In vivo detection of resistance to anthracycline based neoadjuvant chemotherapy in locally advanced and inflammatory breast cancer with technetium-99m sestamibi scintimammography.

Silvia Mezi, Francesca Primi, Francesca Capoccetti, Francesco Scopinaro, Mauro Modesti, Orazio Schillaci

Research output: Contribution to journalArticle

Abstract

Neoadjuvant chemotherapy (NACT) is the treatment of choice in patients (pts) with locally advanced (LABC) and inflammatory breast cancer (IBC). To evaluate the role of Tc-99m sestamibi imaging in the prediction of response to NACT and in the in vivo functional detection of intrinsic or acquired chemoresistance, 24 female pts with LABC (n=21) or IBC (n=3) were prospectively studied. Tc-99m scintimammography was performed 1-3 days before treatment (first) and 2-5 days after the completion (second) of NACT (epirubicin and cyclophosphamide for LABC and doxorubicin and vinorelbine for IBC). Three planar images (2 lateral prone and one anterior supine, 10 min/each) were obtained 10 min postinjection and a lateral prone image (10 min) of the affected breast (B) was obtained at 4 h. To calculate the tumor to normal B ratio (TBR), 2 identical irregular regions of interest (ROIs) were drawn around the tumor (T) and in adjacent ipsilateral normal B on both early (E) and delayed (D) prone lateral images. The TBR was obtained as the ratio of the mean counts per pixels in the 2 ROIs. Then Tc-99m sestamibi retention index (RI) in the T was determined by dividing the D-TBR by the E-TBR. Afterwards, NACT response was assessed pathologically or clinically in inoperable disease. Scintigraphic sensitivity for correct prediction of T presence after NACT was 81% (17/21), whereas specificity for correct prediction of T absence was 100% (3/3). In LABC, 3 patients had a pathological complete response: first RI was high (>0.56) in all 3, while no T uptake was visible on the second scintigraphy. Eighteen patients did not show a pathological complete response: in 5, both first and second RI were low (

Original languageEnglish
Pages (from-to)1233-1240
Number of pages8
JournalInternational Journal of Oncology
Volume22
Issue number6
Publication statusPublished - Jun 2003

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Inflammatory Breast Neoplasms
Technetium Tc 99m Sestamibi
Anthracyclines
Drug Therapy
Epirubicin
Radionuclide Imaging
Doxorubicin
Cyclophosphamide
Neoplasms
Breast
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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In vivo detection of resistance to anthracycline based neoadjuvant chemotherapy in locally advanced and inflammatory breast cancer with technetium-99m sestamibi scintimammography. / Mezi, Silvia; Primi, Francesca; Capoccetti, Francesca; Scopinaro, Francesco; Modesti, Mauro; Schillaci, Orazio.

In: International Journal of Oncology, Vol. 22, No. 6, 06.2003, p. 1233-1240.

Research output: Contribution to journalArticle

Mezi, Silvia ; Primi, Francesca ; Capoccetti, Francesca ; Scopinaro, Francesco ; Modesti, Mauro ; Schillaci, Orazio. / In vivo detection of resistance to anthracycline based neoadjuvant chemotherapy in locally advanced and inflammatory breast cancer with technetium-99m sestamibi scintimammography. In: International Journal of Oncology. 2003 ; Vol. 22, No. 6. pp. 1233-1240.
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abstract = "Neoadjuvant chemotherapy (NACT) is the treatment of choice in patients (pts) with locally advanced (LABC) and inflammatory breast cancer (IBC). To evaluate the role of Tc-99m sestamibi imaging in the prediction of response to NACT and in the in vivo functional detection of intrinsic or acquired chemoresistance, 24 female pts with LABC (n=21) or IBC (n=3) were prospectively studied. Tc-99m scintimammography was performed 1-3 days before treatment (first) and 2-5 days after the completion (second) of NACT (epirubicin and cyclophosphamide for LABC and doxorubicin and vinorelbine for IBC). Three planar images (2 lateral prone and one anterior supine, 10 min/each) were obtained 10 min postinjection and a lateral prone image (10 min) of the affected breast (B) was obtained at 4 h. To calculate the tumor to normal B ratio (TBR), 2 identical irregular regions of interest (ROIs) were drawn around the tumor (T) and in adjacent ipsilateral normal B on both early (E) and delayed (D) prone lateral images. The TBR was obtained as the ratio of the mean counts per pixels in the 2 ROIs. Then Tc-99m sestamibi retention index (RI) in the T was determined by dividing the D-TBR by the E-TBR. Afterwards, NACT response was assessed pathologically or clinically in inoperable disease. Scintigraphic sensitivity for correct prediction of T presence after NACT was 81{\%} (17/21), whereas specificity for correct prediction of T absence was 100{\%} (3/3). In LABC, 3 patients had a pathological complete response: first RI was high (>0.56) in all 3, while no T uptake was visible on the second scintigraphy. Eighteen patients did not show a pathological complete response: in 5, both first and second RI were low (",
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