Advertisement

Downstream imaging following abnormal molecular breast imaging, lessons learned and suggestions for success

Published:September 26, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.09.007

      Highlights

      • Imaging workups for abnormal findings on molecular breast imaging (MBI) can vary.
      • Workups are influenced by resources, experience, and interpretation preferences.
      • Mass uptake more likely than nonmass uptake to be found on mammogram and ultrasound.
      • MRI may be needed for inconclusive workups generated from MBI.

      Abstract

      Objectives

      Molecular breast imaging (MBI) is a supplemental screening modality that assists in detection of breast cancer. Objectives were to investigate how abnormal MBI findings were further evaluated on subsequent imaging studies and assess outcomes.

      Methods

      Retrospective single-institution review included patients who underwent supplemental screening MBI between October 2018 and October 2021, utilizing 300 MBq (8 mCi) 99mTc-sestamibi as radiotracer. Patients with abnormal MBI were assessed for subsequent imaging, biopsies, or surgeries performed. Outcome metrics included recall rate, cancer detection rate, and positive predictive values for recall (PPV1) and biopsy (PPV3); 95% confidence intervals calculated via Wilson score interval. All tests were two-sided; p < 0.05 considered statistically significant.

      Results

      Total of 716 MBI exams performed, 93 of which were read as abnormal with ultimate detection of 11 malignancies. Recall rate was 13.0%, cancer detection rate was 15.4/1000 (invasive: 11.2/1000), PPV1 was 11.8%, and PPV3 was 27.5%. Of 11 malignancies, 7 (63.6%) were not visible on concurrent or most recent mammogram. Initial subsequent imaging study detected a correlate for mass uptake in 20/22 (90.9%) cases compared to 42/70 (60.0%) for nonmass uptake (p < 0.007), with correlates for nonmass uptake seen on ultrasound or mammogram in only 5/19 (26.3%). MRI was utilized in 63 (8.8%) cases overall.

      Conclusion

      Screening MBI afforded a high cancer detection rate, yet lower detection of nonmass uptake on subsequent ultrasound/mammography resulted in increased usage of MRI compared to prior reports. As utilization of MBI increases, more reported experiences are needed to establish best practices and understand effects of implementation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tabár L.
        • Vitak B.
        • Chen T.H.
        • et al.
        Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades.
        Radiology. 2011; 260: 658-663
        • Tabár L.
        • Fagerberg C.J.
        • Gad A.
        • et al.
        Reduction in mortality from breast cancer after mass screening with mammography: randomised trial from the breast cancer screening working Group of the Swedish National Board of health and welfare.
        Lancet. 1985; 1: 829-832
        • Richman I.B.
        • Hoag J.R.
        • Xu X.
        • et al.
        Adoption of digital breast tomosynthesis in clinical practice.
        JAMA Intern Med. 2019; 179: 1292-1295
        • Conant E.F.
        • Zuckerman S.P.
        • McDonald E.S.
        • et al.
        Five consecutive years of screening with digital breast tomosynthesis: outcomes by screening year and round.
        Radiology. 2020; 295: 285-293
        • Bahl M.
        • Gaffney S.
        • McCarthy A.M.
        • Lowry K.P.
        • Dang P.A.
        • Lehman C.D.
        Breast cancer characteristics associated with 2D digital mammography versus digital breast tomosynthesis for screening-detected and interval cancers.
        Radiology. 2018; 287: 49-57
        • Mandelson M.T.
        • Oestreicher N.
        • Porter P.L.
        • et al.
        Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers.
        J Natl Cancer Inst. 2000; 92: 1081-1087
        • Kolb T.M.
        • Lichy J.
        • Newhouse J.H.
        Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.
        Radiology. 2002 Oct; 225: 165-175
        • Hruska C.B.
        • Phillips S.W.
        • Whaley D.H.
        • Rhodes D.J.
        • O’Connor M.K.
        Molecular breast imaging: use of a dual-head dedicated gamma camera to detect small breast tumors.
        AJR. 2008; 191: 1805-1815
        • Weinmann A.L.
        • Hruska C.B.
        • O’Connor M.K.
        Design of optimal collimation for dedicated molecular breast imaging systems.
        Med Phys. 2009; 36: 845-856
        • Rechtman L.R.
        • Lenihan M.J.
        • Lieberman J.H.
        • et al.
        Breast-specific gamma imaging for the detection of breast cancer in dense versus nondense breasts.
        AJR. 2014; 202: 293-298
        • Rhodes D.J.
        • Hruska C.B.
        • Phillips S.W.
        • Whaley D.H.
        • O’Connor M.K.
        Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts.
        Radiology. 2011; 258: 106-118
        • Rhodes D.J.
        • Hruska C.B.
        • Conners A.L.
        • Tortorelli C.L.
        • Maxwell R.W.
        • Jones K.N.
        • Toledano A.Y.
        • O'Connor M.K.
        Journal club: molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts.
        Am J Roentgenol. 2015 Feb; 204: 241-251
        • Hruska C.B.
        • Conners A.L.
        • Jones K.N.
        • O'Connor M.K.
        • Moriarty J.P.
        • Boughey J.C.
        • Rhodes D.J.
        Diagnostic workup and costs of a single supplemental molecular breast imaging screen of mammographically dense breasts.
        Am J Roentgenol. 2015 Jun; 204: 1345-1353
        • Shermis R.B.
        • Wilson K.D.
        • Doyle M.T.
        • Martin T.S.
        • Merryman D.
        • Kudrolli H.
        • Brenner R.J.
        Supplemental breast cancer screening with molecular breast imaging for women with dense breast tissue.
        Am J Roentgenol. 2016 Aug; 207: 450-457
        • Conners A.L.
        • Hruska C.B.
        • Tortorelli C.L.
        • Maxwell R.W.
        • Rhodes D.J.
        • Boughey J.C.
        • Berg W.A.
        Lexicon for standardized interpretation of gamma camera molecular breast imaging: observer agreement and diagnostic accuracy.
        Eur J Nucl Med Mol Imaging. 2012 Jun; 39: 971-982
        • D’Orsi C.J.
        • Sickles E.A.
        • Mendelson E.B.
        • Morris E.A.
        • et al.
        ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System.
        American College of Radiology, Reston, VA2013
        • Huppe A.I.
        • Mehta A.K.
        • Brem R.F.
        Molecular breast imaging: a comprehensive review.
        Semin Ultrasound CT MR. 2018 Feb; 39: 60-69
        • Shermis R.B.
        • Redfern R.E.
        • Burns J.
        • Kudrolli H.
        Molecular breast imaging in breast cancer screening and problem solving.
        Radiographics. 2017; 37: 1309-1327
        • Hruska C.B.
        Updates in molecular breast imaging.
        Semin Roentgenol. 2022 Apr; 57: 134-138
        • Hruska C.B.
        Molecular breast imaging for screening in dense breasts: state of the art and future directions.
        Am J Roentgenol. 2017 Feb; 208: 275-283
        • Tao A.T.
        • Hruska C.B.
        • Conners A.L.
        • Hunt K.N.
        • Swanson T.N.
        • Tran T.D.
        • Manduca A.
        • Borges L.
        • Maidment A.D.A.
        • Lake D.
        • Johnson M.P.
        • Carter R.E.
        • Rhodes D.J.
        • O'Connor M.K.
        Dose reduction in molecular breast imaging with a new image-processing algorithm.
        AJR Am J Roentgenol. 2020 Jan; 214: 185-193
        • Hruska C.B.
        Let's get real about molecular breast imaging and radiation risk.
        Radiol Imaging Cancer. 2019 Sep 27; 1e190070
        • Maimone S.
        • Morozov A.P.
        • Li Z.
        • Craver E.C.
        • Elder E.A.
        • McLaughlin S.A.
        Recalibrating the decision for MRI-directed breast ultrasound in patients with newly diagnosed breast cancer, factors predicting sonographic success.
        Clin Imaging. 2021 Dec; 80: 391-399
        • Spick C.
        • Baltzer P.A.
        Diagnostic utility of second-look US for breast lesions identified at MR imaging: systematic review and meta-analysis.
        Radiology. 2014 Nov; 273: 401-409
        • Newburg A.R.
        • Chhor C.M.
        • Young Lin L.L.
        • Heller S.L.
        • Gillman J.
        • Toth H.K.
        • Moy L.
        Magnetic resonance imaging-directed ultrasound imaging of non-mass enhancement in the breast: outcomes and frequency of malignancy.
        J Ultrasound Med. 2017 Mar; 36: 493-504
        • Abe H.
        • Schmidt R.A.
        • Shah R.N.
        • et al.
        MR-directed (“Second-Look”) ultrasound examination for breast lesions detected initially on MRI: MR and sonographic findings.
        Am J Roentgenol. 2010 Feb; 194: 370-377
        • Adrada B.E.
        • Moseley T.
        • Kappadath S.C.
        • Whitman G.J.
        • Rauch G.M.
        Molecular breast imaging-guided percutaneous biopsy of breast lesions: a new frontier on breast intervention.
        J Breast Imaging. 2020; 2: 484-491
        • Collarino A.
        • Olmos R.A.V.
        • Neijenhuis P.A.
        • den Hartog W.C.
        • Smit F.
        • de Geus-Oei L.F.
        • Arias-Bouda L.M.P.
        First clinical experience using stereotactic breast biopsy guided by 99mTc-sestamibi.
        AJR Am J Roentgenol. 2017 Dec; 209: 1367-1373
        • Brem R.F.
        • Mehta A.K.
        • Rapelyea J.A.
        • Akin E.A.
        • Bazoberry A.M.
        • Velasco C.D.
        Gamma imaging-guided minimally invasive breast biopsy: initial clinical experience.
        Am J Roentgenol. 2018 Mar; 210: 695-699
        • Hendee W.R.
        • O'Connor M.K.
        Radiation risks of medical imaging: separating fact from fantasy.
        Radiology. 2012 Aug; 264: 312-321
        • Albert J.M.
        Radiation risk from CT: implications for cancer screening.
        Am J Roentgenol. 2013 Jul; 201: W81-W87
        • Hendrick R.E.
        • Tredennick T.
        Benefit to radiation risk of breast-specific gamma imaging compared with mammography in screening asymptomatic women with dense breasts.
        Radiology. 2016; 281: 583-588
        • Brown M.
        • Covington M.F.
        Comparative benefit-to-radiation risk of molecular breast imaging, two-dimensional full-field digital mammography with and without tomosynthesis, and synthetic mammography with tomosynthesis.
        Radiol Imaging Cancer. 2019; 1e190005