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Background  Molecular breast imaging (MBI) performed with  99m Tc sestamibi has been shown to be a valuable technique for the detection of breast cancer. Alternative radiotracers such as  99m Tc maraciclatide may offer improved uptake in breast lesions. The purpose of this study was to compare relative performance of  99m Tc sestamibi and  99m Tc maraciclatide in patients with suspected breast cancer, using a high-resolution dedicated gamma camera for MBI. Women with breast lesions suspicious for malignancy were recruited to undergo two MBI examinations—one with  99m Tc sestamibi and one with  99m Tc maraciclatide. A radiologist interpreted MBI studies in a randomized, blinded fashion to assign an assessment score (1–5) and measured lesion size. Lesion-to-background (L/B) ratio was measured with region-of-interest analysis.    Results  Among 39 analyzable patients, 21 malignant tumors were identified in 21 patients. Eighteen of 21 tumors (86%) were seen on  99m Tc sestamibi MBI and 19 of 21 (90%) were seen on  99m Tc maraciclatide MBI ( p  = 1). Tumor extent measured with both radiopharmaceuticals correlated strongly with pathologic size ( 99m Tc sestamibi,  r  = 0.84;  99m Tc maraciclatide,  r  = 0.81). The L/B ratio in detected breast cancers was similar for the two radiopharmaceuticals: 1.55 ± 0.36 (mean ± S.D.) for  99m Tc sestamibi and 1.62 ± 0.37 (mean ± S.D.) for  99m Tc maraciclatide ( p  = 0.53). No correlation was found between the L/B ratio and molecular subtype for  99m Tc sestamibi ( r    s   = 0.12,  p  = 0.63) or  99m Tc maraciclatide ( r    s   = −0.12,  p  = 0.64). Of 20 benign lesions, 10 (50%) were seen on  99m Tc sestamibi and 9 of 20 (45%) were seen on  99m Tc maraciclatide images ( p  = 0.1). The average L/B ratio for benign lesions was 1.34 ±0.40 (mean ±S.D.) for  99m Tc sestamibi and 1.41 ±0.52 (mean ±S.D.) for  99m Tc maraciclatide ( p  = 0.75). Overall diagnostic performance was similar for both radiopharmaceuticals. AUC from ROC analysis was 0.83 for  99m Tc sestamibi and 0.87 for  99m Tc maraciclatide ( p  = 0.64).    Conclusions    99m Tc maraciclatide offered comparable lesion uptake to  99m Tc sestamibi, in both malignant and benign lesions. There was good correlation between lesion extent and uptake measured from both radiopharmaceuticals.  99m Tc maraciclatide offered a marginal (but not significant) improvement in sensitivity over  99m Tc sestamibi. Our findings did not support an association between the uptake of either radiopharmaceutical and tumor molecular subtype.    Trial registration  ClinicalTrials.gov,  NCT00888589

Comparison of Tc-99m maraciclatide and Tc-99m sestamibi molecular breast imaging in patients with suspected breast cancer