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Carcinoembryonic antigen immunoscintigraphy complements mammography in the diagnosis of breast carcinoma
Author(s) -
Goldenberg David M.,
AbdelNabi Hani,
Sullivan Cynthia L.,
Serafini Aldo,
Seldin David,
Barron Bruce,
Lamki Lamk,
Line Bruce,
Wegener William A.
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(20000701)89:1<104::aid-cncr15>3.0.co;2-e
Subject(s) - medicine , carcinoembryonic antigen , immunoscintigraphy , carcinoma , breast carcinoma , pathology , biopsy , ductal carcinoma , lymph node , histopathology , breast cancer , radiology , cancer , antibody , monoclonal antibody , radioimmunotherapy , immunology
BACKGROUND An adjunctive noninvasive test that is predictable and highly specific for breast carcinoma would complement the high false‐positive rate of mammography in certain patients. METHODS This prospective, multicenter study evaluated the accuracy, safety, and immunogenicity of carcinoembryonic antigen (CEA) antibody imaging in women with known or suspected breast carcinoma. Scintigraphic breast images were obtained approximately 3–8 hours after the administration of technetium 99m ( 99 Tc) labeled anti‐CEA Fab′ and correlated with histopathology. RESULTS The 99 Tc labeled anti‐CEA Fab′ detected tumor CEA expression in 46 of 49 women (94%) initially entered with known primary breast carcinoma regardless of histology or serum CEA levels. In women scheduled for biopsy confirmation of mammographic and physical examination findings, 104 99 Tc labeled anti‐CEA Fab′ studies had a sensitivity of 61% (17 of 28 cases) and a specificity of 91% (69 of 76 cases). In total, 99 Tc labeled anti‐CEA Fab′ detected 52 of 62 invasive ductal carcinomas, 5 of 5 invasive lobular carcinomas, and 3 of 6 noninvasive tumors (2 ductal carcinomas in situ and 1 intracystic papillary carcinoma). Tumor size significantly affected sensitivity ( P = 0.041), with 11 of 14 missed lesions ≤ T1, and proliferative histology significantly affected specificity ( P = 0.012), with 5 of 7 false‐positive tumors being premalignant. In 50 breast carcinoma patients, 99 Tc labeled anti‐CEA Fab′ also demonstrated axillary lymph node involvement regardless of serum CEA levels, with a sensitivity of 80% when more than three lymph nodes were positive. No immune response or other meaningful side effects occurred. CONCLUSIONS 99 Tc labeled anti‐CEA Fab′ had high specificity and positive predictive values for breast carcinoma and the majority of false‐positive studies were associated with an increased risk of malignancy. Improved imaging techniques, including dedicated gamma cameras for breast and axillary lymph node imaging, will likely improve the test's sensitivity for smaller lesions. Cancer 2000;89:104–15. © 2000 American Cancer Society.