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## Complete Summary

#### GUIDELINE TITLE

Procedure guideline for breast scintigraphy.

#### BIBLIOGRAPHIC SOURCE(S)

Society of Nuclear Medicine. Procedure guideline for breast
scintigraphy. Version 2.0. Reston (VA): Society of Nuclear Medicine;
2004 Jun 2. 4 p.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Procedure guideline for
breast scintigraphy, 1.0. J Nucl Med 1999 Jul;40(7):1233-5.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Breast cancer

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation

#### CLINICAL SPECIALTY

Nuclear Medicine\
Radiology

#### INTENDED USERS

Allied Health Personnel\
Physicians

#### GUIDELINE OBJECTIVE(S)

To assist nuclear medicine practitioners in recommending, performing,
interpreting, and reporting the results of ^99m^Tc-sestamibi breast
scintigraphy (mammoscintigraphy, scintimammography)

#### TARGET POPULATION

Women with suspected or documented breast cancer

#### INTERVENTIONS AND PRACTICES CONSIDERED

^99m^Tc-sestamibi breast scintigraphy (mammoscintigraphy,
scintimammography)

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Literature searches were performed. In addition, references known to
experts and references from the nuclear medicine community were
considered.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Drafts of the guideline were submitted to members of the Guideline
Development subcommittee (methodologists) and the Task Force (subject
experts). These reviewers indicated on a line-by-line basis any
suggestions or recommendations for the revision of the guideline. The
percentage of agreement for all reviewers was calculated for each
revision and compiled by the Society of Nuclear Medicine (SNM) central
office. It is expected that the percentage of agreement will increase
with each revision.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

When the Task Force and Guideline Development Subcommittee completed
their edits, draft procedure guidelines were distributed to the Society
of Nuclear Medicine (SNM) Sample Review Group for comment. (The SNM
Sample Review Group is a cross-section of approximately 100 nuclear
medicine practitioners representing every field of specialization).

The guideline was approved by the SNM Commission on Health Care Policy,
the Board of Directors, and the House of Delegates.

The update was approved June 2, 2004

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Background Information and Definitions**

Breast scintigraphy is performed after intravenous administration of
^99m^Tc-sestamibi and includes planar and/or single-photon emission
computed tomography (SPECT).

**Examples of Clinical or Research Applications**

A.  Evaluate breast cancer in patients in whom mammography is
    nondiagnostic, equivocal, or difficult to interpret (e.g., the
    presence of scar tissue, mammographically dense breast tissue,
    implants, or severe dysplastic disease)

B.  Assist in identifying multicentric and multifocal carcinomas in
    patients with tissue diagnosis of breast cancer

C.  May be useful in the evaluation of the effectiveness of neoadjuvant
    chemotherapy for breast carcinoma

**Procedure**

The detailed procedure recommendations in the guideline address the
following areas: patient preparation; information pertinent to
performing the procedure (i.e., important data that the physician should
have about the patient at the time the exam is performed and
interpreted); precautions; information regarding the radiopharmaceutical
(i.e., ranges of administered activity, organ receiving the largest
radiation dose, effective dose), image acquisition; interventions;
processing; interpretation/reporting; quality control, and sources of
error.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

The intent of the procedure guideline is to describe breast
scintigraphy, in order to maximize the diagnostic information obtained
in the study while minimizing the resources that are expended.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The Society of Nuclear Medicine (SNM) has written and approved these
    guidelines as an educational tool designed to promote the
    cost-effective use of high quality nuclear medicine procedures or in
    the conduct of research and to assist practitioners in providing
    appropriate care for patients. The guidelines should not be deemed
    inclusive of all proper procedures or exclusive of other procedures
    reasonably directed to obtaining the same results. They are neither
    inflexible rules nor requirements of practice and are not intended
    nor should they be used to establish a legal standard of care. For
    these reasons, SNM cautions against the use of these guidelines in
    litigation in which the clinical decisions of a practitioner are
    called into question.

-   The ultimate judgment about the propriety of any specific procedure
    or course of action must be made by the physician when considering
    the circumstances presented. Thus, an approach that differs from the
    guidelines is not necessarily below the standard of care. A
    Conscientious practitioner may responsibly adopt a course of action
    different from that set forth in the guidelines when, in his or her
    reasonable judgment, such course of action is indicated by the
    condition of the patient, limitations on available resources, or
    advances in knowledge or technology subsequent to publication of the
    guidelines.

-   All that should be expected is that the practitioner will follow a
    reasonable course of action based on current knowledge, available
    resources, and the needs of the patient to deliver effective and
    safe medical care. The sole purpose of these guidelines is to assist
    practitioners in achieving this objective.

-   Advances in medicine occur at a rapid rate. The date of a guideline
    should always be considered in determining its current
    applicability.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness\
Staying Healthy

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Society of Nuclear Medicine. Procedure guideline for breast
scintigraphy. Version 2.0. Reston (VA): Society of Nuclear Medicine;
2004 Jun 2. 4 p.

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 Jul (revised 2004 Jun 2)

#### GUIDELINE DEVELOPER(S)

Society of Nuclear Medicine, Inc - Medical Specialty Society

#### SOURCE(S) OF FUNDING

Society of Nuclear Medicine (SNM)

#### GUIDELINE COMMITTEE

Task Force

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Authors*: Iraj Khalkhali, MD (Harbor-UCLA Medical Center, Torrance,
CA); Gina Caravaglia, MD (Harbor-UCLA Medical Center, Torrance, CA);
Hani H. Abdel-Nabi, MD, PhD (University of Buffalo, Buffalo, NY);
Patrick J. Peller, MD (Woodburn Nuclear Medicine, Annandale, VA);
Raymond Taillefer, MD (Hospital Hotel-Dieu de Montreal, Montreal,
Quebec, Canada); Penny R. Vande Streek, DO (Sutter Roseville Medical
Center, Roseville, CA); Christophe Van de Wiele, MD (Universitair
Ziekenhuis, Ghent, Belgium)

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Procedure guideline for
breast scintigraphy, 1.0. J Nucl Med 1999 Jul;40(7):1233-5.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [Society of Nuclear Medicine (SNM)
Web site](http://interactive.snm.org/index.cfm?PageID=801&RPID=772).

Print copies: Available from SNM, Division of Health Care Policy, 1850
Samuel Morse Dr, Reston, VA 20190-5316; Phone: 1-800-513-6853 or
1-703-326-1186; Fax: 703-708-9015; E-Mail:
[ServiceCenter@snm.org](mailto:servicecenter@snm.org).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Society of Nuclear Medicine. Procedure guideline for guideline
    development. Reston (VA): Society of Nuclear Medicine; 2001 Jun
    (version 3.0). Electronic copies: Available from the [Society of
    Nuclear Medicine Web
    site](http://interactive.snm.org/index.cfm?PageID=793&RPID=772).

-   Society of Nuclear Medicine. Performance and responsibility
    guidelines for NMT. Reston (VA): Society of Nuclear Medicine; 2003.
    Electronic copies: Available from the [Society of Nuclear Medicine
    Web
    site](http://interactive.snm.org/index.cfm?PageID=1929&RPID=772).

Print copies: Available from SNM, Division of Health Care Policy, 1850
Samuel Morse Dr, Reston, VA 20190-5316; Phone: 1-800-513-6853 or
1-703-326-1186; Fax: 703-708-9015; E-Mail:
[ServiceCenter@snm.org](mailto:servicecenter@snm.org).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on July 20, 1999. It was verified by
the guideline developer as of August 5, 1999. This NGC summary was
updated by ECRI on April 28, 2005. The updated information was verified
by the guideline developer on June 30, 2005.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

### DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008