PURPOSE: To determine the sensitivity of iodine 123 (123I)-labeled cis-11β-methoxy-17α-iodovinyl estradiol (Z-MIVE) scintigraphy for the detection of estrogen receptors in patients with primary breast carcinoma. MATERIALS AND METHODS: In 22 patients, estrogen receptor status was assessed with planar scintigraphy and single photon emission computed tomography (SPECT) 4 hours after the injection of 185 MBq 123I-labeled Z-MIVE. For histologic and estrogen receptor immunohistochemical analysis, breast carcinoma tissue was obtained in all patients by means of biopsy or resection of the primary tumor. Two experienced physicians semiquantitatively scored the scintigraphic and immunohistochemical findings. The uptake ratio at scintigraphy and the immunohistologic staining intensity were scored as negative, weak, intermediate, or strong. RESULTS: All patients had histologically proven breast cancer. Immunohistologic staining for estrogen receptors yielded negative findings in four patients and positive findings in 18 (weak staining, n = 2; intermediate staining, n = 6; strong staining, n = 10). Planar 123I-labeled Z-MIVE scintigraphic findings were negative in five patients and positive in 17 (weak uptake, n = 2; intermediate uptake, n = 10; strong uptake, n = 5), resulting in one false-negative finding. Findings at 123I-labeled Z-MIVE SPECT were negative in four patients and positive in 18. The sensitivities of 123I-labeled Z-MIVE scintigraphy for estrogen receptors were 100% with SPECT and 94% with planar scintigraphy. The correlation between immunohistologic and planar scintigraphic scores of estrogen receptor status was 0.72 (P < .01). CONCLUSION: 123I-labeled Z-MIVE scintigraphy is a sensitive noninvasive tool for the detection of estrogen receptors in patients with breast cancer.