Locally advanced breast cancer (LABC) is a common cancer in the developing countries.
Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such
tumors and hence that the disease can be down staged and made amenable for surgery.
All the tumors do not respond to the therapy equally. Hence, it becomes very important
to predict the response of chemotherapy in such cases. This study evaluated the role
of scintimammography in assessing the response to NACT in 23 patients with LABC. Histologically
proven 23 patients of LABC were recruited in this study. Prechemotherapy tumor size
was measured clinically in all patients and technitium (Tc)-99m sestamibi test was
performed before NACT for each patient. Early (10 min) and delayed (2 h) image of
the breast were acquired in anterior and lateral views after Tc-99m sestamibi intravenous
injections and wash out rate (WOR) was computed. After 3-4 cycles of chemotherapy,
surgery in the form of modified radical mastectomy was performed in 20 out of 23 patients
(3 patients lost to follow-up) with pathologic evaluation of the residual tumor size.
The pretherapy Tc-99m sestamibi WOR ranged from 8.3% to 68% with mean ± SD of 34.5%
±16.5%. The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR
>45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients.
When the WOR cut-off was set at >45%, the predictivity of the test was indicated by
sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and
negative predictive value of 82.3% with a likelihood ratio of 0.1. Tc-99m sestamibi
WOR is a reliable test for predicting tumor response to NACT. WOR >45% is highly predictive
of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of
chemoresponsiveness.
Keywords
Breast cancer - neoadjuvant chemotherapy - response assessment - scintimammography
