99mTc-3P4-RGD2 scintimammography in the assessment of breast lesions: comparative study with 99mTc-MIBI

Qingjie Ma, Bin Chen, Shi Gao, Tiefeng Ji, Qiang Wen, Yan Song, Lei Zhu, Zheli Xu, Lin Liu, Qingjie Ma, Bin Chen, Shi Gao, Tiefeng Ji, Qiang Wen, Yan Song, Lei Zhu, Zheli Xu, Lin Liu

Abstract

Purpose: To compare the potential application of (99m)Tc-3P-Arg-Gly-Asp ((99m)Tc-3P4-RGD2) scintimammography (SMM) and (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) SMM for the differentiation of malignant from benign breast lesions.

Method: Thirty-six patients with breast masses on physical examination and/or suspicious mammography results that required fine needle aspiration cytology biopsy (FNAB) were included in the study. (99m)Tc-3P4-RGD2 and (99m)Tc-MIBI SMM were performed with single photon emission computed tomography (SPECT) at 60 min and 20 min respectively after intravenous injection of 738 ± 86 MBq radiotracers on a separate day. Images were evaluated by the tumor to non-tumor localization ratios (T/NT). Receiver operating characteristic (ROC) curve analysis was performed on each radiotracer to calculate the cut-off values of quantitative indices and to compare the diagnostic performance for the ability to differentiate malignant from benign diseases.

Results: The mean T/NT ratio of (99m)Tc-3P4-RGD2 in malignant lesions was significantly higher than that in benign lesions (3.54 ± 1.51 vs. 1.83 ± 0.98, p<0.001). The sensitivity, specificity, and accuracy of (99m)Tc-3P4-RGD2 SMM were 89.3%, 90.9% and 89.7%, respectively, with a T/NT cut-off value of 2.40. The mean T/NT ratio of (99m)Tc-MIBI in malignant lesions was also significantly higher than that in benign lesions (2.86 ± 0.99 vs. 1.51 ± 0.61, p<0.001). The sensitivity, specificity and accuracy of (99m)Tc-MIBI SMM were 87.5%, 72.7% and 82.1%, respectively, with a T/NT cut-off value of 1.45. According to the ROC analysis, the area under the curve for (99m)Tc-3P4-RGD2 SMM (area = 0.851) was higher than that for (99m)Tc-MIBI SMM (area = 0.781), but the statistical difference was not significant.

Conclusion: (99m)Tc-3P4-RGD2 SMM does not provide any significant advantage over the established (99m)Tc-MIBI SMM for the detection of primary breast cancer. The T/NT ratio of (99m)Tc-3P4-RGD2 SMM was significantly higher than that of (99m)Tc-MIBI SMM. Both tracers could offer an alternative method for elucidating non-diagnostic mammograms.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. T/NT for 99m Tc-RGD and…
Figure 1. T/NT for 99mTc-RGD and 99mTc-MIBI in malignant and benign tumors.
(A) The T/NT for 99mTc-RGD in breast cancer was significantly higher than that in benign lesions (p<0.001). (B) The T/NT for 99mTc-MIBI in breast cancer was significantly higher than that in benign lesions (p<0.001).
Figure 2. A 2.2 cm ductal carcinoma…
Figure 2. A 2.2 cm ductal carcinoma in situ of the right breast in a 31-year-old woman (Patient 15).
(A) CT scan demonstrates a mass in the right breast. (B) 99mTc-3P4-RGD2 SMM demonstrates focal uptake of 99mTc-3P4-RGD2 in the tumor (T/NT = 2.96). (C) 99mTc-MIBI SMM demonstrates low uptake of 99mTc-MIBI in the tumor (T/NT = 1.31).
Figure 3. A 3.2 cm fibroadenoma of…
Figure 3. A 3.2 cm fibroadenoma of the left breast in a 47-year-old woman (Patient 30).
(A) CT scan demonstrates a mass in the left breast. (B) 99mTc-3P4-RGD2 SMM demonstrates low uptake of 99mTc-3P4-RGD2 in the tumor (T/NT = 1.34). (C) 99mTc-MIBI SMM demonstrates focal uptake of 99mTc-MIBI in the tumor (T/NT = 2.81).
Figure 4. Comparison the sensitivity and specificity…
Figure 4. Comparison the sensitivity and specificity of 99mTc-3P4-RGD2 SMM and 99mTc-MIBI SMM.
Comparison between 99mTc-3P4-RGD2 SMM and 99mTc-MIBI SMM in the differential diagnosis of breast cancer and benign lesions using ROC analysis (solid line: 99mTc-3P4-RGD2 SMM, dashed line: 99mTc-MIBI SMM). The area under the curve of both 99mTc-3P4-RGD2 SMM and 99mTc-MIBI SMM are 0.851 and 0.781, respectively. The difference was not significant.

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