Meme kanseri varlığı/şüphesi olan olgularda sintimamografinin hasta yönetimine etkisinin araştırılması
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Date
2006
Authors
Güneş, Neşe
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Tc-99m Sestamibi sintimamografi (SM) memeyi görüntülemek için kullanılan noninvaziv, ağrısız, nispeten yeni bir nükleer tıp yöntemidir. Çalışmada, sintimamografi sonuçları operasyon ve/veya biyopsi kararından önce elde edilen MM, USG ve biyopsi gibi diğer verilerle birlikte ele alınarak, hasta yönetimine etkisi irdelenmiştir. Bu prospektif çalışmaya, Ekim 2004 ile Haziran 2005 tarihleri arasında SM çalışması için refere edilen ve yaş ortalaması 42.2 olan toplam 106 kadın hasta dahil edildi. Ayrıntılı öyküleri, meme ile ilgili şikayetleri ve daha önceki görüntülemelerin sonuçları kaydedildi. Tüm hastalara 740-925 MBq Tc-99mMIBI, araştırılan memenin karşı tarafındaki koldan yada tercihen (mümkünse) ayak venlerinden intravenöz olarak enjekte edildi. Sintimamografi yüksek rezolüsyonlu kolimatörü olan tek başlı ve/veya çift başlı gama kamera kullanılarak çekildi. Enjeksiyon uygulamasından 10 dakika sonra yüzüstü yatar pozisyonda sağ ve sol posterolateral oblik ile sırtüstü yatar pozisyonda anterior planar meme görüntüleri alındı. Memelerdeki tutulumlar ‘’tutulum yok (normal)’’ ve ‘‘fokal’’ ya da ‘‘diffüz’’ olmak üzere, ‘‘düşük’’, ‘‘orta’’ ve ‘‘yüksek’’ dereceli tutulumlar olarak derecelendirilerek yorumlandı. Tüm hastalarda SM’nin yönetime etkisi, SM bulgularından önceki ve sonraki ‘’yönetim kararı’’ cerrahla tartışılarak değerlendirildi. 106 olgu içinden meme kanseri olarak saptanan 11 tanesinin 9’unda belirgin artmış fokal aktivite tutuluşu ve 1 hastada hafif artmış fokal aktivite tutuluşu saptanırken 1 hastanın sintigrafisinde patolojik tutulum saptanmadı. Histopatoloji ve/veya diğer tanı yöntemleri ve takipler sonucunda nihai tanısı benign olan 95 hastanın 60’ında SM negatif kalırken 11 hastada hafif fokal aktivite artışı ve diğer 11 hastada orta/belirgin derecede fokal aktivite artışı saptandı. 13 hastada ise memelerde heterojen artmış aktivite tutuluşu gözlendi. Kitle şikayeti/bulgusu ile değerlendirilen 50 olguda fizik muayenede 51 palpabl kitle tespit edildi ve 23 olguda normal sintigrafik tutulum, 6 olguda heterojen tutulum, 7 olguda hafif dereceli fokal tutulum ve 15 olguda orta/belirgin dereceli fokal tutulum paterni tespit edildi. Palpabl kitle saptanmayan 56 olgunun sintigrafik bulguları analiz edildiğinde, 38 olguda normal sintigrafik tutulum, 6 olguda heterojen, 6 olguda hafif ve kalan 6 olguda da orta/belirgin fokal tutulum paterni izlendi. Primer meme kanserinin tespitinde SM’nin toplam duyarlılığı %81, özgüllüğü %87, pozitif öngörü değeri %41, negatif öngörü değeri %97 ve doğruluğu %86 olarak hesaplandı. SM’nin klinik veriler ve görüntüleme protokollerine eklenmesi ile 9 olguda benign lezyonlarda gereksiz biyopsi sayısını azaltma yönünde, 2 olguda eksizyonel biyopsi kararlaştırılması yönünde, 2 olguda genişletilmiş rezeksiyon kararının pekiştirilmesi yönünde, 4 olguda geniş cerrahi eksizyon kararlaştırılması yönünde, 1 olguda TxN1 tümör vakalarını incelemede ve 2 olguda daha sıkı klinik takip kararlaştırılması yönünde etki etti. Böylece 106 hastalık serimizde toplam 20 (%18.8) hastada SM sonuçları hasta yönetimine az ya da çok direkt olarak etki ettiği görüldü. Literatür ışığında bulgularımız göstermiştir ki, SM meme kanseri için bir tarama testi değildir, ancak fizik inceleme ve MM, USG gibi geleneksel görüntülemeler yapıldıktan sonra, bazı olgularda hasta yönetimine katkı sağlayabilir.
Tc-99m Sestamibi scintimammography (SM) is a non-invasive, painless and relatively new nuclear medicine method for breast imaging. In this study, we examined the results of SM results, as well as other data obtained like mammography, ultrasound and biopsy, with regard to its effect on patient management. A total of 106 women (mean age 42.2) reffered for scintimammographic evaluation between October 2004 and June 2005 were included in this prospective study. Data related to their breast problem like complaints, history, results of previous diagnostic procedures were recorded at the time of SM examination. 740-925 MBq of 99mTc-sestamibi was IV injected in the arm contralateral to the breast with the abnormality or preferentially, if suitable, in a pedal vein. Scintimammography was performed using a single-head and/or a dual-head gamma camera equipped with a high-resolution collimator. Planar left- and right- posterolateral oblique images in prone position and an anterior supine acquisition image were obtained 10 min after the injection. Breast uptakes were graded as ‘’no abnormal uptake (normal)’’, and ‘’mild’’, ‘’moderate’’ or ‘’prominent’’ focal or diffuse uptake. The effects of SM on patient management were defined by obtaining the ‘’management decision’’ from the surgeon before and after SM findings. Eleven of 106 patients were finally diagnosed as having breast cancer. Prominent fokal uptake in 9, and mild focal uptake in 1 of the 11 patients were found on SM. No abnormal finding was observed in the remaining one patient. 95 patients were diagnosed benign with histopathology and/or other diagnosis methods. Sixty of these patients were diagnosed negative with scintimammography, mild focal increased tracer uptake was observed in 11 patients, while moderate/prominent focal increased tracer uptake was observed in other 11 patients. In addition, heterogenous increased tracer uptake was observed at mammary of 13 patients. Fifty-one palpable masses were found in physical examination of 50 subjects with mass symptom; normal tracer uptake at 23 subjects, heterogenic increased tracer uptake at six subjects, mild focal increased tracer uptake at seven subjects and moderate/prominent focal increased tracer uptake at 15 subjects were also detected by scintigraphy. In analyses of scintigraphic findings of 56 subjects without detecting of palpable mass; normal tracer uptake at 38 subjects, heterogenic increased tracer uptake at six subjects, mild focal increased tracer uptake at six subjects and moderate/prominent focal increased tracer uptake at six subjects were detected. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SM were 81%, 87%, 41%, 97% and 86% respectively for primary breast cancer. The addition of SM to clinical data and imaging protocols had effects such as; decreasing of number of unnecessary biopsies performed in benign lesions of 9 subjects, decision of excisional biopsy in two subjects, confirmation of decision of extended resection in two subjects, decision of wide surgical excision in four subjects, examination of TxN1 tumour in one subject and decision of closer clinical follow-up in two subjects. Thus, results of SM had an effect on patient management in 20 (18.8%) patients in our series of 106 patients. Our result indicated with accordance with literature that SM is not a screening test for breast cancer but it can help to patient management at some subjects after conventional methods, such as physical examination, mammography and ultrasonography, are performed.
Tc-99m Sestamibi scintimammography (SM) is a non-invasive, painless and relatively new nuclear medicine method for breast imaging. In this study, we examined the results of SM results, as well as other data obtained like mammography, ultrasound and biopsy, with regard to its effect on patient management. A total of 106 women (mean age 42.2) reffered for scintimammographic evaluation between October 2004 and June 2005 were included in this prospective study. Data related to their breast problem like complaints, history, results of previous diagnostic procedures were recorded at the time of SM examination. 740-925 MBq of 99mTc-sestamibi was IV injected in the arm contralateral to the breast with the abnormality or preferentially, if suitable, in a pedal vein. Scintimammography was performed using a single-head and/or a dual-head gamma camera equipped with a high-resolution collimator. Planar left- and right- posterolateral oblique images in prone position and an anterior supine acquisition image were obtained 10 min after the injection. Breast uptakes were graded as ‘’no abnormal uptake (normal)’’, and ‘’mild’’, ‘’moderate’’ or ‘’prominent’’ focal or diffuse uptake. The effects of SM on patient management were defined by obtaining the ‘’management decision’’ from the surgeon before and after SM findings. Eleven of 106 patients were finally diagnosed as having breast cancer. Prominent fokal uptake in 9, and mild focal uptake in 1 of the 11 patients were found on SM. No abnormal finding was observed in the remaining one patient. 95 patients were diagnosed benign with histopathology and/or other diagnosis methods. Sixty of these patients were diagnosed negative with scintimammography, mild focal increased tracer uptake was observed in 11 patients, while moderate/prominent focal increased tracer uptake was observed in other 11 patients. In addition, heterogenous increased tracer uptake was observed at mammary of 13 patients. Fifty-one palpable masses were found in physical examination of 50 subjects with mass symptom; normal tracer uptake at 23 subjects, heterogenic increased tracer uptake at six subjects, mild focal increased tracer uptake at seven subjects and moderate/prominent focal increased tracer uptake at 15 subjects were also detected by scintigraphy. In analyses of scintigraphic findings of 56 subjects without detecting of palpable mass; normal tracer uptake at 38 subjects, heterogenic increased tracer uptake at six subjects, mild focal increased tracer uptake at six subjects and moderate/prominent focal increased tracer uptake at six subjects were detected. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SM were 81%, 87%, 41%, 97% and 86% respectively for primary breast cancer. The addition of SM to clinical data and imaging protocols had effects such as; decreasing of number of unnecessary biopsies performed in benign lesions of 9 subjects, decision of excisional biopsy in two subjects, confirmation of decision of extended resection in two subjects, decision of wide surgical excision in four subjects, examination of TxN1 tumour in one subject and decision of closer clinical follow-up in two subjects. Thus, results of SM had an effect on patient management in 20 (18.8%) patients in our series of 106 patients. Our result indicated with accordance with literature that SM is not a screening test for breast cancer but it can help to patient management at some subjects after conventional methods, such as physical examination, mammography and ultrasonography, are performed.
Description
Keywords
Sestamibi, Sintimamografi, Radyonüklid görüntüleme, Meme neoplazmları, Scintimammography, Radionuclide imaging, Breast neoplasms
Citation
Güneş, N. (2006). Meme kanseri varlığı/şüphesi olan olgularda sintimamografinin hasta yönetimine etkisinin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.