Current and future perspectives of molecular breast imaging with [99mTc]Tc-Sestamibi: An IAEA international expert panel.

PURPOSE: This IAEA international expert panel aims to provide an updated overview of Molecular Breast Imaging (MBI) using [99mTc]Tc-sestamibi, emphasising its technical advances, current clinical applications in breast cancer and future perspectives. METHODS: Relevant studies, clinical guidelines and technical reports were assessed to evaluate the use of MBI with [99mTc]Tc-sestamibi in breast cancer, focusing on evolving practices and technological advancements. RESULTS: MBI has evolved from its origins as scintimammography, benefiting from innovations such as dual-head cadmium zinc telluride detectors. Dedicated MBI systems offer higher sensitivity, improved spatial resolution and reduced radiation dose relative to conventional gamma cameras. MBI is a complementary tool to digital mammography, demonstrating ability to detect mammographically-occult breast cancer, especially in patients with dense breasts or inconclusive conventional imaging. Moreover, MBI-guided systems enable biopsy of the most metabolically active lesions. CONCLUSION: MBI with [99mTc]Tc-sestamibi remains a valuable modality in breast imaging, offering high sensitivity for the detection of small, node negative disease and detection of large, advanced cancers that are undetected by mammographic screening. MBI is performed at a safe radiation dose, is well-tolerated by patients, and has exceedingly low risk of adverse events. Further efforts to reduce image acquisition time, assess cost-effectiveness and standardise protocols are essential to expand MBI’s clinical use.