Diagnostic Efficacy of Technetium-99m-Sestamibi Scintimammography in Comparison with Mammography to Detect Breast Lesions: A Systematic Review

Background: To systematically review the performance of scintimammography compared with mammography in detecting breast lesions. Methods: A literature search was performed in PubMed and ScienceDirect databases with “scintimammography and breast lesions,” “mammography and breast lesions,” “diagnostic value,” and “accuracy” as keywords to identify all related studies published in English from January 1, 2000, to August 1, 2017. Twenty-five studies, with a total of 4094 patients with clinically suspicious breast lesions, were included in the final analysis to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of scintimammography vs. mammography in detecting breast lesions. Results: The sensitivity and specificity of mammography were 75.82 ± 10.53 (95% confidence interval [CI], 50-84) and 59.58 ± 22.79 (95% CI, 20-91.4), respectively. The PPV and NPV of mammography were 75.60 ± 2.21 (95% CI, 42- 93) and 61.62 ± 1.67 (95% CI, 39.1-86), respectively. The sensitivity of scintimammography was 86.64 ± 8.84 (95% CI, 58.3-100), and the specificity was 83.42 ± 10.74 (95% CI, 60-100). The PPV and NPV of scintimammography were 82.10 ± 11.65 (95% CI, 58-98.30) and 81.02 ± 17.00 (95% CI, 45-100), respectively. Conclusions: Although mammography has a high sensitivity in the examination of older patients with fatty breast tissue, it is less reliable in detecting breast lesions in young and premenopausal patients with dense breasts. Diagnostic accuracy of scintimammography, as a functional imaging modality, is not affected by breast density, contrary to mammography. Therefore, scintimammography can improve the specificity of mammography.