Browse the corpus

Breast cancer is increasing in incidence and is one of the leading types of cancer. Once thought to be mostly a disease of elderly females, there is an increase in the incidence of breast cancer in women during their third and fourth decades of life. With increasing awareness, screening has become more prevalent, which in turn has increased the overall number of positive findings and subsequent testing. This activity reviews the applications of mammoscintigraphy in medicine today and highlights its advantages and disadvantages in the management of patients with breast pathology on screening or initial diagnostic studies. Objectives: Summarize the indications for mammoscintigraphy. Describe the preparation and technique required for mammoscintigraphy. Outline potential complications of mammoscintigraphy. Identify interprofessional team strategies for improving care coordination to advance mammoscintigraphy and improve outcomes. Access free multiple choice questions on this topic.

Breast cancer is increasing in incidence and is one of the leading types of cancer. Once thought to be mostly a disease of elderly females, there is an increase in the incidence of breast cancer in women during their third and fourth decades of life. With increasing awareness, screening has become more prevalent, which in turn has increased the overall number of positive findings. Additionally, post-treatment monitoring increases with an overall increase in studies and survival rates. In an effort to decrease the morbidity and mortality of breast cancer, technological advances in breast imaging have been developed and are continuing to expand to detect breast cancers earlier. Methods of examination for breast cancer include self physical examination, physician physical examination, mammogram, tomography, ultrasound, magnetic resonance imaging (MRI), and positron emission tomography (PET). Another less commonly known and rarely used modality is scintimammography or mammoscintigraphy. Scintimammography is a type of nuclear medicine imaging, which has been considered adjuvant to mammography specifically for cases containing post-surgical changes, indeterminate mammogram findings, post neoadjuvant chemotherapy follow-up, and suspected multifocal disease. MRI of the breast has largely taken the place of scintimammography because it can provide similar information and more such as a high-quality preoperative evaluation. Currently, clinicians have not decided on definite indications for scintimammography, resulting in many studies evaluating its utility.[1][2][3][4] Studies have attempted to define the importance of scintimammography by comparing statistical data, including positive predictive values, false negatives, and false positives. The positive predictive value is low for mammograms, given the higher rates of false positives, but when combined with another modality, the positive predictive value will increase, which improves patient care and satisfaction overall. Breast malignancies have been shown to have increased uptake of radiopharmaceuticals as compared to normal breast parenchyma. The diagnostic evaluation consists of intravenous injection of technetium 99m sestamibi (technetium 99m - DMSA or technetium 99m MDP can also be used but are less sensitive) with subsequent imaging of the breasts.[5]

The procedure is relatively non-invasive with few adverse effects; however, potential complications could include extravasation of radiopharmaceuticals and allergic reaction to radiopharmaceuticals. Extravasation of technetium 99m has not been shown to cause significant harmful effects to the tissue involved, and usually, surgical intervention would not be necessary. Allergic reactions to radiopharmaceuticals are rare, but if they happen or are at risk of occurring, appropriate steps are given by the American College of Radiology, which includes preparation with corticosteroids and antihistamines as well as emergent medications pending the development of any symptoms; these would include epinephrine and labetalol.[12]

Scintimammography is a diagnostic imaging modality using radiopharmaceuticals to identify breast malignancies. With limited complications, allergic reaction to radiopharmaceuticals, and extravasation of radiopharmaceuticals, the most effective way of enhancing healthcare team outcomes is through identifying every step of the process and assigning a role to each team member. Prior to the patient arriving at the hospital or clinic for their examination, the following should be done: Appropriate scheduling should be provided to the patient to allow for optimal patient satisfaction. Screening for a history of recent surgeries, menstrual cycle, recent imaging with radiopharmaceuticals, history of contrast/radiopharmaceutical reactions, and personal medical history should be administered. Appropriate preparation for the patient should be overseen by the radiologist. The nuclear medicine technician should perform quality control according to the general guidelines by the Society of Nuclear Medicine on the scintillation camera. The radiologist should review the imaging to understand the case better and ensure that the study meets the appropriate criteria. Radiopharmaceuticals of choice should be prepared and shipped within the appropriate timeframe to prevent radioactive decay. When these interprofessional roles have been assigned and are accomplished without interruption, the coordinated efforts of the entire interprofessional healthcare team, including the patient, demonstrate an overall better experience and more positive outcomes. [Level 5]