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Breast
Imaging
Special Topics in Screening and Diagnostic Imaging
Molecular Breast Imaging (MBI and BSGI)
Molecular Breast Imaging (MBI and BSGI)
Amy Lynn Conners, MD; Amy M. Fowler, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Molecular breast imaging (MBI)
          • Breast-specific gamma imaging (BSGI)

        • Definitions

          • Megabecquerel (MBq) = 10⁶ disintegrations per second
          • Millicurie (mCi) = 37 MBq
          • Dedicated breast gamma imaging
            • MBI: Breast immobilized between 2 cadmium-zinc-telluride (CZT) semiconductor detectors
              • 20 cm x 16 cm or 24 cm x 16 cm FOV, pixel size of 1.6 mm or 2.5 mm, respectively
            • BSGI: Breast immobilized between compression plate and single sodium iodide (NaI) or cesium iodide (CsI) scintillating crystal detector
              • 20 cm x 15 cm or 25 cm x 20 cm FOV, pixel size of 3 mm or 3.2 mm, respectively
          • Conventional gamma camera imaging (scintimammography)
            • Limited use; low sensitivity for malignancies < 1 cm
          • Tc-99m sestamibi (trade names Cardiolite, Miraluma)
            • FDA approved for breast imaging in 1997
            • Lipophilic cation that accumulates in mitochondria → ↑ uptake in metabolically active cells
            • Uptake related to ↑ blood flow and negative transmembrane potential
            • Tc-99m half-life = 6 hours; 140 keV photon energy peak
          • Radiopharmaceuticals used
            • Tc-99m tetrofosmin (trade name Myoview)
              • Used mainly outside of United States; no FDA approved indication for breast imaging

        IMAGING

        • Patient Considerations

          • Imaging Protocol

            • Biopsy Technique

              DIAGNOSTIC CHECKLIST

              • Image Interpretation

                • Diagnostic Performance

                  • Indications

                    • New Horizons

                      Selected References

                      1. Kim S et al: Breast-specific gamma imaging versus MRI: Comparing the diagnostic performance in assessing treatment response after neoadjuvant chemotherapy in patients with breast cancer. AJR Am J Roentgenol. 1-10, 2019
                      2. Ching JG et al: Breast Lesions Detected via Molecular Breast Imaging: Physiological Parameters Affecting Interpretation. Acad Radiol. ePub, 2018
                      3. Manapragada PP: Molecular Imaging in Management of Breast Cancer. Semin Roentgenol. 53(4):301-310, 2018
                      4. Narayanan D and Berg WA: Dedicated breast gamma camera imaging and breast PET: Current status and future directions. PET Clin. 13(3):363-381, 2018
                      5. Swanson T et al: Best practices in molecular breast imaging: A guide for technologists. J Nucl Med Technol. ePub, 2018
                      6. ACR Practice Parameter for the Performance of Molecular Breast Imaging (MBI) Using a Dedicated Gamma Camera. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/MBI.pdf. Accessed December 2017
                      7. Collarino A et al: Is Technetium-99m Sestamibi Imaging Able to Predict Pathologic Nonresponse to Neoadjuvant Chemotherapy in Breast Cancer? A Meta-analysis Evaluating Current Use and Shortcomings. Clin Breast Cancer. ePub, 2017
                      8. Hruska CB et al: Background parenchymal uptake on molecular breast imaging as a breast cancer risk factor: a case-control study. Breast Cancer Res. 18(1):42, 2016
                      9. Brem RF et al: Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk. J Nucl Med. 57(5):678-84, 2016
                      10. Collarino A et al: Methodological aspects of 99mTc-sestamibi guided biopsy in breast cancer. Clin Transl Imaging. 4(5):367-376, 2016
                      11. Shermis RB et al: Supplemental breast cancer screening with molecular breast Imaging for women with dense breast tissue. AJR Am J Roentgenol. 207(2):450-7, 2016
                      12. Conners AL et al: Direct-conversion molecular breast imaging of invasive breast cancer: Imaging features, extent of invasive disease, and comparison between invasive ductal and lobular histology. AJR Am J Roentgenol. 205(3):W374-81, 2015
                      13. Hruska CB et al: Diagnostic workup and costs of a single supplemental molecular breast imaging screen of mammographically dense breasts. AJR Am J Roentgenol. 204(6):1345-53, 2015
                      14. Rhodes DJ et al: Journal club: molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts. AJR Am J Roentgenol. 204(2):241-51, 2015
                      15. O'Connor MK et al: Factors influencing the uptake of 99mTc-sestamibi in breast tissue on molecular breast imaging. J Nucl Med Technol. 43(1):13-20, 2015
                      16. Hruska CB et al: Effect of menstrual cycle phase on background parenchymal uptake at molecular breast imaging. Acad Radiol. 22(9):1147-56, 2015
                      17. Johnson N et al: Breast-specific gamma imaging is a cost effective and efficacious imaging modality when compared with MRI. Am J Surg. 207(5):698-701; discussion 701, 2014
                      18. Hruska CB et al: Nuclear imaging of the breast: translating achievements in instrumentation into clinical use. Med Phys. 40(5):050901, 2013
                      19. Sun Y et al: Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis. Eur J Nucl Med Mol Imaging. 40(3):450-63, 2013
                      20. Edwards C et al: Breast-specific gamma imaging influences surgical management in patients with breast cancer. Breast J. 19(5):512-9, 2013
                      21. Conners AL et al: Gamma camera breast imaging lexicon. AJR Am J Roentgenol. 199(6):W767-74, 2012
                      22. Kim BS: Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast: a comparative study with MRI. Ann Nucl Med. 26(2):131-7, 2012
                      23. Goldsmith SJ et al: SNM practice guideline for breast scintigraphy with breast-specific gamma-cameras 1.0. J Nucl Med Technol. 38(4):219-24, 2010
                      24. Hendrick RE: Radiation doses and cancer risks from breast imaging studies. Radiology. 257(1):246-53, 2010
                      25. O'Connor MK et al: Comparison of radiation exposure and associated radiation-induced cancer risks from mammography and molecular imaging of the breast. Med Phys. 37(12):6187-98, 2010
                      26. Brem RF et al: Detection of occult foci of breast cancer using breast-specific gamma imaging in women with one mammographic or clinically suspicious breast lesion. Acad Radiol. 17:735-43, 2010
                      27. Killelea BK et al: George Peters Award: How does breast-specific gamma imaging affect the management of patients with newly diagnosed breast cancer? Am J Surg. 198(4):470-4, 2009
                      28. Zhou M et al: Clinical utility of breast-specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient. Am J Surg. 197(2):159-63, 2009
                      Related Anatomy
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          • Diagnostic Checklist

                            TERMINOLOGY

                            • Abbreviations

                              • Molecular breast imaging (MBI)
                              • Breast-specific gamma imaging (BSGI)

                            • Definitions

                              • Megabecquerel (MBq) = 10⁶ disintegrations per second
                              • Millicurie (mCi) = 37 MBq
                              • Dedicated breast gamma imaging
                                • MBI: Breast immobilized between 2 cadmium-zinc-telluride (CZT) semiconductor detectors
                                  • 20 cm x 16 cm or 24 cm x 16 cm FOV, pixel size of 1.6 mm or 2.5 mm, respectively
                                • BSGI: Breast immobilized between compression plate and single sodium iodide (NaI) or cesium iodide (CsI) scintillating crystal detector
                                  • 20 cm x 15 cm or 25 cm x 20 cm FOV, pixel size of 3 mm or 3.2 mm, respectively
                              • Conventional gamma camera imaging (scintimammography)
                                • Limited use; low sensitivity for malignancies < 1 cm
                              • Tc-99m sestamibi (trade names Cardiolite, Miraluma)
                                • FDA approved for breast imaging in 1997
                                • Lipophilic cation that accumulates in mitochondria → ↑ uptake in metabolically active cells
                                • Uptake related to ↑ blood flow and negative transmembrane potential
                                • Tc-99m half-life = 6 hours; 140 keV photon energy peak
                              • Radiopharmaceuticals used
                                • Tc-99m tetrofosmin (trade name Myoview)
                                  • Used mainly outside of United States; no FDA approved indication for breast imaging

                            IMAGING

                            • Patient Considerations

                              • Imaging Protocol

                                • Biopsy Technique

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation

                                    • Diagnostic Performance

                                      • Indications

                                        • New Horizons

                                          Selected References

                                          1. Kim S et al: Breast-specific gamma imaging versus MRI: Comparing the diagnostic performance in assessing treatment response after neoadjuvant chemotherapy in patients with breast cancer. AJR Am J Roentgenol. 1-10, 2019
                                          2. Ching JG et al: Breast Lesions Detected via Molecular Breast Imaging: Physiological Parameters Affecting Interpretation. Acad Radiol. ePub, 2018
                                          3. Manapragada PP: Molecular Imaging in Management of Breast Cancer. Semin Roentgenol. 53(4):301-310, 2018
                                          4. Narayanan D and Berg WA: Dedicated breast gamma camera imaging and breast PET: Current status and future directions. PET Clin. 13(3):363-381, 2018
                                          5. Swanson T et al: Best practices in molecular breast imaging: A guide for technologists. J Nucl Med Technol. ePub, 2018
                                          6. ACR Practice Parameter for the Performance of Molecular Breast Imaging (MBI) Using a Dedicated Gamma Camera. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/MBI.pdf. Accessed December 2017
                                          7. Collarino A et al: Is Technetium-99m Sestamibi Imaging Able to Predict Pathologic Nonresponse to Neoadjuvant Chemotherapy in Breast Cancer? A Meta-analysis Evaluating Current Use and Shortcomings. Clin Breast Cancer. ePub, 2017
                                          8. Hruska CB et al: Background parenchymal uptake on molecular breast imaging as a breast cancer risk factor: a case-control study. Breast Cancer Res. 18(1):42, 2016
                                          9. Brem RF et al: Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk. J Nucl Med. 57(5):678-84, 2016
                                          10. Collarino A et al: Methodological aspects of 99mTc-sestamibi guided biopsy in breast cancer. Clin Transl Imaging. 4(5):367-376, 2016
                                          11. Shermis RB et al: Supplemental breast cancer screening with molecular breast Imaging for women with dense breast tissue. AJR Am J Roentgenol. 207(2):450-7, 2016
                                          12. Conners AL et al: Direct-conversion molecular breast imaging of invasive breast cancer: Imaging features, extent of invasive disease, and comparison between invasive ductal and lobular histology. AJR Am J Roentgenol. 205(3):W374-81, 2015
                                          13. Hruska CB et al: Diagnostic workup and costs of a single supplemental molecular breast imaging screen of mammographically dense breasts. AJR Am J Roentgenol. 204(6):1345-53, 2015
                                          14. Rhodes DJ et al: Journal club: molecular breast imaging at reduced radiation dose for supplemental screening in mammographically dense breasts. AJR Am J Roentgenol. 204(2):241-51, 2015
                                          15. O'Connor MK et al: Factors influencing the uptake of 99mTc-sestamibi in breast tissue on molecular breast imaging. J Nucl Med Technol. 43(1):13-20, 2015
                                          16. Hruska CB et al: Effect of menstrual cycle phase on background parenchymal uptake at molecular breast imaging. Acad Radiol. 22(9):1147-56, 2015
                                          17. Johnson N et al: Breast-specific gamma imaging is a cost effective and efficacious imaging modality when compared with MRI. Am J Surg. 207(5):698-701; discussion 701, 2014
                                          18. Hruska CB et al: Nuclear imaging of the breast: translating achievements in instrumentation into clinical use. Med Phys. 40(5):050901, 2013
                                          19. Sun Y et al: Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis. Eur J Nucl Med Mol Imaging. 40(3):450-63, 2013
                                          20. Edwards C et al: Breast-specific gamma imaging influences surgical management in patients with breast cancer. Breast J. 19(5):512-9, 2013
                                          21. Conners AL et al: Gamma camera breast imaging lexicon. AJR Am J Roentgenol. 199(6):W767-74, 2012
                                          22. Kim BS: Usefulness of breast-specific gamma imaging as an adjunct modality in breast cancer patients with dense breast: a comparative study with MRI. Ann Nucl Med. 26(2):131-7, 2012
                                          23. Goldsmith SJ et al: SNM practice guideline for breast scintigraphy with breast-specific gamma-cameras 1.0. J Nucl Med Technol. 38(4):219-24, 2010
                                          24. Hendrick RE: Radiation doses and cancer risks from breast imaging studies. Radiology. 257(1):246-53, 2010
                                          25. O'Connor MK et al: Comparison of radiation exposure and associated radiation-induced cancer risks from mammography and molecular imaging of the breast. Med Phys. 37(12):6187-98, 2010
                                          26. Brem RF et al: Detection of occult foci of breast cancer using breast-specific gamma imaging in women with one mammographic or clinically suspicious breast lesion. Acad Radiol. 17:735-43, 2010
                                          27. Killelea BK et al: George Peters Award: How does breast-specific gamma imaging affect the management of patients with newly diagnosed breast cancer? Am J Surg. 198(4):470-4, 2009
                                          28. Zhou M et al: Clinical utility of breast-specific gamma imaging for evaluating disease extent in the newly diagnosed breast cancer patient. Am J Surg. 197(2):159-63, 2009