Supporting women whose lives have been touched by breast cancer

Scintimammography in nuclear medicine

There is no patient preparation...Patients may eat, drink
and take all their medications.

Scan consists of 2 parts with a 3 hour break inbetween.

Patients will initially be booked in the am for their 2 part test. When the patient comes to the nuclear medicine dept, they will be changed into a gown and asked to remove their bra. Then we lay the patient down on a stretcher where they will be given an iv injection through a butterfly needle into a vein in their foot. It is important that we inject in the patients foot if at all possible because if any mibi leaks outside of the vein, it > will be taken up by the lymph nodes. Since uptake in the lymph nodes is indicative of malignancy, this can lead to false positives if we were to inject in the patients arm veins and some of the injection was to go interstitially and show up in their axillary nodes. If it is impossible to inject in the patients foot vein, then we will inject in the hand on the opposite side of the breast cancer.

Immediately upon injection the patient will be asked to lie down on their stomach on the imaging bed. They will be lying on sponge cushions so that their bodies are raised up off the imaging beds and their breasts are hanging down freely so that they can be imaged. Patients will be asked to keep their arms above their heads and keep their head to one side. Initially the tomographic images and spect ct (MOVIES) are 25 minutes. When the this tomographic image is finished the patient will be given a break to stretch and then 2 further static images will be
taken. This whole session takes approximately one hour. Then the patient will be given a time to come back 2 hours later and all the images will be repeated. ( the total time is 3 hours between injection and return for delay pictures)

The delayed pictures also take an hour so the patient can plan on being there for another hour in the afternoon so they can plan for their time and parking.

Once the second set of images are complete, the patient is free to go. There are no side effects to the injection and patients are told to do everything they normally would do with no restrictions.

The great thing about this test, is the camera is able to detect the lesion in both blood flow and the accumulation of the radiotracer and so the docs can see if the lesion is shrinking and if the chemo is working.

Why do you need the scan ?

It is an awesome study that lets the physician quantify the uptake in tumours. It used to be that the only way to see if the chemo was working and the tumour was shrinking was through ultrasound which is what i had during my treatment. The problem with ultrasound is that it is so technically dependant and there is huge variation between techs/physicians. There is considerable less technical variation in this study because it combines nuclear medicine tomographic images along with a spect CT.

The patients receive an injection of mibi which is the same radipharmaceutical that we use for cardiac imaging. Mibi has been shown to go to tumours and this was found initially as incidental finding on patients undergoing cardiac imaging, and when we would scan them, we would often see a lung or breast tumour or a parathyroid adenoma. So given this, affinity for tumour tissue, mibi is now used for detecting tumours.

Patients often will have scintimammo's initially upon diagnosis and prior to chemo. They they will be checked after 2-3 cycles of chemo to check for response and< then after chemo is finished and before breast surgery. The test shows how well the tumour is responding to chemo based on the quantification of uptake in the lesion in the breast and/or lymph nodes. Sometimes, the regular mammo has picked up the lesion in the breast but they don't know if there are any positive lymph nodes present until surgery...however they often show up on the initial scintimammo and then the patient can be more accurately staged. As more and more patients are undergoing neoadjuvent chemo, sometimes at surgery the nodes are cancer free after chemo and we have no way of knowing whether or not they were positive initially so this test can give the docs some insight.