Abstract
Purpose: The aim was to retrospectively assess the performance of molecular breast imaging (MBI) as an adjunct diagnostic tool when symptoms could not be explained by conventional imaging, or when mammography or ultrasound findings were equivocal.
 Methods: The analysis was comprised of women who underwent further testing with MBI after diagnostic mammography and/or targeted ultrasound. Outcome measures included sensitivity, specificity, and positive and negative predictive values. Receiver-operating characteristic (ROC) curve was constructed and analyzed as a performance measure.
 Results: In 301 women with a complete reference standard, 18 (6.0%) were diagnosed with cancer. MBI detected cancer in 16 subjects; two interval cancers occurred. 15 of the 16 cancers detected by MBI were invasive. Overall sensitivity of MBI in this sample was 88.9 % (95% CI 65.6 – 98.6), with 97.5% specificity (95% CI 95.0 – 99.0). Positive predictive value (PPV) was 69.6%, while negative predictive value for recall (NPV) was calculated as 99.3%. ROC curves demonstrated excellent performance (area under the curve = 0.933).
 Conclusions: MBI is a valuable diagnostic tool for further evaluation or to guide management when conventional imaging is incomplete. The majority of tumors in this study were invasive carcinomas with node negative status, important for timely treatment.
Highlights
The aim was to retrospectively assess the performance of molecular breast imaging (MBI) as an adjunct diagnostic tool when symptoms could not be explained by conventional imaging, or when mammography or ultrasound findings were equivocal
This study aims to evaluate the use of MBI as an adjunct diagnostic tool in patients where conventional imaging provided inconclusive results
Of 301 included patients, 18 (5.98 %) were diagnosed with cancer; 16 of these were detected with MBI yielding a sensitivity of 88.9%
Summary
The aim was to retrospectively assess the performance of molecular breast imaging (MBI) as an adjunct diagnostic tool when symptoms could not be explained by conventional imaging, or when mammography or ultrasound findings were equivocal. Mammography may not be well-suited for the diagnosis of isodense and/or slow growing cancers [4, 5] Adjunct modalities such as targeted ultrasound are often used to correlate to mammography in cases where images are not conclusive or do not provide enough information about a potential lesion [6, 7]. The technique suffered from intrinsically low resolution and required a relatively high dose of 99mTc-sestamibi [19] These limitations have been overcome by MBI [20], which employs two separate semiconductor gamma cameras to construct high resolution images. This study aims to evaluate the use of MBI as an adjunct diagnostic tool (problem solver) in patients where conventional imaging provided inconclusive results
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