• Radiodense breast tissue difficult to image.
• Evaluation of indeterminate or suspicious lesions identified by mammography.
• Post-surgical or post-therapeutic evaluation of mammographic tissue changes.
• Evaluation of multiple lesions or clusters of microcalcifications to aid in biopsy target selection.
• Palpable mass not demonstrated in mammogram or ultrasound.
• Determining the extent of the primary lesion.
• Detecting multicentric and multifocal disease for treatment planning.
• Evaluating the axillary region for node status in breast cancer patients.
• For use in patients where MRI is indicated, but not possible.

A patient is intravenously injected with a small dose of sestamibi. Imaging can begin immediately and continue as needed for approximately two hours. After about two hours the washout of sestamibi has begun and may compromise image quality. Patients are seated comfortably throughout the imaging process and each view takes between 6 and 10 minutes to acquire. Sestamibi is the same pharmaceutical used in cardiac stress tests safely for over 15 years.

Breast-Specific Gamma Imaging (BSGI) has been performed on over 8,000 patients in both hospitals and private imaging centers across the country. The following cases detail mammogram, BSGI and histopathology of several patients who demonstrate true positives, true negatives and imaging complications not resolvable with mammography alone.

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• Normal Mammogram with Positive BSGI
• Abnormal Mammogram with Negative BSGI
• Indeterminate Mammogram with Positive BSGI
• Incidental Cancer
• Implants
• Mammographically Occult Reoccurrence
• Dense Breast Tissue
• Occult Secondary Lesion
• Confirmed Suspicious Radiodensity
• Multifocal Cancer
• DCIS
• False Negative Biopsy

The utility of BSGI has been demonstrated in two recent publications. In the first study, by Brem et al, BSGI detected cancers missed by mammography and clinical examination in a group of patients who were at high risk for cancer (Occult Breast Cancer: Scintimammography with High-Resolution Breast-Specific Gamma Camera in Women at High Risk for Breast Cancer, 2005). The second study reported on the ability of BSGI to detect lobular carcinoma, a form of breast cancer which is often missed with mammography. In this work, BSGI detected 100% of the lobular carcinomas (Detecting Infiltrating Lobular Carcinoma Using Scintimammographic Breast-Specific Gamma Imaging, 2005).

Patients whose mammograms produce a BIRADS 0, 3 or 4 rating are especially appropriate for BSGI.