© 1998 by Oxford University Press
Journal Of The National Cancer Institute, Vol 90, 846-849, Copyright © 1998 by Oxford University Press
J Tolmos, JA Cutrone, B Wang, HI Vargas, M Stuntz, FS Mishkin, LE Diggles, RJ Venegas, SR Klein and I Khalkhali
BACKGROUND: In randomized trials, screening mammography has led to
decreased mortality from breast cancer. However, the low positive
predictive value of mammography (i.e., the proportion of patients with a
positive test result who actually have breast cancer) results in a large
number of unnecessary biopsies. We determined whether scintimammography
with technetium-99m-sestamibi is a useful supplemental diagnostic tool for
women with nonpalpable breast abnormalities identified by conventional
mammography. METHODS: Scintimammography was performed preoperatively on 70
women who were 31- 66 years of age (mean age and median age = 51 years).
These women had nonpalpable breast abnormalities identified by conventional
mammography; subsequently, a needle-localization excisional biopsy of each
suspicious lesion was performed. Scintimammographic images were interpreted
independently by two nuclear medicine physicians who were blinded to all
clinical and pathologic data, and an interobserver variation analysis was
performed. RESULTS: Interobserver variation analysis of the
scintimammographic findings showed an agreement for breast diagnosis of 97%
and a kappa coefficient of 0.90. Comparison of scintimammographic findings
and histopathologic results revealed that the sensitivity (proportion of
patients with breast cancer who had a positive test result), the
specificity (proportion of patients without breast cancer who had a
negative test result), the positive predictive value and the negative
predictive value (proportion of patients with a negative test result who
actually did not have breast cancer) of scintimammography were 56% (95%
confidence interval [CI] = 23%-85%), 87% (95% CI = 75%-94%), 38% (95% CI =
15%-68%), and 93% (95% CI = 82%- 98%), respectively. Four of nine breast
cancers were not detected by scintimammography. CONCLUSION: Because of
excellent interobserver agreement, scintimammography provides an objective
way of detecting primary breast carcinoma. In view of its low sensitivity
and positive predictive value, however, scintimammography is not currently
recommended as a screening test in patients with nonpalpable positive
mammographic findings.
ARTICLES
Scintimammographic analysis of nonpalpable breast lesions previously identified by conventional mammography
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
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