ratio. Retention index (RI) was calculated from the early uptake ratio (EUR) and delayed uptake ratio (DUR). Visual and semiquantitative methods (include ROC curve analysis) were used to analyze all imaging. The correlation between T/N ratio and some clinicopathological factors (include serum CA153 levels ) of 27 patients with breast carcinoma were statistically analyzed.Result:①Visual analysis: The sensitivity,specificity and accuracy of ^99mTc-HL91 hypoxia imaging and ^99mTc-MIBI tumoraffin imaging in breast carcinoma were 85.2%(23/27),75.0%(9/12), 82.1%(32/39) and 81.5%(22/27),66.7%(8/12),76.9%(30/39),respectively. Meanwhile the sensitivity of lymphaden imaging was 72.7%(8/11) and 63.6%(7/11),respectively. The difference was not significant between either two groups of them (P>0.05).②semiquantitative analysis: The EUR, DUR, and RI of ^99mTc-HL91 hypoxia imaging in benign group were 1.14±0.14,1.10±0.11 and -0.04±0.10,respectively; while in malignant group, they were 1.66±0.43,1.75±0.51 and 0.08±0.12,respectively. The EUR, DUR, and RI of ^99mTc-MIBI imaging in benign group were 1.18±0.16,1.15±0.11 and -0.09±0.12,respectively;while in malignant group, they were 1.54±0.36,1.63±0.39 and 0.06±0.13,respectively. The EUR, DUR, and RI of ^99mTc-HL91 and ^99mTc-MIBI in malignant group were all obviously higher than that in benign group, and the DUR were all higher than EUR in malignant group. The uptake and retention of ^99mTc-HL91 in the tissue of breast carcinoma was higher than that of ^99mTc-MIBI. There were all significant differences above.③ROC curve analysis: The AUCROC of ^99mTc-HL91 imaging at corresponding phase was about 5% higher than ^99mTc-MIBI imaging. Each threshold was gained from ROC curve at corresponding phase and was used to distinguish the character of the mammary neoplasms.The semiquantitative diagnosis index (sensitivity+ specificity) at corresponding phase was higher than that of qualitation and the semiquantitative diagnosis index of ^99mTc-HL91 raised to 184.3%.④There were positive correlations between T/N ratio (the uptake of ^99mTc-HL91, ^99mTc-MIBI in breast carcinoma) and the grade of the breast tumor, the expressions of c-erbB-2 , Ki67 in breast carcinoma tissue.Conclusion: The imaging quality and the diagnosis capability of ^99mTc-HL91 are superior to that of ^99mTc-MIBI. Using of semiquantitative analysis and ROC curve can further improve the diagnosis capability of it. The biological behavior and prognosis of breast carcinoma can be assessed by the uptake of ^99mTc-HL91 and ^99mTc-MIBI of breast carcinoma to some extent.