***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED This study evaluated the role of (99m)Tc-sestamibi washout in the prediction of pathologic tumor response to neoadjuvant chemotherapy in 30 patients with locally advanced breast cancer . METHODS Two (99m)Tc-sestamibi studies were performed before and after chemotherapy for each patient . Early ( 10 min ) and delayed ( 240 min ) planar breast views were acquired after a 740-MBq (99m)Tc-sestamibi intravenous injection , and the washout rate ( WOR ) was computed . All patients underwent radical mastectomy  with pathologic evaluation of the residual tumor size . RESULTS The pretherapy (99m)Tc-sestamibi WOR ranged from 14 % to 92 % ( mean + /- SD , 50 % + /- 18 % ) . At pathologic examination , 15 patients showed no tumor response to chemotherapy and 15 patients showed an objective response to chemotherapy . The pretherapy (99m)Tc-sestamibi study predicted chemoresistance ( WOR > 45 % ) in 18 of 30 patients and no chemoresistance ( WOR < or = 45 % ) in 12 of 30 patients . When the WOR cutoff was set at > 45 % , the prognostic performance of the test was indicated by a sensitivity of 100 % ; a specificity of 80 % ; positive and negative predictive values of 83 % and 100 % , respectively ; and a likelihood ratio of 5 . The repeatability of the test was good , with 80%-93 % interreader agreement ( kappa = 0.57 - 0.85 ) . Posttherapy (99m)Tc-sestamibi studies confirmed the pretherapy study prediction in 29 of 30 patients . CONCLUSION (99m)Tc-Sestamibi WOR is a reliable test for predicting tumor response to neoadjuvant chemotherapy . In fact , negative findings ( WOR < or = 45 % ) rule out chemoresistance and positive findings ( WOR > 45 % ) indicate a high risk of chemoresistance The aim of the present study was to assess the feasibility of a portable gamma camera ( PGC ) for guiding surgical treatment in locally advanced breast cancer ( LABC ) after neoadjuvant therapy ( NT ) . Since January 2012 , a PGC ( Sentinella 102 , ONCOVISION ) has been available in our center . We planned to perform a feasibility monocentric prospect i ve study involving 15–20 patients with LABC for assessing the diagnostic performance of this PGC after NT ( Breast Cancer Surgery-S102 ) . Before the surgical treatment and at the end of NT an injection of 99mTc-Sestamibi ( 100–150 MBq ) was made . Conventional scintimmamography ( SMM ) and Sentinella 102 images were obtained from 18 patients . 10 ( 55.5 % ) patients showed a focal uptake of tracer in the breast or lymph nodes before or after the surgical excision ( on histological specimen ) , while 8 did not . The histological specimen concluded for a complete response to NT in 4 ( 22.2 % ) patients and for a partial or no response to treatment in the remnant 14 subjects . The specificity and false-negative rate of the Sentinella 102 compared to SMM were 100 % for both and 38 % vs. 60 % , respectively . The global diagnostic accuracy of Sentinella 102 was : 66.7 % ( 95 % confidence interval : 44.88–88.44 % ) . The present feasibility study shows how a new nuclear imaging device can be useful in the operating theatre for guiding a radical surgery approach in patients with LABC after NT Introduction : Neoadjuvant chemotherapy ( NACT ) is an essential part of multi-disciplinary management of locally advanced breast cancer ( LABC ) . In this study , we aim ed at evaluating the role of Tc99m-Sestamibi scinti-mammography in assessing response to NACT in patients with LABC . Material s and Methods : A total of 42 patients of histologically proven LABC were enrolled in this prospect i ve study . Imaging was performed according to pre-defined protocol at 10 min and 4 h after injection of tracer before the start of chemotherapy , 48 h after start of chemotherapy and at the end of chemotherapy . Quantitative parameters were obtained by calculating the ratio of activity in a region of interest ( ROI ) drawn over the tumor and the same sized ROI drawn in corresponding location in contra lateral breast . Results : At the end of chemotherapy , 6 patients achieved complete response , 25 achieved partial response , 11 had stable disease . Various retention indices calculated at baseline , 48 h after first cycle of NACT , and at the end of chemotherapy showed statistically significant difference in responders and non-responders . By using 84.05 as cut-off point for retention index ( RI ) of tumor calculated 48 h after first cycle of NACT ( RI 2 ) the positive predictive value and negative predictive value , were found to be 41.9 % and 72.7 % respectively in differentiating responders from non-responders . Conclusion : Early response assessment in patients with LABC to NACT with Tc99m-Sestamibi scintimammography is feasible and if confirmed by further studies can find routine clinical application in differentiating responders from non-responders PURPOSE The aim of the study was to evaluate the clinical value of scintimammography ( SMG ) with technetium-99 m methoxyisobutylisonitrile ( Tc-MIBI ) for evaluating the efficacy of neoadjuvant chemotherapy ( NAC ) . MATERIAL S AND METHODS A total of 65 patients with advanced breast cancer ( BC ) were included in the study . Planar SMG with 740 MBq of Tc-MIBI was performed before the start and after two to three and four to six cycles of NAC . NAC efficacy was estimated as progression ( grade I ) , stabilization ( grade II ) , partial effect ( grade III ) , prominent efficacy ( grade IV ) , and complete response ( grade V ) . In 59 women , histopathologic verification of BC response to NAC was performed according to the Miller-Payne classification with the same scores as were used in the evaluation of scintigraphic response . RESULTS After two to three cycles of NAC , disease progression was detected in five of 65 ( 7.7 % ) patients . In 27 ( 41.5 % ) patients SMG detected early stabilization of BC . Only one of these patients achieved prominent ( grade IV ) response after the end of NAC .  Partial ( grade III ) response after two to three cycles of NAC was seen in 24 ( 36.9 % ) patients . One-third of them had grade s IV-V response at the end of treatment . The most promising was the group of nine ( 13.8 % ) patients with early- grade s IV-V response , all of which transformed to complete response at the end of NAC . As per histopathologic verification , early SMG had 85.7 % sensitivity , 94.2 % specificity , and 93.2 % accuracy in predicting complete pathologic response to four to six cycles of NAC . CONCLUSION After two to three cycles of NAC , SMG with Tc-MIBI can determine patients with low , intermediate , and high probability of complete response to five to six cycles of NAC Video Abstract : http://links.lww.com/NMC/A43 Background Lymph node status is the most important prognostic indicator in breast cancer in recently diagnosed primary lesion . As a part of an interregional protocol using scintimammography with Tc99 m compounds , the value of planar Tc99 m sestamibi scanning for axillary lymph node evaluation is presented . Since there is a wide range of reported values , a st and ardized protocol of planar imaging was performed . Methods One hundred and forty-nine female patients were included prospect ively from different regions . Their mean age was 55.1 ± 11.9 years . Histological report was obtained from 2.987 excised lymph nodes from 150 axillas . An early planar chest image was obtained at 10 min in all patients and a delayed one in 95 patients , all images performed with 740–925 MBq dose of Tc99 m sestamibi . Blind lecture of all axillary regions was interpreted by 2 independent observers considering any well defined focal area of increased uptake as an involved axilla . Diagnostic values , 95 % confidence intervals [ CI ] and also likelihood ratios ( LR ) were calculated . Results Node histology demonstrated tumor involvement in 546 out of 2987 lymph nodes . Sestamibi was positive in 30 axillas ( 25 true-positive ) and negative in 120 ( only 55 true-negative ) . The sensitivity corresponded to 27.8 % [ CI = 18.9–38.2 ] and specificity to 91.7 % [ 81.6–97.2 ] . The positive and negative LR were 3.33 and 0.79 , respectively . There was no difference between early and delayed images . Sensitivity was higher in patients with palpable lesions . Conclusion This work confirmed that non tomographic Tc99 m sestamibi scintimammography had a very low detection rate for axillary lymph node involvement and it should not be applied for clinical assessment of breast cancer Abstract . Presurgical neoadjuvant chemotherapy has shown promise in the treatment of locally advanced breast carcinoma ( LABC ) . Response assessment by clinical examination and mammography is difficult . This study evaluated and compared fluorine-18 fluorodeoxyglucose positron emission tomography ( 18F-FDG-PET ) and technetium-99 m sestamibi scintimammography ( SMM ) as potential methods for the early assessment of tumour response to neoadjuvant chemotherapy in patients with LABC . Seven patients underwent  PET and SMM [ planar and single-photon emission tomography ( SPET ) ] before beginning chemotherapy , after the first and second cycles of chemotherapy and after completing chemotherapy prior to surgery . PET and SMM results were evaluated visually and semi-quantitatively by calculating st and ardised uptake values ( SUV ) and tumour/lung ratios in the initial and subsequent studies . The findings were correlated with the initial clinical and mammographic findings and the final histopathological diagnoses . There was a highly significant correlation between SUVmean , SUVmax and the tumour/lung ratio determined with SMM-SPET in the studies performed before and during neoadjuvant chemotherapy . All three patients with complete remission showed decreasing FDG and sestamibi uptake as early as 8 days after therapy . In the presurgical study , increased sestamibi and FDG uptake was no longer evident . Three patients had partial remission with clearly reduced but persisting focal FDG and sestamibi uptake after neoadjuvant therapy . One patient who did not respond to therapy had unchanged intense tracer uptake during chemotherapy that was evident with both techniques . An early decline in glucose metabolism or sestamibi uptake 8 days after beginning therapy did not necessarily predict complete tumour remission in the further course of chemotherapy . On the other h and , increased tracer uptake after the first cycle did not exclude a partial tumour response . After the second chemotherapeutic cycle both techniques were able to distinguish between complete and partial/no response . There was a good correlation between preoperative FDG and sestamibi uptake and the histopathologically determined tumour size . However , small residual invasive tumours in patients with clinical ly complete remission could not be visualised with either technique . The preliminary data demonstrate that sestamibi SMM is as useful as FDG-PET for the monitoring of tumour response to neoadjuvant chemotherapy PURPOSE To determine , in women with primary operable breast cancer , if preoperative doxorubicin ( Adriamycin ) and cyclophosphamide ( Cytoxan ; AC ) therapy yields a better outcome than postoperative AC therapy , if a relationship exists between outcome and tumor response to preoperative chemotherapy , and if such therapy results in the performance of more lumpectomies . PATIENTS AND METHODS Women ( 1,523 ) enrolled onto National Surgical Adjuvant Breast and Bowel Project ( NSABP ) B-18 were r and omly assigned to preoperative or postoperative AC therapy . Clinical tumor response to preoperative therapy was grade d as complete ( cCR ) , partial ( cPR ) , or no response ( cNR ) . Tumors with a cCR were further categorized as either pathologic complete response ( pCR ) or invasive cells ( pINV ) . Disease-free survival ( DFS ) , distant disease-free survival ( DDFS ) , and survival were estimated through 5 years and compared between treatment groups . In the preoperative arm , proportional-hazards models were used to investigate the relationship between outcome and tumor response . RESULTS There was no significant difference in DFS , DDFS , or survival ( P = .99 , .70 , and .83 , respectively ) among patients in either group . More patients treated preoperatively than postoperatively underwent lumpectomy and radiation therapy ( 67.8 % v 59.8 % , respectively ) . Rates of ipsilateral breast tumor recurrence ( IBTR ) after lumpectomy were similar in both groups ( 7.9 % and 5.8 % , respectively ; P = .23 ) . Outcome was better in women whose tumors showed a pCR than in those with a pINV , cPR , or cNR ( relapse-free survival [ RFS ] rates , 85 
    Output:
    
Our results indicated that Tc-99 m MIBI scintimammography had acceptable sensitivity in the prediction of neoadjuvant chemotherapy response in breast cancer ; however , its relatively low specificity showed that a combination of other imaging modalities would still be needed .
Subgroup analysis indicated that performing early mid-treatment Tc-99 m MIBI scintimammography ( using the reduction rate of one or two cycles or within the first half-courses of chemotherapy compared with the baseline ) was better than carrying out later ( after three or more courses ) or post-treatment scintimammography in the prediction of neoadjuvant chemotherapy response