• 西安交通大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院影像中心,西安,710061;

目的 　探討Technetium-99m-MIBI( 99mTc-MIBI)乳腺核素顯像診斷原發(fā)乳癌及腋窩淋巴結(jié)轉(zhuǎn)移的價值.
方法 　檢索Cochrane 圖書館、MEDLINE、Springer、Elsevier及中國期刊網(wǎng)中有關(guān)99mTc-MIBI乳腺核素顯像標(biāo)準(zhǔn)與病理診斷(金標(biāo)準(zhǔn))比較診斷原發(fā)乳癌及腋窩淋巴結(jié)轉(zhuǎn)移的前瞻性臨床試驗(yàn),提取并評價各納入研究的特征性信息及檢測敏感度、特異度等指標(biāo).根據(jù)不同的效應(yīng)量選擇不同的效應(yīng)模型,并進(jìn)行加權(quán)定量合并,計算匯總敏感度、特異度及其相應(yīng)的95%CI,繪制匯總受試者工作特征曲線(SROC),計算曲線下面積(AUC)來評價其診斷價值.
結(jié)果 　99mTc-MIBI乳腺核素顯像診斷乳腺癌的匯總敏感度和特異度及其相應(yīng)的95%CI分別為86%[95%CI (82%,89%)]和80%[95%CI(75%,80%)],AUC為90.29%.對于可觸之的乳腺包塊99mTc-MIBI乳腺核素顯像診斷乳腺癌的匯總敏感度和特異度及其相應(yīng)95%CI分別為86%[95%CI(83%,88%)]和83%[95%CI (77%,86%)], AUC為94.68%.對不可觸之乳腺腫塊,相應(yīng)匯總值分別為69%[95%(47%,85%)]和69%[95%CI(52%,82%)], AUC為78.97%.對腋窩淋巴結(jié)轉(zhuǎn)移診斷的匯總敏感度和特異度及其相應(yīng)95%CI分別為75%[95%CI (66%,81%)]和84%[95%CI(75%,91%)], AUC為87.64%.
結(jié)論 　對于可觸之的乳腺腫塊99mTc-MIBI乳腺核素顯像診斷原發(fā)性乳腺癌的價值較高對腋窩淋巴結(jié)轉(zhuǎn)移的特異性也較好,但敏感度尚需提高.然而對于不可觸之的乳腺腫塊,其診斷價值則有限.

引用本文： 劉 敏,郭佑民,郭曉娟,陳 敏,張少娟. 99mTc-MIBI乳腺核素顯像診斷原發(fā)乳腺癌的Meta分析. 中國循證醫(yī)學(xué)雜志, 2005, 05(7): 536-542. doi: 復(fù)制

1. Rodes N, Lopez M, Pearson D. The impact of breast cancer screening on survival: a 5-to10-year follow-up up study[J].Cancer,1986;57(3):581-585.
2. Wingo PA, Tong T, Bolden S. Cancer statistics,1995[J].CA Cancer J Clin,1995;45(1):8-30.
3. Jense OM, Esteve J, Moller H, Renard H. Cancer in European community and its member states[J].Eur J Cancer,1990;26(11-12): 1167-1256.
4. Müller ST, Guth-Tougelides B, Creutzig H. Imaging of malignant tumors with MIBI-99mTc SPECT[J] .J Nucl Med,1987;28(2):562p.
5. Waxman A, Ashok G, Kooba A. The use of 99mTc-methoxy isobutyl isontrile(MIBI) in the evaluation of patients with primary carcinoma of the breast[J]. Clin Nucl Med, 1992; 9(7): 761p.
6. Campeau RJ, Kronemer KA. Sutherland CM. Concordant uptake of Tc-99m sestamibi and Tl-201in unsuspected breast tumor[J]. Clin Nucl Med,1992;179(12):936-937.
7. Khalkhali I, Mena I, Diggles L. Review of imaging techniques for the diagnosis of breast cancer :a new role of prone scintimsmmography using technetium-99m sestamibi[J]. Eur J Nucl Med, 1994;21(4): 357-362.
8. Kao CH,Wang SJ,Liu TJ.The use of technetium-99m-metheoxyisobutilisonitrile breast scintigraphy to evaluate palpable breast masses[J]. Eur J Nucl Med, 1994;21(5):432-436.
9. Deeks JJ. systematic reviews of evaluations of diagnostic and screening tests. In:Egger M,Smith SD,Altman G,editors:systematic reviews. London; BMJ Publishing, 2001, 248-282.
10. Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of Meta-analysis[J]. Chinese Journal of Evidence-Based Medicine, 2003; 3(1): 41-44.
11. T Justin Clark,Christopher H. Mann,Neil Shan Khalid .K,Fujian S,Janesh KG. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer : a systematic quantitative review[J]. BJOG, 2002;109,313-321.
12. McAlister Fa,Straus SE,Sackett DL.Why we need large simple studies of the clinical examination:the problem and a proposed solution[J]. Lancet, 1999;354(9191):1721-1724.
13. Moses Le,Shapiro D,Littenberg B.Combining independent studies of a diagnostic test into a summary ROC curve: data analytic approaches and some additional considerations[J].StatMed,1993;129 (14) :1293-1316.
14. Chen LC, Yin YQ, Chen JX, Sun XG,Yang X, Liu WG.The usefulness of technetium-99m-MIBI scintimammography in diagnosis of breast cancer: using surgical histopathologic diagnosis as the gold standard[J]. Anticancer research, 1997;17(3B);1695-1698.
15. Raymond T,Andre R,Raymond L, Sophie T , Jacques C,Jean L.Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement[J]. J Nucl Med,1995;36 (10): 1758-1765.
16. Iraj Khalkhali,John C,Ismael M,Linda D,Rose V,Herman V,et al.Technetium-99m-sestamibi scintimammo -graphy of breast lesions:clinical and pathological follow-up[J].J Nucl Med,1995;36(10):1784-1789.
17. J.Villanueva-Meyer J,Leonard MH,Briscoe F,Cesani,SA,Rhoden M,D.Cowan..Mammoscintigraphy with technetium-99m-sestamibi in suspected breast cancer[J].J Nucl Med,1996;37(6):926-930.
18. Douglas H,Robert S,David C, Linda L.Technetium-99m sestamibi scitimammography:the influence of histopathological characteristics ,leision size and the presence of carcinoma in situ in the detection if breast carcinoma[J]. Eur J Nucl Med, 1999;26(11):1475-1481.
19. Palmedo H, Biersack H, Lastoria S, Maublant J, Prats E,Stegner H. Scintimammography with technetium-99m methoxyisobutylisontrile:results of a prospective European multicentre trial[J]. EurJ Nucl Med, 1998;25(4):375-385.
20. Danielsson R, Bone B, Perbeck L, Aspelin P. Sensitivity and specificity of planar scintimammography with 99mTc-sestamibi[J]. Acta Radiol, 1999;40(4):394-399.
21. Cwikla B, Buscombe R, Parbhoo P, Davidson T, Holloway B, Hilson W. What is the best way to find breast cancer[J]? Nucl Med Commun,2000;21 (4):388.
22. Prast E,Banzo J,MeronnoE, Herranz R, Carril JM.99m-Tc-MIBIscintimammorgraphy as a complement of the mammography in patients with suspected breast cancer[J]. Breast, 2001;10 (2)109-116.
23. Bagni B,Franceschetto A,Casolo A, M De Santis, I Bagni, F Pansini, and C Di Leo.Scintimammography with 99mTc-MIBI and magnetic resonance imaging in the evaluation of breast cancer[J]. Eur J Nucl Med Mol Imaging, 2003;30 (10): 1383-1388.
24. Prast E,Carril J,Meronoe E, Herranz R,Banzo J, YE Gtemegmmt.A spainish multicenter scintigraphic study of the breast using Tc99mMIBI : Report of results[J]. Rev Esp Med Nucl, 1998,17(5):338-350.
25. Massimo I,Silvana DV,Albina R,Leonardo P,Francesco DS,Francesca DGet al. Scintimammography with 99mTc-MIBI versus dynamic MRI for non-invasive characterization of breast masses[J]. Eur J Nucl Med, 2001;28(1):56-63.
26. Tofani A, Sciuto R, Semprebene A, Festa A, Pasqualoni R, Giunta S.99mTc-MIBI Scintimam mography in 300 consecutive patients: factors that may affect accuracy[J]. Nucl Med Commun, 1999;20 (12):1113-1121.
27. Yang XW, Jin G,Wang ZC,Yang WL.Detection of primary breast cancer and axillary lyphm node matastasis by 99mTc-MIBI prone scintimammography[J]. Chin Jof General Surgey, 2000,9(6):538-540.
28. Sergey M,Judith S,Maya C,Shlomo L and Ernesto L. Technetium-99m-MIBI scintimammorgrahy in palpable and nonpalpable breast lesions[J]. J Nucl Med, 1998;39(1):86-91.
29. Palmedo H, Schomburg A, Grunwald F,Mallmann P,Krebs D,Biersack HJ.Technetium-99m-MIBI scintimammorgray for suspicious breast lesions[J].J Nucl Med,1996;37(4):626-630.
30. Zagorski.S,Cirangle.P,Delaplain.C,S.Kim ,J.Kavolus.Sestamibi scintimammogrphy in the evalution of breast pathology[J]. Current Surgery, 1999;56(7):438-450.
31. Deng NY, Zhang JS,TangY.99mTc-MIBI scintimammography in the evaluation of breast cancer[J]. China General Surgery, 2003;12(10):784-785.
32. Guo DS, WangYT, Lu GZ.Value of 99mTc-MIBI scintimammography in the differential diagnosis between bengin breast tumor ,breast cancer and lymph node involvement[J]. China Oncology, 2000;10 (16) : 542-544.
33. Chen J,Wu H, Hu J Zhou J. 99mTc-MIBI mammoscintigraphy in differentiation of nodular lesions of breast and detection of axillary lymph nodes metastasis from breast cancer[J]. Radiol Practice, 2003;18(1):59-61.
34. Omar A,Teresa M,LB,Delgado,Jorge H,Levent K,Augusto L,et al.Is 99mTc-MIBI scintimammography complementary to conventional mamm-ography for detecting breast cancer in patients with palpable masses[J]? J Nucl Med, 2001;42 (11):1614-1621.
35. Sun SS,Jih Fang Hsieh,Shin-chuanTsai,HO YJ,LEE JK,Kao CH.The role of Tc-99m methoxysiobutylisonitrile scintimam-mography as compared to mammography in evaluating palpable breast masses of Taiwanese women[J]. Anticancer research, 2000;20(3B):2133-2136.
36. Isabel U,Jose M,Remedios O, Rosario G , OlgaT, Alfonso M. Optimization of X-ray mammography and technetium-99m methoxy-isobutylisonitrile scintimammography in the diagnosis of non-palpable breast lesions[J]. Eur J Nucl Med, 1998;25(5):491-496.
37. JM Carril, R Gomez-Barquin, R Quirce, O Tabuenca, I Uriarte, and A Montero.Contribution of 99mTc-MIBI scintimammography to the diagnosis of non-palpable breast lesions in relation to mammographic probability of malignancy[J]. Anticancer research, 1997;17(3B):1677-1682.
38. Raymond T,Andre R,Sophie T,Raymond L,Jacques C,Jean L,et al.Metasttic axillary lymph node technetium-99m-MIBI imaging in primary breast cancer[J]. J Nucl Med, 1998;39(7):459-464.
39. Lam WW, Yang WT, Chan YL, Stewart IE, Metreweli C, King W. Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy,ultrasound and conventional mammography[J]. Eur J Nucl Med, 1996;23(3):498-503.
40. Perre CI, Rutter JE, Vos PA, de Hooge P.Technetium-99m-sestamibi uptake in axillary lymph node metastases in breast cancer patients[J]. Eur J Surg Oncol, 1997;23(2)142-144.
41. Tolmos J, Khalkhali I, Vargas H, Stuntz M, Cutrone J, Mishkin F,et al..Detection od axillary lymph node metastases of breast carcinoma with technetium-99m sestamibi scintimammography[J]. Am Surg, 1997;63 (10):850-853.
42. Orazio S,Francesco S,Roberta D,Rosanna T,Pina C et al.Technetium-99m sestamibi imaging in the detection of axillary lymph node involvement[J].J Nucl Med,1995;36(10):1758-1765.
43. Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL.Evaluation of breast masses and axillary lymph nodes with (F-18) 2-deoxy-2-fluoro-d-glucose PET[J]. Radiology,1993;187(3):743-750.
44. Rodier JF, Routiot T, Mignotte H, Janser JC, Bremond A, David E, et al. Lymphatic mapping and sentinel node biopsy of operable breast cancer[J]. World Journal of Surgery, 2000; 24(10):2313-2323.
  1. 1. Rodes N, Lopez M, Pearson D. The impact of breast cancer screening on survival: a 5-to10-year follow-up up study[J].Cancer,1986;57(3):581-585.
  2. 2. Wingo PA, Tong T, Bolden S. Cancer statistics,1995[J].CA Cancer J Clin,1995;45(1):8-30.
  3. 3. Jense OM, Esteve J, Moller H, Renard H. Cancer in European community and its member states[J].Eur J Cancer,1990;26(11-12): 1167-1256.
  4. 4. Müller ST, Guth-Tougelides B, Creutzig H. Imaging of malignant tumors with MIBI-99mTc SPECT[J] .J Nucl Med,1987;28(2):562p.
  5. 5. Waxman A, Ashok G, Kooba A. The use of 99mTc-methoxy isobutyl isontrile(MIBI) in the evaluation of patients with primary carcinoma of the breast[J]. Clin Nucl Med, 1992; 9(7): 761p.
  6. 6. Campeau RJ, Kronemer KA. Sutherland CM. Concordant uptake of Tc-99m sestamibi and Tl-201in unsuspected breast tumor[J]. Clin Nucl Med,1992;179(12):936-937.
  7. 7. Khalkhali I, Mena I, Diggles L. Review of imaging techniques for the diagnosis of breast cancer :a new role of prone scintimsmmography using technetium-99m sestamibi[J]. Eur J Nucl Med, 1994;21(4): 357-362.
  8. 8. Kao CH,Wang SJ,Liu TJ.The use of technetium-99m-metheoxyisobutilisonitrile breast scintigraphy to evaluate palpable breast masses[J]. Eur J Nucl Med, 1994;21(5):432-436.
  9. 9. Deeks JJ. systematic reviews of evaluations of diagnostic and screening tests. In:Egger M,Smith SD,Altman G,editors:systematic reviews. London; BMJ Publishing, 2001, 248-282.
  10. 10. Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of Meta-analysis[J]. Chinese Journal of Evidence-Based Medicine, 2003; 3(1): 41-44.
  11. 11. T Justin Clark,Christopher H. Mann,Neil Shan Khalid .K,Fujian S,Janesh KG. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer : a systematic quantitative review[J]. BJOG, 2002;109,313-321.
  12. 12. McAlister Fa,Straus SE,Sackett DL.Why we need large simple studies of the clinical examination:the problem and a proposed solution[J]. Lancet, 1999;354(9191):1721-1724.
  13. 13. Moses Le,Shapiro D,Littenberg B.Combining independent studies of a diagnostic test into a summary ROC curve: data analytic approaches and some additional considerations[J].StatMed,1993;129 (14) :1293-1316.
  14. 14. Chen LC, Yin YQ, Chen JX, Sun XG,Yang X, Liu WG.The usefulness of technetium-99m-MIBI scintimammography in diagnosis of breast cancer: using surgical histopathologic diagnosis as the gold standard[J]. Anticancer research, 1997;17(3B);1695-1698.
  15. 15. Raymond T,Andre R,Raymond L, Sophie T , Jacques C,Jean L.Technetium-99m-sestamibi prone scintimammography to detect primary breast cancer and axillary lymph node involvement[J]. J Nucl Med,1995;36 (10): 1758-1765.
  16. 16. Iraj Khalkhali,John C,Ismael M,Linda D,Rose V,Herman V,et al.Technetium-99m-sestamibi scintimammo -graphy of breast lesions:clinical and pathological follow-up[J].J Nucl Med,1995;36(10):1784-1789.
  17. 17. J.Villanueva-Meyer J,Leonard MH,Briscoe F,Cesani,SA,Rhoden M,D.Cowan..Mammoscintigraphy with technetium-99m-sestamibi in suspected breast cancer[J].J Nucl Med,1996;37(6):926-930.
  18. 18. Douglas H,Robert S,David C, Linda L.Technetium-99m sestamibi scitimammography:the influence of histopathological characteristics ,leision size and the presence of carcinoma in situ in the detection if breast carcinoma[J]. Eur J Nucl Med, 1999;26(11):1475-1481.
  19. 19. Palmedo H, Biersack H, Lastoria S, Maublant J, Prats E,Stegner H. Scintimammography with technetium-99m methoxyisobutylisontrile:results of a prospective European multicentre trial[J]. EurJ Nucl Med, 1998;25(4):375-385.
  20. 20. Danielsson R, Bone B, Perbeck L, Aspelin P. Sensitivity and specificity of planar scintimammography with 99mTc-sestamibi[J]. Acta Radiol, 1999;40(4):394-399.
  21. 21. Cwikla B, Buscombe R, Parbhoo P, Davidson T, Holloway B, Hilson W. What is the best way to find breast cancer[J]? Nucl Med Commun,2000;21 (4):388.
  22. 22. Prast E,Banzo J,MeronnoE, Herranz R, Carril JM.99m-Tc-MIBIscintimammorgraphy as a complement of the mammography in patients with suspected breast cancer[J]. Breast, 2001;10 (2)109-116.
  23. 23. Bagni B,Franceschetto A,Casolo A, M De Santis, I Bagni, F Pansini, and C Di Leo.Scintimammography with 99mTc-MIBI and magnetic resonance imaging in the evaluation of breast cancer[J]. Eur J Nucl Med Mol Imaging, 2003;30 (10): 1383-1388.
  24. 24. Prast E,Carril J,Meronoe E, Herranz R,Banzo J, YE Gtemegmmt.A spainish multicenter scintigraphic study of the breast using Tc99mMIBI : Report of results[J]. Rev Esp Med Nucl, 1998,17(5):338-350.
  25. 25. Massimo I,Silvana DV,Albina R,Leonardo P,Francesco DS,Francesca DGet al. Scintimammography with 99mTc-MIBI versus dynamic MRI for non-invasive characterization of breast masses[J]. Eur J Nucl Med, 2001;28(1):56-63.
  26. 26. Tofani A, Sciuto R, Semprebene A, Festa A, Pasqualoni R, Giunta S.99mTc-MIBI Scintimam mography in 300 consecutive patients: factors that may affect accuracy[J]. Nucl Med Commun, 1999;20 (12):1113-1121.
  27. 27. Yang XW, Jin G,Wang ZC,Yang WL.Detection of primary breast cancer and axillary lyphm node matastasis by 99mTc-MIBI prone scintimammography[J]. Chin Jof General Surgey, 2000,9(6):538-540.
  28. 28. Sergey M,Judith S,Maya C,Shlomo L and Ernesto L. Technetium-99m-MIBI scintimammorgrahy in palpable and nonpalpable breast lesions[J]. J Nucl Med, 1998;39(1):86-91.
  29. 29. Palmedo H, Schomburg A, Grunwald F,Mallmann P,Krebs D,Biersack HJ.Technetium-99m-MIBI scintimammorgray for suspicious breast lesions[J].J Nucl Med,1996;37(4):626-630.
  30. 30. Zagorski.S,Cirangle.P,Delaplain.C,S.Kim ,J.Kavolus.Sestamibi scintimammogrphy in the evalution of breast pathology[J]. Current Surgery, 1999;56(7):438-450.
  31. 31. Deng NY, Zhang JS,TangY.99mTc-MIBI scintimammography in the evaluation of breast cancer[J]. China General Surgery, 2003;12(10):784-785.
  32. 32. Guo DS, WangYT, Lu GZ.Value of 99mTc-MIBI scintimammography in the differential diagnosis between bengin breast tumor ,breast cancer and lymph node involvement[J]. China Oncology, 2000;10 (16) : 542-544.
  33. 33. Chen J,Wu H, Hu J Zhou J. 99mTc-MIBI mammoscintigraphy in differentiation of nodular lesions of breast and detection of axillary lymph nodes metastasis from breast cancer[J]. Radiol Practice, 2003;18(1):59-61.
  34. 34. Omar A,Teresa M,LB,Delgado,Jorge H,Levent K,Augusto L,et al.Is 99mTc-MIBI scintimammography complementary to conventional mamm-ography for detecting breast cancer in patients with palpable masses[J]? J Nucl Med, 2001;42 (11):1614-1621.
  35. 35. Sun SS,Jih Fang Hsieh,Shin-chuanTsai,HO YJ,LEE JK,Kao CH.The role of Tc-99m methoxysiobutylisonitrile scintimam-mography as compared to mammography in evaluating palpable breast masses of Taiwanese women[J]. Anticancer research, 2000;20(3B):2133-2136.
  36. 36. Isabel U,Jose M,Remedios O, Rosario G , OlgaT, Alfonso M. Optimization of X-ray mammography and technetium-99m methoxy-isobutylisonitrile scintimammography in the diagnosis of non-palpable breast lesions[J]. Eur J Nucl Med, 1998;25(5):491-496.
  37. 37. JM Carril, R Gomez-Barquin, R Quirce, O Tabuenca, I Uriarte, and A Montero.Contribution of 99mTc-MIBI scintimammography to the diagnosis of non-palpable breast lesions in relation to mammographic probability of malignancy[J]. Anticancer research, 1997;17(3B):1677-1682.
  38. 38. Raymond T,Andre R,Sophie T,Raymond L,Jacques C,Jean L,et al.Metasttic axillary lymph node technetium-99m-MIBI imaging in primary breast cancer[J]. J Nucl Med, 1998;39(7):459-464.
  39. 39. Lam WW, Yang WT, Chan YL, Stewart IE, Metreweli C, King W. Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy,ultrasound and conventional mammography[J]. Eur J Nucl Med, 1996;23(3):498-503.
  40. 40. Perre CI, Rutter JE, Vos PA, de Hooge P.Technetium-99m-sestamibi uptake in axillary lymph node metastases in breast cancer patients[J]. Eur J Surg Oncol, 1997;23(2)142-144.
  41. 41. Tolmos J, Khalkhali I, Vargas H, Stuntz M, Cutrone J, Mishkin F,et al..Detection od axillary lymph node metastases of breast carcinoma with technetium-99m sestamibi scintimammography[J]. Am Surg, 1997;63 (10):850-853.
  42. 42. Orazio S,Francesco S,Roberta D,Rosanna T,Pina C et al.Technetium-99m sestamibi imaging in the detection of axillary lymph node involvement[J].J Nucl Med,1995;36(10):1758-1765.
  43. 43. Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL.Evaluation of breast masses and axillary lymph nodes with (F-18) 2-deoxy-2-fluoro-d-glucose PET[J]. Radiology,1993;187(3):743-750.
  44. 44. Rodier JF, Routiot T, Mignotte H, Janser JC, Bremond A, David E, et al. Lymphatic mapping and sentinel node biopsy of operable breast cancer[J]. World Journal of Surgery, 2000; 24(10):2313-2323.