Search

Background: The aim of this study was to compare the maximum standardized uptake values on positron emission tomography/ computed tomography and survival of lung invasive adenocarcinoma subgroups., Methods: Between January 2010 and January 2016, a total of 152 patients (112 males, 40 females; mean age: 64.2±8.6 years; range, 41 to 88 years) who underwent lung resection for an invasive adenocarcinoma were retrospectively analyzed. The patients were divided into subgroups as follows: acinar, lepidic, micropapillary, papillary, and solid. The maximum standardized uptake values in the imaging study and their relationship with survival were examined., Results: There were 84 acinar (55%), 31 solid (20%), 23 lepidic (15%), nine papillary (5%), and five micropapillary (3%) cases. The positron emission tomography/computed tomography enhancement showed a statistically significant difference among the subgroups (p=0.004). The solid subgroup was the most involved (9.76), followed by micropapillary (8.98), acinar (8.06), papillary (5.82), and lepidic (4.23) subgroups, respectively. According to Tumor, Node, Metastasis staging, Stage I was present in 48.68% (n=74) of the cases, Stage II in 25.0% (n=38), Stage III in 25.0% (n=38), and Stage IV in 1.31% (n=2). The one-year, three-year, and five-year survival rates were significantly different among the disease stages (p=0.01). The longest survival duration was in the lepidic subgroup, although it did not reach statistical significance among the subgroups (p=0.587)., Conclusion: The evaluation of invasive adenocarcinomas based on maximum standardized uptake values provides valuable information and may guide neoadjuvant and adjuvant therapies in the future., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2021, Turkish Society of Cardiovascular Surgery.)

Background: Infective endocarditis (IE) is an infection of the heart's endocardial surface. In recent years, nuclear imaging methods have gained importance in the diagnosis of IE. The present study aims to investigate the imaging potential of 99m Tc-labeled vancomycin ( 99m Tc-Vancomycin) as a new agent that would enable the diagnosis of IE in its early stages when it is difficult to diagnose or has small vegetation in the experimental rat model., Methods: 99m Tc-Vancomycin scintigraphy was evaluated for its accumulation in IE with Staphylococcus aureus performed in an experimental rat model. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. The heart was identified as an infected organ, the liver was identified as a non-infected organ and the heart/liver uptake ratio (T / NT ratio) was compared between infective endocarditis and sterile endocarditis groups., Results: Planar scintigrams (in vivo measurements) showed more uptake in the heart of rats in the infective endocarditis group compared to the uptake in the heart of rats in the sterile endocarditis group, but this difference was not statistically significant (p>0.05). From the ex vivo measurements, the 99m Tc-Vancomycin heart uptake increased significantly (p = 0.016), liver uptake was significantly decreased (p = 0.045) and the T/NT ratio was significantly higher (p = 0.014) in the infective endocarditis group compared to the sterile endocarditis group., Conclusion: In this experimental study, 99m Tc-Vancomycin scintigraphy ensured the detection of ex vivo infected tissue in a rat model of IE. In addition, the absence of significant 99m Tc-Vancomycin uptake in the sterile endocarditis group indicates that this agent targeted the infected tissue instead of the sterile inflammatory tissue. Finally, this agent should also be evaluated with animal- specific imaging devices., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The neoadjuvant chemotherapy (NAC) is the gold standard initial treatment of the locally advanced breast cancer (LABC). However, the reliability of methods that used to assess response the NAC is still controversial. In this study, patients with LABC who underwent NAC were evaluated retrospectively. The assessment of response to NAC and the effect of axillary approach were investigated on LABC course.The study comprised 94 patients who received NAC with an LABC diagnosis between 2008 and 2020. In our center, magnetic resonance imaging, ultrasonography, and F-flouro deoxyglucose positron emission tomography/computed tomography, and, for some patients, fine-needle aspiration biopsy of suspicious axillary lymph nodes have been performed to assess the effects of NAC. Patients with positive hormone receptor status received adjuvant hormonotherapy, and those with human epidermal growth factor receptor 2 gene expression were treated with trastuzumab. Adjuvant radiotherapy was applied to all patients undergoing breast conserving surgery. Radiotherapy was applied to the peripheral lymphatic areas in the clinical N1 to N3 cases regardless of the response to NAC.The clinical response to the NAC was found that partial in 59% and complete in 19% of the patients. However, 21.2% of the patients were unresponsive. The mean of lymph nodes that excised with the procedure of sentinel lymph node biopsy (SLNB) was 2.4 (range 1-7). In 22 of the 56 patients who underwent SLNB, axillary dissection (AD) was added to the procedure upon detection of metastasis in frozen section examinations. There was no difference between the SLNB and AD groups regarding overall survival (OS; P = .472) or disease-free survival (DFS) rates (P = .439). However, there were differences in the OS (P < .05) and DFS (P = .05) rates on the basis of the LABC histopathological subtypes.The study found that a relationship between molecular subtypes and LABC survival. However, the post-NAC axillary approach had no effect on OS or DFS. Therefore, multiple imaging and interventional methods are needed for the evaluation of NAC response. In addition, morbidity can be avoided after AD by the use of SLNB in cN0 patients.

Objective: Lutetium-177 ( 177 Lu) prostate specific membrane antigen (PSMA) radionuclide therapy (RNT) is an effective and safe treatment option in patients with metastatic castration resistant prostate cancer (mCRPC). The first aim of this study was to determine RNT response rate. The second and main aim of this study is measure overall and progression-free survival (OS and PFS) and to determine the factors have effect on OS and PFS., Material and Methods: Patients with mCRPC had 177 Lu PSMA RNT every 6-8 weeks. Therapy response of each cycle determined wit PSA after 6-8 weeks. Overall survival and PFS were measured, then effects of age, Gleason grade, local recurrence, extraabdominopelvic located lymph node metastasis, visceral metastasis, prostate specific antigen (PSA) changing after the first RNT, pretreatment PSA, hemoglobin (Hb), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) values on survivals were determined., Results: Forty-five patients were treated with total of 164 cycles of RNT. Fifteen patients (33%) had PSA decline of ≥50%, 23 patients (51%) showed any PSA decline and 20 patients (44%) showed PSA increase of ≥25%. Median OS and PFS were 17,1 months and 7,4 months. Patients had any or ≥50% PSA response after the first cycle, lower initial ALP (<120U/L) had longer OS and PFS. Patients had normal Hb showed longer OS and patients had lower initial PSA (<51ng/mL) had longer PFS. Patients had PSA progression of ≥25% had shorter OS and PFS., Conclusion: Prostate specific antigen response after the first cycle, lower initial ALP is related to longer OS and PFS. Normal pretreatment Hb is a predictor of longer OS and lower initial PSA is related to longer PFS. Prostate specific antigen progression after the first cycle causes shorter OS and PFS.

Purpose: The primary aim of this study was to evaluate the volumetric therapy response via Ga-68 PSMA I&T PET/CT in patients treated with Lu-177 PSMA I&T therapy. The secondary purpose was to determine the impact of volumetric parameter responses to overall survival., Methods: PSMA tumor volumes (PSMA-TV) and tumor lesion PSMA expressions (TL-PSMA) were calculated with a semi-automatic program on Ga-68 PSMA I&T PET/CT images that were obtained before and after Lu-177 PSMA I&T therapies with 19 patients. The median overall survival was compared with PSMA-TV, TL-PSMA, SUV max , PSA, and alteration in PERCIST criteria., Results: PSMA-TV values were decreased in 12 patients (63%), and TL-PSMA values were decreased in 15 patients (79%) following the therapy. The SUV max and the PSA values were also decreased in 14 (74%) and 10 (53%) patients, respectively. The complete remission (CR) was observed in two patients (10%). The partial response (PR) and progressive disease were observed in 6 (32%) and 11 (58%) patients, respectively, according to PRECIST criteria. The survival rates were statistically significant in patients with a decrease in PSMA-TV and TL-PSMA values than patients without any decrease (p 0.001, p < 0.001, respectively). However, the survival rates did not differ in responders (PR or CR) and non-responders according to the PERCIST criteria (p 0.232). The survival rates did not also differ in responders and non-responders according to the SUV max and PSA values (p 0.140, p 0.206, respectively)., Conclusions: Molecular and volumetric parameters are beneficial in the assessment of Lu-177 PSMA I&T therapy response. Although the number of patients is small, TL-PSMA response, which includes both the tumor volume and PSMA expression in tumor, may be considered as the most valuable parameter for the evaluation of the therapy response and the prediction of survival rate.

Ochronosis (alkaptonuria) is an autosomal recessive inherited metabolic disease that causes pigmentation by accumulation of homogenous acid in the connective tissue. The most important causes of morbidity are ochronotic arthropathy and cardiovascular involvement seen in fourth and sixth decades, respectively. In this case report, we report the prevalence of F-FDG PET/BT findings in a 48-year-old man with ochronosis who underwent F-FDG PET/BT imaging for the evaluation of mediastinal lymphadenopathy.

Objective: The aim of this study was to compare images from Tc-99m MDP bone scan (BS) and Ga-68 PSMA PET/CT of patients with prostate cancer in terms of bone metastases., Methods: Overall, 34 patients exhibited a mean age of 66 ± 9.5 (50-88) years, mean PSA of 51 ± 159ng/ml (0-912), and mean Gleason score of 8 (6-9). BS and Ga-68 PSMA PET/CT were applied to 34 patients within 30 days, and the results were evaluated, retrospectively. In both tests, radiopharmaceutical uptake in bones were compared., Results: In 7 patients (20.5%), uptake was not significant on BS and Ga-68 PSMA PET / CT images, which is related to metastasis. In 14 (41%) patients, bone metastases were observed in both examinations. However, more metastatic lesions were observed in the Ga-68 PSMA PET/CT of 3 patients and in the bone scintigraphy of 2 patients. PSMA expression was not observed on Ga-68 PSMA PET / CT in 13 (38%) patients with increased activity in bone scintigraphy. Two (6%) of these patients were thought to be metastatic, 2 (6%) were suspicious for metastasis, and 9 (26%) had no metastasis. When a lesion-based evaluation was performed, a total of 480 activities were evaluated: increased activity uptake was found in 305 BS, and 427 PSMA expression activity was detected. Furthermore, 435 of these activities were evaluated as metastatic., Conclusion: Ga-68 PSMA PET/CT provides an additional contribution to the BS evaluation of activity areas because of the presence of PSMA expression and anatomical lesions. In 6% of the patients, activity on BS and metastatic appearance in CT images were observed and the presence of lesions in the absence of PSMA was determined. This suggests that bone metastases without PSMA expression may also be present., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: Myocardial perfusion scintigraphy (MPS) is a diagnostic test which is frequently used in the diagnosis of coronary heart disease (CHD). MPS is generally interpreted as ischemia present or absent; however, it has a power in predicting the disease, similar to other diagnostic tests. In this study, we aimed to assist in directing the high-risk patients to undergo coronary angiography (CA) primarily by evaluating patients without prior CHD history with pre-test and post-test probabilities., Methods: The study was designed as a retrospective study. Between January 2008 and July 2011, 139 patients with positive MPS results and followed by CA recently (<6 months) were evaluated from patient files. Patients' pre-test probabilities based on the Diamond and Forrester method and the likelihood ratios that were obtained from the literature were used to calculate the patients' post exercise and post-MPS probabilities. Patients were evaluated in risk groups as low, intermediate, and high, and an ROC curve analysis was performed for the post-MPS probabilities., Results: Coronary artery stenosis (CAS) was determined in 59 patients (42.4%). A significant difference was determined between the risk groups according to CAS, both for the pre-test and post-test probabilities (p<0.001, p=0.024). The ROC analysis provided a cut-off value of 80.4% for post- MPS probability in predicting CAS with 67.9% sensitivity and 77.8% specificity., Conclusion: When the post-MPS probability is ≥80% in patients who have reversible perfusion defects on MPS, we suggest interpreting the MPS as "high probability positive" to improve the selection of true-positive patients to undergo CA, and these patients should be primarily recommended CA.

Objective: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. This study aimed to assess the diagnostic performance of 18F-FDG PET/CT for detecting recurrence in gastric cancer patients with radiologic or clinical suspicion of recurrence and its clinical impact on making decision., Methods: We performed a retrospective review of 130 consecutive patients who underwent PET/CT scans for post-treatment surveillance of gastric cancer between January 2008 and March 2012. The mean time between the initial diagnosis of gastric cancer and PET/CT studies was 44 weeks with a median of 18 weeks. The number and site of positive FDG uptake were analyzed and correlated with the final diagnosis by calculating the diagnostic values. We evaluated the diagnostic accuracy of PET/CT for detecting the recurrence in terms of whether or not histology had been SRC/musinous adenocarcinoma. The changes in the clinical management of patients were also evaluated according to the results of PET/CT., Results: Of all 130 patients, 91 patients were confirmed to have true recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of PET/CT for diagnosing true recurrence on a per-person basis were 91.2%, 61.5%, 84.6%, 75.0% and 82.3% respectively. Final diagnoses were confirmed histopathologically in 59 (45.4%) of 130 patients and by clinical and radiological follow-up in the remaining 71 (54.6%) patients. In the subgroup with SRC/mucinous adenocarcinoma differentiation of the primary tumor, there was no statistically significant difference in terms of diagnostic accuracy of PET/CT on a per-person basis. In addition, PET/CT results changed the patients' management in 20 (15%) cases., Conclusions: 18F-FDG PET/CT can provide useful information in discriminating true recurrence in patients with suspected gastric cancer recurrence and may have significant impact on clinical decisions/patient management in a considerable percentage of patients.

We aimed to assess the ability of (131)I-Pentamidine scintigraphy to detect the lesions of Leishmania tropica infection. An experimental model of cutaneous leishmaniasis was developed. The presence of cutaneous leishmaniasis was confirmed. Pentamidine was radioiodinated with (131)I. The radiolabeled pentamidine was validated by the requisite quality control tests to check its radiolabeling efficiency, in vitro stability. (131)I-Pentamidine (activity: 18.5 MBq/100 µl) was injected intracardiacally into infected hamsters. Static whole body images of the hamsters were acquired under the gamma camera at 5 and 30 min, 2, 6 and 24 h following the administration. On the scintigrams, anatomically adjusted regions of interest (ROIs) were drawn over the right feet (target) and left feet (not-target) and various organs. Accumulation of (131)I-Pentamidine at sites of infection is expressed as the target to non-target (T/NT) ratio. The results T/NT ratio decreased with time. In concluding the (131)I-Pentamidine has poor sensitivity in detection of L. tropica infection.

Aim: The radiation can induce vessel injury. The result of this injury can be severe and life-threatening. There are a few studies demonstrating an increase in intima-media thickness (IMT) of the common carotid artery (CCA) after radiotherapy, especially in head and neck cancers. We evaluated the effect of I-131 to the IMT of the CCA in the patients who were treated for hyperthyroidism., Methods: 38 patients (25M, 13W) referred to our department for radioiodine treatment with the diagnosis of nodular goitre (25 patients) and diffuse hyperplasia (Graves disease (GD), 13 patients) were included to the prospective study. An USG was performed for all the patients before therapy, 3, 6 and 12 months after radioiodine therapy in order to measure IMT of CCA and the femoral artery (FA). The IMT was measured at the level of proximal part of bulbus anteriorly on the left and right side. The IMT of FA was measured just before the bifurcation., Results: There was a statistically significant increase in IMT of both CCA and FA bilaterally in nodular hyperthyroid patients. However, in the patients with Graves disease, there was only statistically significant increase in the left IMT of CCA at 0-3rd, 0-6th month measurements and in the right IMT of FA at 0-3rd month measurements., Conclusion: Though the limitation of the study is the interobserver and intraobserver variability, it was seen that I-131 therapy might affect the IMT of CCA in the patients with NG. I-131 effect on the IMT of CCA in patients with nodular goitre was higher than the IMT of CCA in patients with GD. I-131 effect on the IMT of CCA might be due to administered dose and adjacency. The interesting point of our study was the increased thickness of IMT in FA. We think that the increase in IMT is due to the systemic effect of radioactivity circulating in the blood vessel. I-131 effect on the IMT of FA in patients with nodular goitre was higher than the IMT of FA in the patients with GD due to I-131 uptake of thyroid gland. Because I-131 uptake was lower in patients with nodular goitre, I-131 in systemic circulation was higher., Conflict of Interest: None declared.

Objective: Using accurate localization techniques and the quick intra-operative parathyroid assay (QPTH), surgery for primary hyperparathyroidism due to a solitary adenoma has moved from the traditional wide bilateral neck exploration to more limited approaches such as minimally invasive single-gland exploration (MISGE) and minimally invasive radio-guided parathyroidectomy (MIRP). This study investigated whether the MISGE could take the place of MIRP with the help of the QPTH., Design: From 2007 to 2009, 56 patients with primary hyperparathyroidism were studied. All patients were pre-operatively investigated by imaging techniques to improve the pre-operative determination of adenomas. Twenty-five patients were in the MIRP group and 31 in the MISGE group. QPTH was routinely measured; a 50% reduction in the QPTH level indicated complete excision., Results: There were no differences in the complication rates, surgical time, anaesthesia time or mean length of hospital stay between the groups. However, total hospital charges were more favourable in the MISGE group with a mean saving of $400 per case., Conclusion: This study demonstrates that with the additon of the QPTH, MISGE can be performed as a quick and reliable procedure in correct adenoma removal instead of MIRP. Moreover MISGE achieves the optimal time interval between injection and exploration, reduces the radiation exposure of both patient and surgeon, decreases the cost, and decreases usage of pre-operative imaging and intra-operative equipment.

The aim of this study is to calculate the exposure of surgical staff during radioguided parathyroidectomy. Two parathyroidectomy operations on patients with parathyroid adenoma were selected. Fifty-centimeter spaced circles were drawn surrounding the operation bed on the floor of the operation room. During the operation, radiation dose was measured according to the drawn circles at distances of 50-200 cm from the side of patient's head, bilateral neck and abdomen while the patient lied on the operation bed. All the operations were recorded throughout with a video camera. Three physicians watched all records. The time spent at each distance for every staff during the operation was recorded. Whole body dose to senior surgeon was calculated as 8.78-11.00 microSv which means that a senior surgeon can perform 91-114 procedures per year to reach the annual International Commission on Radiological Protection (ICRP) radiation dose limit for a member of the public. We concluded that radiation risk to the surgical staff is low from radioguided parathyroidectomy.

To assess the value of (67) Ga scintigraphy in the lesions of Trichinella spiralis, an animal model was developed. Three infected and five healthy animals were enrolled in this study. After the injection of 7.4 MBq (200 micro Ci) (67) Ga citrate intravenously, static images from whole body were obtained at 24(th), 48 (th) and 72 (nd) hours Visual and semiquantitative analyses were performed. In semiquantitative analysis, activity counts were calculated over the whole body, diaphragm, neck muscles and extremities muscles of all animals. Between the infected animals and control group, mean bodies activity ratios were compared as visually and statistically. (67) Ga scintigraphy can't successfully demonstrate the lesions of Trichinella spiralis.

Objective: To determine the predictive value of different imaging methods,-computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and single-photon emission tomography (SPECT),-for cervical node metastasis., Design: Prospective clinical trial., Setting: An academic otolaryngology department., Methods: Twenty-three consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy. All patients underwent clinical, CT, MRI, US, and SPECT examinations. Neck dissection was performed for 31 neck sides, and the results of the preoperative evaluation were confirmed by the surgical and histopathologic findings., Main Outcome Measures: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each method and a comparison of the methods was done., Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT, MRI, US, and SPECT were 77.7%, 85.7%, 91.3%, 66.6%, and 80.4%; 59.2%, 92.8%, 94.1%, 54.1%, and 70.7%; 81.4%, 64.2%, 81.4%, 64.2%, and 75.6%; 55.5%, 92.8%, 93.7%, 52.0%, and 68.2%, respectively. Both CT and US were found to be superior to clinical examination. There was no statistically significant difference between US and CT. US was found to be superior to MRI and SPECT in detecting cervical node metastasis. CT was also superior to SPECT., Conclusion: Our data show that, despite high specificity rates, especially with SPECT, none of the currently available imaging methods are reliable in evaluating the occult regional metastasis because the negative predictive values of all of these methods are rather low.

This study was undertaken to assess the correlation between the degree of accumulation and the washout of 99m technetium methoxyisobutylisonitrile ((99m)Tc-MIBI) and angiogenesis in MIBI-positive breast lesions. Twenty-eight patients (mean age, 51+/-11 years) with 31 breast lesions who underwent scintimammography were studied. Anterior, left and right prone lateral images were obtained 20 min and 3 h after the injection of 740 MBq (99m)Tc-MIBI. All breast lesions showed increased (99m)Tc-MIBI uptake. Early and delayed tumor to background activity ratios (T/BG) and washout index (early tumor uptake-delayed tumor uptake divided by early tumor uptake) were calculated. Vascular endothelium was immunohistochemically labeled using a biotinylated monoclonal antibody directed against the factor-VIII-associated antigen using standard biotin-avidin technique. Angiogenesis was evaluated by assessing the vascular surface density (VSD) and the microvessel number (NVES) within 10 randomly chosen areas. All pathological data were compared with early and delayed T/BG activity ratios and washout index of (99m)Tc-MIBI. Statistical analysis was performed using Spearman correlation test. There was no statistically significant correlation between the degree of angiogenesis and early T/BG (r = .287, P > .05 with VSD, r = .351, P > .05 with NVES), delayed T/BG (r = .277, P > .05 with VSD, r = .315, P > .05 with NVES) and the washout index (r = .268, P > .05 with VSD, r = .285, P > .05 with NVES) of (99m)Tc-MIBI in all breast lesions. There was no statistically significant correlation between the degree of angiogenesis and early T/BG (r = .235, P > .05 with VSD, r = .356, P > .05 with NVES), delayed T/BG (r = .181, P > .05 with VSD, r = .285, P > .05 with NVES) and the washout index (r = .158, P > .05 with VSD, r = .187, P > .05 with NVES) of (99m)Tc-MIBI in 24 invasive breast lesions. No statistically significant correlation was found between the degree of angiogenesis and early T/BG (r = -.036, P > .05 with VSD, r = -.107, P > .05 with NVES), delayed T/BG (r = -.500, P > .05 with VSD, r = -.429, P > .05 with NVES), but there was a high correlation between angiogenesis and the washout index (r = .893, P < .05 with VSD, r = .964, P < .05 with NVES) of (99m)Tc-MIBI in seven noninvasive breast lesions. Amount of (99m)Tc-MIBI uptake in breast lesions is dependent on several factors. Our study indicates that early and delayed (99m)Tc-MIBI uptakes in MIBI-positive breast lesions are not related to angiogenesis in both invasive and noninvasive breast lesions. But washout index of (99m)Tc-MIBI in noninvasive breast lesions is highly correlated with angiogenesis. (99m)Tc-MIBI scintigraphy does not seem to be able to indicate angiogenic property of invasive breast lesions.

Breast cancer is the most common cancer and the second leading cause of cancer deaths among women in developed countries. Bone is a frequent site of metastatic disease with a stage-dependent incidence. Most women with breast cancer are at risk of osteoporosis due to their age or their breast cancer treatment. Scintigraphy enables imaging of the entire skeleton with high sensitivity but limited specificity. The false positive rate varies from 1.6% to as high as 22%, while the false negative rate varies from 0.96% to 13%. We observed a 70-year-old woman with a diagnosis of breast cancer and a false negative bone scan despite extensive bone metastases. She was under alendronate treatment for osteoporosis at the time. The false negative finding might be due to a transient phenomenon of alendronate, a bisphosphonate cleared from the plasma by uptake into bone and by renal excretion. 99mTc-MDP is eliminated via the same pathways, and therefore competition may occur between the two substances. Another possible explanation for the false negative bone scan could be that bone metastases, indicating hematogenous tumor spread, are detected earlier by CT scan or MRI than by bone scan. Breast cancer patients under bisphosphonate treatment for osteoporosis must be carefully evaluated for bone metastasis during radionuclide studies with 99mTc-MDP.

Aim: Investigation of the diagnostic role of technetium-99m methoxyisobutylisonitrile ((99m)Tc sestamibi) scintimammography in non-palpable, suspicious breast lesions described as microcalcification, mass and increased density using mammography., Patients and Method: 35 women with non-palpable breast lesions were enrolled in the study. Anterior, left and right lateral, ipsilateral posterior oblique images were obtained 15 min after the injection of 740 MBq of (99m)Tc sestamibi. All scintigraphic images were evaluated visually and focal increased (99m)Tc sestamibi uptake was accepted as malignant lesion. Breast lesions were classified as microcalcification (13 women), mammographic mass (16 women) and increased density (6 women). Excisional biopsy was performed in all of them irrespective of the scintigraphic results., Results: The focally increased (99m)Tc sestamibi uptake was seen in 11 breast lesions with malignant lesions and in 4 breast lesions with benign lesions. The diffuse uptake of (99m)Tc sestamibi was seen in 18 breast lesions with benign lesions and 2 breast lesions with malignant lesions. There was no false positive result of (99m)Tc sestamibi in microcalcification group and there was no false negative result of the mammographic mass and increased density groups., Conclusion: Scintimammography might be a complementary method in decision making for the non-palpable, suspicious breast lesions that were evaluated as microcalcification, mass and increased density mammograpically.