Clin Nucl Med 2006 Jun; 31(6): 355-6 (Read article online)

Sharma R, Bhatnagar P, Mondal A, Sawroop K, Datta M, Kashyap R

Tc-99m sestamibi is known to concentrate in bronchogenic cancer but it lacks the anatomic details for proper management of the patient. Tc-99m MIBI SPECT imaging can detect bronchogenic cancer with high specificity and high positive predictive value. Tc-99m sestamibi SPECT/CT was performed with a gamma camera mounted anatomic x-ray tomography (GMAXT-GE Medical Systems, Millenium VG with Hawkeye). For comparison with GMAXT, additional high-resolution CT of the mediastinum was performed. Correct preoperative localization was achieved. The lesions found on the MIBI scan were found to be located in the right lung. Apart from this, another lesion was noted on the MIBI scan. On fusion images, this lesion was found to be in the right anterior axillary fold. CT-nuclear medicine fusion imaging guided fine needle aspiration cytology done from the lesion in the axillary fold gave a diagnosis of metastatic adenocarcinoma. This was later confirmed by surgical biopsy of the lymph node. Later biopsy reports on bronchoscopy confirmed the lung lesion to be adenocarcinoma.