New possibilities for molecular imaging and intervention in breast cancer and other female malignancies

The work described in this thesis shows new possibilities for molecular imaging in breast and vulvar cancer and demonstrates how to simultaneously encompass all current and future applications of nuclear medicine in female cancers. General introduction and outline of this thesis are reported in Chapter 1. In part one of this thesis the reader is introduced to molecular imaging using 99mTc-sestamibi in breast cancer. Chapter 2 provides a systematic review and meta-analysis on 99mTc-sestamibi imaging in the prediction of pathological nonresponse to neoadjuvant chemotherapy in primary locally advanced breast cancer. Chapter 3 presents the experimental validation of SPECT/CT quantification for response monitoring in breast cancer. In chapter 4, the clinical use of MBI is evaluated in 287 patients with newly diagnosed breast cancer scheduled for lumpectomy. Part two of this thesis describes the methodological aspects and clinical evaluation of 99mTc-sestamibi-guided biopsy. Chapter 5 addresses the methodological aspects of 99mTc-sestamibi MBI-guided biopsy. In chapter 6, the first clinical experience using stereotactic biopsy guided by 99mTc-sestamibi is evaluated in 38 women. Part three presents the radioguided interventions in gynaecological malignancies. Chapter 7 provides an overview of the state-of-the-art of sentinel lymph node mapping in gynaecological malignancies, including vulvar cancer, cervical cancer and endometrial cancer. In chapter 8, the lymphatic drainage pattern, using SPECT/CT, is evaluated in 83 patients with vulvar cancer scheduled for the sentinel lymph node procedure. In Chapter 9 we investigate the value of dual-time-point 18F-FDG PET/CT in the prediction of lymph node status in 33 patients with invasive vulvar cancer, scheduled for inguinofemoral lymph node dissection. Discussion and future perspectives are reported in the fourth part of this thesis. Chapter 10 discusses the novel frontiers of dedicated molecular imaging in breast cancer diagnosis. Chapter 11 highlights some recent advances for gynaecological malignancies particularly in vulvar cancer.