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Breast-Specific Gamma Imaging

About Breast-Specific Gamma Imaging (BSGI)

Breast-Specific Gamma Imaging (BSGI) can detect early stage cancers (as small as 3 mm), see lesions independent of tissue density, and provide multiple angle views for direct correlation to mammograms.

Functional, or nuclear breast imaging, was discovered when large gamma cameras were being used for cardiac imaging. Suspicious areas were often noted in the chest wall of women, and over time physicians began to realize the benefit of applying nuclear medicine to breast cancer diagnosis - in its early incarnation this diagnostic procedure was called "scintimammography."

Ongoing advances in gamma detector technology have led to the development of a functional breast imaging procedure, BSGI, which uses a detector optimized for high-resolution breast imaging. Having evolved from scintimammography, BSGI is also based on the enhanced uptake of Sestamibi in tumors within the breast.

When post-mammogram evaluation is indicated, BSGI as a "next-step measure" is an excellent complement to mammography because of its high specificity and sensitivity for sub-centimeter lesions.

Radiology Indications

Using a physiological approach to breast cancer detection allows for more specific evaluations and improved management of challenging cases. BSGI is a molecular study of the breast that provides physiological data not available from any other imaging modality and can help quickly determine the nature of suspicious lesions and, in many cases, the extent of disease.

BSGI complements mammography for patients who are difficult to diagnose, or have:

• Dense breast tissue
• Palpable lesions not detected by mammography or ultrasound
• Multiple suspicious lesions or clusters of calcifications
• Pre-biopsy evaluation of suspect areas (helps determine extent of disease)
• Implants
• Post-surgical or post-therapeutic mass

From a radiological perspective, BSGI delivers the following benefits:

• Helps evaluate the need for 6-month follow-up
• Provides high specificity and negative predictive values - approximately 92 percent and 99 percent respectively
• Helps evaluate the need, and localize areas of interest, for biopsy
• Significantly aids in the differentiation of benign and malignant tissue
• Sensitivity to smaller non-palpable and/or medially located lesions
• Highest sensitivity for detecting DCIS and lobular carcinomas
• Permits imaging in all mammographic views

Surgical Indications

Using a physiological approach to breast cancer detection allows for more specific evaluations and improved management of challenging cases. BSGI is a molecular study of the breast that provides physiological data not available from any other imaging modality and can help quickly determine the nature of suspicious lesions and, in many cases, the extent of disease.

BSGI complements mammography for surgical patients with:

• Radiodense breasts that are difficult to image
• Evaluation of indeterminate or suspicious lesions identified by mammography
• Post-surgical or post-therapeutic evaluation of mammographic tissue changes
• Evaluation of multiple lesions or clusters of microcalcifications to aid in biopsy target selection
• Palpable mass not demonstrated in mammogram or ultrasound
• Lobular Carcinoma & DCIS

BSGI is also fundamental when:

• Determining the extent of the primary lesion
• Evaluating the axillary region for node status in breast cancer patients
• Multi-focality and multicentricity
• Monitoring primary tumor response to neoadjuvant chemotherapy

From a surgical perspective, BSGI delivers the following benefits:

• Permits imaging in all mammographic views
• Improves management of difficult to diagnose patients
• Helps evaluate the need for 6-month follow-up
• Significantly aids in the differentiation of benign and malignant tissue
• Sensitive to smaller non-palpable and/or medially located lesions
• Helps evaluate the need, and localize areas of interest, for biopsy
• Evaluates extent of disease for breast conservation surgery

BSGI in the Diagnostic Protocol

Because BSGI provides high sensitivity and specificity, it is an excellent complementary diagnostic procedure to mammography. While X-ray mammograms image tissue densities, not cancer activity, BSGI uses radiotracer uptake to detect cancer independent of tissue density.

Additionally, BSGI - as a functional procedure - images cellular activity while both MRI and ultrasound image tissue density. While certain types of breast tissue may interfere with cancer detection, functional imaging allows physicians to see the breast more clearly by accessing a map of cellular metabolism.

If your patient has a mammogram at RMI and it is found to be inconclusive, we may recommend BSGI as a follow-up.