| Part IComparative Study of BSGI, Mammography, Ultrasonography and Joint Imaging in the Diagnosis of Breast CancerObjective: To compare the efficiency of breast specific gamma imaging (BSGI), mammography, ultrasonography and joint imaging for the diagnosis of breast carcinoma.Methods:Ninety-five Patients suspected of breast cancer underwent BSGI, mammography (MMG) and ultrasonography (US) with less than 15 d interval before surgery, and the diagnosis results were verified with histological examination. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of BSGI, MMG, US and combination of either two and three of them for diagnosing the breast carcinoma were calculated.X2 or Fisher tests was applied for statistical analysis.Results:The sensitivity of BSGI, MMG, US, combination of BSGI and MMG, BSGI and US, MMG and US and combination of three together in diagnosis of breast carcinoma were 95.2%(60/63),82.5%(52/63),93.7%(59/63),100%(63/63), 98.4%(62/63).98.4%(62/63) and 100% (63/63), respectively. Other results detailed in the following were all listed with the same order as above. Specificity were 75.0% (24/32),75.0%(24/32),65.6%(21/32),87.5%(27/32),84.4%(27/32), 84.4%(27/32) and 87.5%(27/32). Accuracy were 88.4%(84/95),80.0%(77/95), 84.2%(80/95),95.8%(91/95),93.7%(89/95),93.7%(89/95) and 95.8%(91/95). Positive predictive value were 88.2%(60/68),86.7%(52/60),84.3%(59/70), 94.0%(63/67),92.5%(62/67),92.5%(62/67) and 94.0%(63/67). Negative predictive value were 88.9%(24/27),68.6%(24/35),84.0%(21/25),100%(28/28),96.4%(27/28), 96.4%(27/28) and 100%(28/28), respectively. There were seven breast carcinoma patients with dense breast tissue were missed diagnosed by MMG, however, they were all accurately identified when BSGI and US was joint. Additionally, there were three, two and one DCIS cases were misdiagnosed by US, MMG, and BSGI, respectively, which were all accurately judged by joint imaging of BSGI and MMG.Conclusions:BSGI is a useful supplementary imaging modality for the diagnosis of breast carcinoma, especially useful for diagnosis of malignant lesions in dense breast and DCIS not suffering calcification. Moreover, it is helpful for improving the diagnosis accuracy of breast carcinoma when BSGI was combined with MMG.Part IIThe Added Diagnostic Value of Dual-phase Breast Specific Gamma Imaging with Tc-99m-Sestamibi in Breast CancerObjective:The study in this part was to evaluate the added diagnostic value of dual-phase breast specific gamma imaging (BSG1) in detecting breast cancer by combining visual and semi-quantitative method.Methods:102 patients with indeterminate breast lesions that underwent dual-phase BSGI enrolled in this study. All included lesions were confirmed by surgery and pathology. BSGI was evaluated based on the visual interpretation and semi-quantitative indices of the higher lesion to non-lesion (L/N) value of CC and MLO. Compared with pathological results, the optimal visual analysis and the value of L/N for double-phase were calculated through ROC curve analysis.Results:Among all lesions in 102 patients,119 were finally confirmed by the pathology, with 69 malignant and 50 benign lesions. Both early and delayed L/N of malignant breast diseases were significantly higher than those of benign (3.18±1.35 vs 1.41±0.58, and 2.84±1.38 vs 1.35±0.53, P<0.05). The optimal visual interpretation is over grade 3.5, and the cut-off L/N was 1.92 and 1.69 for early and delayed imaging, respectively. Compared with visual analysis (95.7% and 76.0%), early L/N (91.4% and 92.0%) or delayed L/N (94.3%and 84.0%) alone, the sensitivity and specificity achieved by visual analysis combined with early-phase L/N in diagnosing primary breast cancer are higher, which were 95.7%and 92.0%, respectively. However, when visual combined with delay-phase L/N, the sensitivity and specificity were 95.7% and 84.0%, respectively.Conclusions:The semi-quantitative analysis improved specificity of BSGI for breast cancer. Moreover, added value was achieved when combining with visual analysis. Here, it has to be pointed out, though the specificity of breast cancer diagnosis by delayed-phase L/N was improved when comparing with early-phase L/N, still not as good as visual method. Also, specificity achieved by combination of visual and early semi-quantitative method is still higher than combination of visual and delayed-phase L/N. Therefore, the potential of delayed BSGI in diagnosing breast cancer required further evaluation. Part ⅢBSGI Semi-quantitative Index Correlation:Immunohistochemical Indices, Subtypes and Clinicopathologic Characteristics on Breast CarcinomaObjective:To determine if there is a correlation between semi-quantitative indices of lesion to non-lesion ratio (L/N) on breast specific gamma imaging (BSGI) and immunohistochemical indices(ER,PR,Her-2 and Ki-67), subtypes and clinicopathologic characteristics(the status of tumor size, grade, invasion and axillary lymph node metastasis) of breast cancer.Methods:This retrospective study involved 102 female patients diagnosed with breast cancer underwent BSGI 10 days before surgery. The tumor specimens were analyzed by immunohistochemical staining with the index of ER, PR, Her-2 and Ki-67, and gene amplification using fluorescence in situ hybridization (FISH) was used to determine Her-2 status in tumors with a score of 2+. On the basis of immunohistochemistry and FISH, the tumors were divided into four subtypes:luminal A, luminal B, Her-2 positive and basal. Independent t-test and pearson linear correlation were applied for statistical analysis.Results:There was no significantly statistical difference between the value of L/N on BSGI and molecular markers, such as ER, PR, Her-2 and Ki-67(P>0.05). The subtypes of luminal A, luminal B, Her-2 positive and Basal also cannot be differentiated. The mean value of L/N of non-invasive and infiltrating breast cancer were 2.25±0.14 and 3.15±0.14, respectively, which was significant difference(t=2.89, P=0.0048).The mean value of L/N of DCIS, grade 2 and grade 3 breast cancer were 2.19±0.13,3.07±0.15 and 3.12±0.17, respectively. There is statistical difference between DCIS and grade 2(t=2.92, P=0.0046), and DCIS and grade 3(t=3.28, P=0.0017). The mean value of L/N of breast cancer without and with axillary lymph node metastasis were 2.80±0.12 and 3.36±0.27, respectively (t=2.22, P=0.029).The mean value of L/N for tumor with diameter of≤2cm and>2cm were 2.64±0.13 and 3.40±0.21, respectively(t=3.25, P=0.0016).And the value of L/N was positively correlated with tumor size (r=0.36,P<0.05).Conclusions: The semi-quantitative index of L/N does not correlate with level of ER, PR, Her-2 and Ki-67, and not reflect the subtypes of breast cancer. But the value of L/N may reflect clinicopathologic characteristics of tumor size, grade, infiltration and axillary lymph node metastasis on breast cancer. |
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