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Breast cancer Definition Breast cancer manifests itself with an uncontrollable, growth of abnormal cells within the breast. It occurs in both genders, although it is rare in men (Discovermi.org - SNM, 2011). According to the American Cancer Society it is estimated that in 2011, there were more than 230,480 new cases of invasive breast cancer diagnosed and about 39,000 expected deaths. (American Cancer Society) It is essential that physicians accurately locate the primary tumor(s) and determine whether the cancer has metastasized when deciding on the best treatment for their patients. Role of molecular imaging There are a variety of imaging technologies available today to detect and evaluate breast cancer. For diagnosis, mammography or clinical breast examination are the usual preferred methods, although MRI, ultrasound, breast scintigraphy and Positron Emission Mammography, or PEM, have been known to be useful in imaging women with dense breasts as well as assisting in guided biopsy. After diagnosis, there are imaging options to help with the initial staging to detect areas of metastasis in the lungs, liver, bones, brain and lymph nodes (Where breast cancer might come back and how to detect it, 2011). However, molecular imaging in breast cancer is useful not only in determining the aggressiveness or extent of disease, but in response to treatment as well (Discovermi.org - SNM, 2011): Positron emission mammography (PEM) Molecular image-guided sentinel node biopsy Lymphatic mapping Breast Scintigraphy or Breast – specific gamma imaging (BSGI) (Discovermi.org - SNM, 2011) Nuclear medicine and PET bone scan Bone palliative therapy Liver – Spleen Scan Molecular imaging can also be used to assess the condition of the heart for breast cancer patients. After staging, a multiple gated acquisition (MUGA) may be performed in patients who will need chemotherapy to assess ejection fraction in the heart. This scan provides an accurate and reproducible means of measuring and monitoring the left ventricular ejection fraction. LVEF calculates the amount of blood your left ventricle pumps every time your heart beats. (MUGA Scans and Anthracyclines, 2009). Radiopharmaceutical Manufacturer Trade names Approved indications in adults Technetium-99m sulfur colloid Pharmalucence To assist in the localization of lymph nodes draining a primary tumor in patients with breast cancer when used with a hand-held gamma counter Imaging areas of functioning reticuloendothelial cells in the liver and spleen Fluorine-18 sodium fluoride Various PET bone imaging agent to delineate areas of altered osteogenesis activity Samarium-153 lexidronam EUSA Pharma Quadramet ® Indicated for relief of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan © 2015 Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. All other marks are the property of their respective owners. . Radiopharmaceutical Manufacturer Strontium-89 chloride Bio-Nucleonics GE Healthcare Metastron Technetium-99m medronate Bracco Diagnostics DRAXIMAGE GE Healthcare Pharmalucence MDP-Bracco MDP-25 MDP Multidose MDP Multidose Technetium-99m oxidronate Covidien Technescan HDP Technetium-99m pyrophosphate Covidien Pharmalucence Technescan PYP Technetium-99m red blood cells Covidien Technetium-99m sestamibi Cardinal Health Covidien DRAXIMAGE Lantheus Medical Imaging Pharmalucence Technetium Tc 99m tilmanocept Navidea Biopharmaceuticals, Inc. Trade names Approved indications in adults Indicated for the relief of bone pain in patients with painful skeletal metastases that have been confirmed prior to therapy TM TM As a bone imaging agent to delineate areas of altered osteogenesis TM TM UltraTag As a bone imaging agent to delineate areas of altered osteogenesis Tc99m-labeled red blood cells are used for: Blood pool imaging including cardiac first pass and gated equilibrium imaging TM Planar breast imaging as a second line diagnostic drug after mammography to assist in the evaluation of breast lesions in patients with an abnormal mammogram or a palpable breast Cardiolite® Lymphoseek TM As a bone imaging agent to delineate areas of altered osteogenesis (adult and pediatric use) ® Lymphoseek (technetium Tc 99m tilmanocept) injection is a radioactive diagnostic agent indicated with or without scintigraphic imaging for: Lymphatic mapping using a handheld gamma counter to locate lymph nodes draining a primary tumor site in patients with solid tumors for which this procedure is a component of intraoperative management. Guiding sentinel lymph node biopsy using a handheld gamma counter in patients with clinically node negative squamous cell carcinoma of the oral cavity, breast cancer or melanoma. MSDS and package insert information © 2015 Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. All other marks are the property of their respective owners. .