Nuclear Medicine in the Imaging and Management of Breast Cancer

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Breast cancer is the most common cancer in women worldwide. Mammography is the main imaging modality used for the detection of breast cancer. Other modalities, including those encountered in nuclear medicine, provide added value in breast cancer imaging. 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging is a combined functional and anatomic modality used in the evaluation of cancer. This modality plays an expanding role in detection and staging of breast cancer and evaluation of recurrence. Bone scan imaging is readily available, and has played a valuable role in the management of breast cancer, specifically in the evaluation of osseous metastases. Sentinel node lymphoscintigraphy is based on the concept that the sentinel node is the first lymph node to potentially harbor breast metastasis. This technique relies on lymphoscintigraphic mapping with colloids such as Technetium-99m (99mTc)-filtered sulfur colloid, and its use can prevent the need for axillary nodal dissection in women with negative sentinel node disease. Scintimammography, which uses the radioactive tracer 99mTc Sestamibi, can be useful in patients with very dense breasts, those with palpable abnormalities not apparent on other imaging modalities, and to assess for multifocal breast cancer.

This article provides an evidence-based discussion and a variety of case examples, stressing the important role of nuclear medicine imaging in the management of breast cancer.

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