Usefulness of for BI-RAD category 4 or higher lesions

• Published in: Korean journal of clinical oncology Vol. 13; no. 1; pp. 43 - 49
• Main Authors: Byun, Jun Suk, Oh, Hyeon Hwa, Lee, Hye Yoon, Kim, Keum Won, Kim, Jin Suk, Yoon, Dae Sung
• Format: Journal Article
• Language: English
• Published: 대한종양외과학회 01-06-2017; Korean Society of Surgical Oncology
• Subjects: bi-rads category 4; breast cancer; scintimammography; 일반외과학; Scintimammography; BI-RADS category 4; Breast cancer
• ISSN: 1738-8082; 2288-4084
• DOI: 10.14216/kjco.17006

Purpose As an alternative to core-needle biopsy in confirming the diagnosis of breast cancer, the usefulness of 99mTc-sestamibi scintimammography (MIBI scan) has been rarely reported. Thus, we aimed to evaluate a direct comparison between general diagnostic modalities and breast MIBI scan, which may be revealed as a potential diagnostic alternative. Methods In a retrospective study, 301 patients with 801 lesions, who underwent breast MIBI scan, ultrasonography, and mammography simultaneously between January 2013 and February 2015, were reviewed. All data were analyzed by McNemar and Kappa test for statistical significance. Results Mean age was 49.2±9.37 years old (range from 26 to 85 years old). Results of Breast MIBI scan were divided into three categories: 236 positive intensity uptakes (29.5%), 565 negative intensity uptakes (70.5%), and 67 suspicious abnormal intensity uptakes (8.4%). Pathologic reports were also allocated into four subgroups: 122 invasive cancers (15.2%), 44 non-invasive cancers (5.5%), 194 proliferative benign lesions (24.2%), and 441 non-proliferative benign lesions (55.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of MIBI scan were 83.5%, 55.6%, 59.1%, and 95.2%, respectively. Specificity of MIBI scan plus general diagnostic modalities increased dramatically, up to 85.2%, compared to general modalities (6.8%). Conclusion In general diagnostic modalities, such as mammography and ultrasound, BI-RAD category 4 or higher lesions were performed by needle biopsy rather than observation. The outstanding specificity and negative predictive value of MIBI scan provided confident results on non-proliferative benign lesions. MIBI scan may offer an alternative diagnostic tool for “invasive” biopsy procedures.