Salman Habib

Chest wall recurrence of breast cancer demonstrated on 99mTc-MIBI scintimammography.

BackgroundThe mastectomy site is usually assessed by clinical examination and ultrasonography for recurrence of breast cancer, although post-surgical and radiotherapy changes limit the accuracy of these methods. MRI has been used successfully but it remains an expensive modality and may not be readily available. Scintimammography is an alternative method which has the advantage of not being affected by post-operative morphological changes. AimTo evaluate the usefulness of planar 99mTc-MIBI scintimammography and supine 99mTc-MIBI SPECT in the detection of chest wall recurrence post-mastectomy. MethodsThe study population comprised of 26 patients (mean age, 47.15 years; median age 47 years; age range, 22–77 years) with suspected chest wall recurrence of breast cancer on clinical examination. All patients received a 740–1000 MBq bolus i.v. injection of 99mTc-MIBI preferably in the pedal vein. At 5–10 min post-injection planar images were obtained in the prone lateral and supine anterior positions using a double-head gamma camera. After planar imaging supine SPECT was performed (64 projections, 64×64 matrix, 30 s·frame−1). MIBI uptake was scored as follows: 1 = normal uptake (compared with contralateral side); 2 = focal low uptake (equivocal); and 3 = focal high uptake (positive). All patients underwent excision biopsy or FNAC for tissue diagnosis. FNAC was considered sufficient if unequivocally positive. ResultsFor the 26 patients, planar scintimammography was found true positive in 14 and true negative in seven. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 78%, 87.5%, 93%, 64% and 81%, respectively (P<0.001). SPECT showed a significantly higher overall sensitivity than planar imaging (89% vs. 78%; P<0.001). SPECT and planar imaging showed the same specificity (87.5%). SPECT showed a significantly higher negative predictive value and accuracy than planar imaging (78% vs. 64% and 88% vs. 81%, respectively; P<0.05). ConclusionScintimammography is a reliable diagnostic tool and appears accurate in the detection of chest wall recurrence. SPECT shows high positive predictive value and aids in the diagnosis of the chest wall recurrence with greater confidence.

Diagnostic Accuracy of Tc-99m-MIBI for Breast Carcinoma in Correlation with Mammography and Sonography

OBJECTIVE To evaluate the accuracy of 99mTc-MIBI scintimammography (SMM) in differentiating malignant breast cancer from benign breast mass and in detecting axillary lymph node metastasis in comparison with mammography and ultrasonography. STUDY DESIGN Comparative cross-sectional study. PLACE AND DURATION OF STUDY At the Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN), Karachi, from December 2006 to May 2007. METHODOLOGY A total of 28 patients (both with breast lumps or/and axillary masses) included were in the study. They underwent clinical examination, mammography and ultrasound imaging followed by planar SMM using a single head detector. All subjects received a 740-1110 MBq bolus injection of 99mTc-Sestamibi. 5-10 minutes and 1 hour delayed images were acquired after the injection. SMM scans were considered positive when there was focal area of increased radiotracer uptake. Qualitative (visual) as well as quantitative evaluation of scans was done and compared with ultrasound and mammography, taking histopathology as Gold standard. Sensitivity, specificity, negative and positive predictive values (NPV and PPV respectively) were determined. RESULTS There were 22 patients presenting with breast lesions (20 palpable, 2 non-palpable) and 6 patients with axillary lump. Scintimammography accurately predicted malignant lesions in the breast (sensitivity 93.3%, specificity. 71.4%, PPV 87.5%, NPV 83.3%, overall accuracy 86.4%) as well as in patients with axillary metastasis (sensitivity 100%, specificity 66%, PPV 75%, NPV 100%, accuracy 83%). A combination of scintimammography with any other imaging modality provides better results than a single test to detect breast cancer. CONCLUSION SMM has good diagnostic accuracy in the detection of breast cancer as well as in axillary metastasis in association with mammography and ultrasound.

Efficacy of different medicines used for the treatment of osteoporosis by using dual energy x-ray absorptiometry

Osteoporosis, a skeletal disease and common condition affecting one in three women and one in twelve men is a major health burden worldwide and in our population as well. A total of 180 patients including 30 in control group, 126 osteoporotics and 54 osteopenics, were diagnosed and analyzed with the help of bone mineral density (BMD) by dual energy x-ray absorptiometry (DEXA) and treated in different groups with different brands of medicines; bisphophonates (alendronates and risederonates). Overall results in the therapy group BMD (g/cm≤) spine improved from 0.748 ± 0.0088 to 0.777 ± 0.0091 after one year of treatment while BMD hip rose from 0.713 ± 0.0087 to 0.730 ± 0.009 in a similar period. In the osteoporotic group (n = 106), BMD spine increased from 0.699 ± 0.0077 to 0.727 ± 0.007 and BMD hip from 0.679 ± 0.009 to 0.693 ± 0.009. In the osteopenic group (n = 44), BMD spine increased from 0.863 ± 0.011 to 0.898 ± 0.011 and BMD hip from 0.793 ± 0.007 to 0.817 ± 0.012. Patients on Osto, Drate and Fosamax (alendronates) did better than those on Dronate and Actonel (risedronates). Of alendronates, Fosamax and Osto treated patients did better than those on Drate. Of risedronates, Actonel treated patients faired better than those on Dronate which showed the least improvement.