Prognostic value of 99mTc-sestamibi washout in predicting response of locally advanced breast cancer to neoadjuvant chemotherapy

Rosa Sciuto, Rosella Pasqualoni, Serenella Bergomi, Germana Petrilli, Patrizia Vici, Franca Belli, Claudio Botti, Marcella Mottolese, Carlo L. Maini

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This study evaluated the role of 99mTc-sestamibi washout in the prediction of pathologic tumor response to neoadjuvant chemotherapy in 30 patients with locally advanced breast cancer. Methods: Two 99mTc-sestamibi studies were performed before and after chemotherapy for each patient. Early (10 min) and delayed (240 min) planar breast views were acquired after a 740-MBq 99mTc-sestamibi intravenous injection, and the washout rate (WOR) was computed. All patients underwent radical mastectomy with pathologic evaluation of the residual tumor size. Results: The pretherapy 99mTc-sestamibi WOR ranged from 14% to 92% (mean ± SD, 50% ± 18%). At pathologic examination, 15 patients showed no tumor response to chemotherapy and 15 patients showed an objective response to chemotherapy. The pretherapy 99mTc-sestamibi study predicted chemoresistance (WOR > 45%) in 18 of 30 patients and no chemoresistance (WOR ≤ 45%) in 12 of 30 patients. When the WOR cutoff was set at >45%, the prognostic performance of the test was indicated by a sensitivity of 100%; a specificity of 80%; positive and negative predictive values of 83% and 100%, respectively; and a likelihood ratio of 5. The repeatability of the test was good, with 80%-93% interreader agreement (κ = 0.57-0.85). Posttherapy 99mTc-sestamibi studies confirmed the pretherapy study prediction in 29 of 30 patients. Conclusion: 99mTc-Sestamibi WOR is a reliable test for predicting tumor response to neoadjuvant chemotherapy. In fact, negative findings (WOR ≤ 45%) rule out chemoresistance and positive findings (WOR > 45%) indicate a high risk of chemoresistance.

Original languageEnglish
Pages (from-to)745-751
Number of pages7
JournalJournal of Nuclear Medicine
Issue number6
Publication statusPublished - 2002


  • Tc-sestamibi
  • Breast cancer
  • Multidrug resistance
  • Neoadjuvant chemotherapy

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology


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