BSGI：乳腺癌术前辅助检查的工具，较MR更优
2011-12-05 MedSci原创 MedSci原创
乳腺癌特定伽马成像（BSGI）为乳腺癌患者提供最初诊断工作和手术计划的信息，较MRI更佳，这项研究在第97届北美放射学会的年会上进行了发布。 Marie Tartar博士，加州大学圣地亚哥分校放射科的助理教授，报告了来自于圣地亚哥斯克里普斯诊所记录的一项回顾性综述。在2009年，斯克里普斯诊所的医生们开始使用
乳腺癌特定伽马成像（BSGI）为乳腺癌患者提供最初诊断工作和手术计划的信息，较MRI更佳，这项研究在第97届北美放射学会的年会上进行了发布。
Marie Tartar博士，加州大学圣地亚哥分校放射科的助理教授，报告了来自于圣地亚哥斯克里普斯诊所记录的一项回顾性综述。在2009年，斯克里普斯诊所的医生们开始使用BSGI，在这项回顾性分析中，研究人员评估了BSGI对于乳腺癌患者的影响。这项研究的56名病人平均年龄为54.6岁。
在这项研究中，医生们使用一个高分辨率的伽马相机进行BSGI。在BSGI前，病人接受一种药物示踪剂，可以被人体所有细胞吸收。因为癌细胞的代谢率增加，其吸收的示踪药物要比正常细胞大，在BSGI成像上显示黑斑。
Tartar博士解释说，BSGI的发现，使用常规成像确认了55%的病人（31/56），可疑发现为25%（14/56）。该诊所使用BSGI诊断出了一些常规成像不能发现的恶性病变或者需要确认的模糊发现。3名病人接受了额外的良性活检，5例病人接受了其他影像学研究。
Tartar博士具体讲述了5个通过BSGI获益的病人。她比较了BSGI和正电子发射断层扫描（PET）。她承认，PET显示出的图像更有吸引力，但是也相信BSGI和PET的诊断效果是一样的。
她解释说，病人会偶尔要求使用伽马成像，可能因为他们不能接受MRI。大多数情况下，还是因为病人感受到乳房有东西，但是乳腺X光检查和超声都不能发现，会使用BSGI。
BSGI确实存在假阳性和假阴性。关于假阴性，Tartar博士解释说，多数情况下没有改变医生诊疗的总体方向。
通过活检证实的18名病人中，83%是导管原位癌，17%是浸润性导管癌，78%有小于1cm的病变。研究人员认为，BSGI是符合成本效益比的，有良好的耐受性，对于新诊断乳腺癌患者的乳腺规划是敏感而有特异的辅助方式。这项技术对于乳房组织致密的年轻女性尤其有用。
参考文献：
Kim BS. Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast: a comparative study with MRI. Ann Nucl Med. 2011 Oct 18
Tadwalkar RV, Rapelyea JA, Torrente J, Rechtman LR, Teal CB, McSwain AP, Donnelly C, Kidwell AB, Coffey CM, Brem RF. Breast-specific gamma imaging as an adjunct modality for the diagnosis of invasive breast cancer with correlation to tumour size and grade. Br J Radiol. 2011 Jun 28.
原始新闻出处：
Breast-specific gamma imaging (BSGI) can provide information in the initial diagnostic work-up and surgical planning for patients with newly diagnosed breast cancer, beyond what magnetic resonance imaging (MRI) can reveal. Researchers reported this finding here at the Radiological Society of North America 97th Scientific Assembly and Annual Meeting.
Marie Tartar, MD, assistant clinical professor in the Department of Radiology at the University of California, San Diego, presented a retrospective review of records from the Scripps Clinic in San Diego during a scientific poster session. The presentation was well attended by physicians who were eager to understand the role of BSGI in clinical practice.
In 2009, clinicians at the Scripps Clinic began to perform BSGI. In the retrospective review, the researchers evaluated BSGI performance in their breast cancer patients. The 56 patients in the study had a mean age of 54.6 years.
BSGI is also known as molecular breast imaging. In this study, BSGI was conducted using a high-resolution gamma camera (Dilon 6800, Dilon Technologies). Before a BSGI, the patient receives a pharmaceutical tracing agent that is absorbed by all of the cells in the body. Because of their increased rate of metabolic activity, cancerous cells in the breast absorb a greater amount of the tracing agent than normal healthy cells, and they generally appear as dark spots on the BSGI image.
Dr. Tartar explained that the BSGI findings were confirmatory of conventional imaging in 55% of patients (31 of 56). Equivocal findings compromised the additive utility of BSGI in 25% of patients (14 of 56).
Using BSGI, the Scripps clinicians identified an additional malignant lesion or clarified ambiguous findings on conventional imaging, or the modality otherwise positively affected management in 20% of cases (11 of 56). Three patients underwent additional benign biopsies and 5 underwent additional imaging studies (8 of 58; 14%).
Dr. Tartar detailed case studies of 5 patients who benefited from BSGI. Although acknowledging that she is not ready to give up MRI, Dr. Tartar explained that "I like having something functional in my repertoire."
She compared the BSGI to positron emission tomography (PET). She acknowledges that the images produced by PET are particularly appealing, but believes that BSGI might be as diagnostic as PET.
She explained that patients occasionally request gamma imaging or choose gamma imaging because they cannot or prefer not to undergo MRI. In most cases, however, she uses BSGI when the patient thinks that they feel something but nothing is visible on mammogram or ultrasound.
BSGI does give some false positives and some false negatives. In the case of the false negatives, Dr. Tartar explained that "most of the time they did not change the overall direction that the physician was going."
Of the 18 patients with biopsy-proven lesions on conventional imaging, 83% (15 of 18) had ductal carcinoma in situ, 17% (3 of 18) had invasive ductal carcinoma, and 78% (14 of 18) had a lesion that was smaller than 1 cm.
The researchers conclude that BSGI is cost effective, well tolerated, and a reasonably sensitive and specific adjunct modality for enhancing presurgical planning for patients with newly diagnosed breast cancer. The investigators found the technique to be especially useful for young female patients with dense breast tissue.
The poster session was hosted by Rachel F. Brem, MD, FACR, director of breast imaging and intervention at The George Washington University in Washington, DC. She discussed the new technique with Medscape Medical News and agrees with Dr. Tartar that BSGI is a useful additional tool. "It gives us very different information than mammography and ultrasound." She described the technique as exciting and robust and much more accessible than MRI.
Dr. Tartar reports being a consultant for Johnson & Johnson. Dr. Brem reports being on the board of directors of iCAD and Dilon Technologies; being a board member of Dilon Technologies; having stock options in iCAD; holding stock in Dilon Technologies; and being a consultant for Siemens AG, U-Systems, Dilon Technologies, and Koninklijke Philips Electronics NV.
Radiological Society of North America (RSNA) 97th Scientific Assembly and Annual Meeting: Abstract LL-BRS-TU5B. Presented November 29, 2011.
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