99Tcm-MIBI乳腺专用伽玛显像在乳腺Paget病中的临床应用价值

Preliminary clinical application of 99Tcm-MIBI breast specific gamma imaging in detecting breast Paget′s disease

目的探讨乳腺Paget病(breast Paget′s disease,BPD)患者99m锝-甲氧基异丁基异腈(technetium-99m methoxyisobutylisonitrile,99Tcm-MIBI)乳腺专用伽玛显像(breast specific gamma imaging,BSGI)检查的特征及其临床应用价值。方法收集7例由组织病理学证实的女性BPD患者,平均年龄51.3岁,初次治疗前行99Tcm-MIBI BSGI、乳腺超声(ultrasonography,US)、乳腺X线摄片(mammography,MMG,6例)和乳腺MRI(4例)检查以进行诊断评估。回顾性复习患者的临床资料和99Tcm-MIBI BSGI显像特征,计算BSGI探查BPD及同时存在的乳腺癌的敏感度,并与US、MMG和MRI的结果比较。结果在7例BPD患者中BSGI探查到6个位于乳头/皮肤的小圆形(5例)或小片状放(1例)射性摄取增高影。其中4个考虑为恶性(敏感度为57.1%),2个考虑为乳头生理性摄取,1个乳头/皮肤部位未见异常。US仅探查到1个乳头皮下低回声(敏感度为14.3%),余6个超声未见异常。6例行MMG检查的患者均未发现乳头/皮肤病灶。4例乳腺MRI检查者中发现2个乳头恶性病灶(敏感度为50.0%)。对于6个同时并存的乳腺癌病灶,BSGI、 US和MMG的敏感度均为66.7%,MRI的敏感度为50.0%(2/4)。结论 99Tcm-MIBI BSGI可以探查到BPD患者乳头/皮肤具有增殖活性的恶性病灶,为BPD的诊治决策提供重要信息。

Objective To describe the features of technetium-99 m methoxyisobutylisonitrile(99Tcm-MIBI)breast specific gamma imaging(BSGI)of breast Paget′s disease(BPD)patients,and to investigate its value in clinical application.Methods Seven patients with histologically proven BPD were collected,with an average age of 51.3 years.99Tcm-MIBI BSGI,ultrasonography(US,n=7),mammography(MMG,n=6)and breast magnetic resonance imaging(MRI,n=4)were performed before the initial therapy.The clinical data and features of 99Tcm-MIBI BSGI were reviewed retrospectively to calculate the sensitivity of BSGI for BPD and concurrent breast cancer,and the results of US,MMG and MRI were compared.Results In 7 BPD patients,BSGI detected 6 small round(n=5)or small lamellar(n=1)incremental radioactive uptake in nipple/skin lesions.Of them,4 patients were considered as malignancy with a sensitivity of 57.1%.US detected subcutaneous hypoechoic area of left nipple in 1 patient with a sensitivity of 14.3%.In 6 patients underwent MMG,no nipple/skin lesions were found.In 4 patients underwent MRI,2 nipple malignancy were found with a sensitivity of 50.0%.For 6 patients with concurrent breast cancer,the sensitivity of BSGI,US and MMG were all 66.7%,respectively,and the sensitivity of MRI was 50.0%.Conclusion 99Tcm-MIBI imaging can detect malignant lesions of nipple/skin with proliferative activity in BPD,and provide important information for the diagnosis and treatment of BPD.