The American Society of Breast Surgeons
Scientific Impact Recognition Award: Molecular breast imaging: A review of the Mayo Clinic experience

https://doi.org/10.1016/j.amjsurg.2008.06.005Get rights and content

Abstract

Background

Molecular breast imaging (MBI) depicts functional uptake of targeted radiotracers in the breast using dedicated gamma cameras.

Methods

MBI studies were performed under several institutional protocols evaluating the use of MBI in screening and diagnosis.

Results

By using a single-head system, sensitivity for breast cancer detection was 85% (57 of 67) overall and 29% for tumors 5 mm or less in diameter. Sensitivity improved to 91% (117 of 128) overall and 69% for tumors 5 mm or less using a dual-head system. In 650 high-risk patients undergoing breast cancer screening, MBI detected 7 cancers, 5 of which were missed on mammography. In 24 of 149 (16%) breast cancer patients MBI detected additional disease not seen on mammography. The sensitivity of MBI was 88% (83 of 94) for invasive ductal carcinoma, 79% (23 of 29) for invasive lobular carcinoma, and 89% (25 of 28) for ductal carcinoma in situ.

Conclusions

MBI can detect invasive ductal carcinoma, ductal carcinoma in situ, and invasive lobular carcinoma. It has a promising role in evaluating the extent of disease and multifocal disease in the breast for surgical treatment planning.

Section snippets

MBI technology

In 2001, our first prototype MBI system was constructed. The system comprised a single, small, field-of-view semiconductor-based gamma camera (G.E. Medical Systems, Haifa, Israel) mounted on a modified mammography gantry. The detector, previously described in detail,17, 18, 19 was made up of an array of 80 × 80 cadmium zinc telluride (CZT) elements, each 2.5 × 2.5 mm, providing a 20 × 20 cm field of view. This CZT prototype offered improved energy resolution and spatial resolution relative to

Single-head prebiopsy study

Of the 100 women in the study, 53 patients had breast cancer confirmed at surgery, and 47 patients had benign findings. In the 53 patients with breast cancer, 59 tumors initially were identified with mammography and/or ultrasound and 8 additional tumors were identified with MBI, for a total of 67 tumors in the study. MBI detected 57 of the 67 tumors for a sensitivity of 85%. The average tumor size was 1.3 cm. Thirty-five tumors were 10 mm or less in diameter, of which 26 were detected on MBI

Comments

MBI has been studied in more than 900 patients at the Mayo Clinic during the past 6 years. In our experience, we have found the dedicated semiconductor-based MBI technology to offer optimal breast positioning analogous to mammography and superior spatial and energy resolution compared with conventional SMM cameras. From the body of work performed at the Mayo Clinic and at other laboratories23, 24, 25, 26, 27 it is clear that MBI has a potentially important role as an adjunct to mammography in

Acknowledgments

This work was supported by the National Institutes of Health and the Susan G. Komen Foundation.

The authors wish to thank Terry Brinkman, Peggy-Drews Radke, Barb Siem, Lori Johnson, Torey Alabin, Michelle Bartel, and Tracy Decklever for their assistance with this research.

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