Breast Digital Infrared Analysis (DIRA) , a forgotten and set aside procedure.

Visita: termografiamamaria.blogspot.com (Version en Español)

Breast DIRA (previously named Thermography) already proved in the past that it´s use as an screening procedure had low specificity and high sensitive values for it to be recommended as an standard care Breast diagnosis tool .
Yet , until recently (last 5 years) active research mainly by Surgical Oncologists or Breast Surgeons have published interesting results.( Cornell NY , Addenbrooke Cambridge , Ville Marie Montreal , Taiwan and Mexico CEPREC)
FDA previous published criteria were prohibiting DIRA as well as the A.C. of Radiologists ( as an initial SCREENING TOOL)

Yet it has been cleared by the FDA approval as an adjunctive screening tool for breast cancer .( under 510 k) .

DIRA´s meaning is not an ANATOMIC or ARCHITECTURAL procedure ,it is a METABOLIC or PHYSIOLOGIC ONE so at first it ´s current recommendation should be only as a COMPLEMENTARY STUDY.

As such DIRA could help in specific scenarios, BIRADS 0,3,4 and give potential useful additional data in BIRADS5. EVEN BEFORE BIOPSY
Could aid mammogram in young,dense and breast prosthesis patients, and should be evaluated in other clinical scenarios as a Neoadyuvant Monitoring tool.
Finally as an early detecion procedure specifically in underdeveloped countries , could Triage in search of aggresive forms of the disease(T1,G2_G3). And aid Physical Exam of the Breast .
This site is dedicated to open mind Breast specialists ONLY .
¨EXPANDING OUR CURRENT COMPREHENSION, UNDERSTANDING AND APPROACH OF IMAGE AND DIAGNOSIS IN BREAST CANCER¨

lunes, 16 de enero de 2012

Case Number #2. High Risk - Breast Implants


High Risk in her 60,s female ( Mother : Stage III breast cancer diagnosed al 86). Two previous aesthetic breast implant surgeries . Under self exam , detected a minimal asymptomatic lump in her left breast.


Digital Mammogram Images SUSPECTED LESION in the LEFT UPPER QUADRANT
vas non detected in these 2 views (Eklund views were not performed).


Ultrasound Images , under DOPPLER 1.2 cm irregular shaped nodule with augmented surrounding blood vessels. BIRADS IVc



ADIR Images , Base line study (LEFT) little assymetry between both breasts , yet in the functional or cold series , the Highest Thermal measure in the both glands , was coincident with the suspected nodule. With little or non associated thermovascular network , a summit of just 31.2 centigrades , a Surrounding Tissue Difference (STD) of 1.2 and a Contralateral Difference or Delta CTLD of 2.0

CCan ir-score of 165 , proved to be a Infiltrating Ductal Carcinoma Well Differenciated , with 3 Negative Sentinel Lymph Nodes. Her 2 neu Negative . Estrogen Receptor Positive 100%

Score Lesser than 170 , is associated with a BETTER Prognosis. Based on the analysis of 15 independent different variables
As a complementary Study , DIRA gives additional information about the biological behaviour of the interest lesion (ir-behaviour)

"Non standard procedure or information that could be considered worthless , time consuming or even useless since it was already detected"

Yet : is useful information always worthless or considered EXTRA?

DIRA is noninvasive 5 to 10 min procedure. As a surgical Oncologist´s , prospective controlled essays can give rise to data that can be incorporated to our every day therapeutic decisions , safely and under our current standard of care"

"Attitude or decision making may not be changed , yet comprehension of the biologic behaviour of a suspected lesion can be anticipated" EMC

Add: By the way this particular patient is under control after 2 years and she actually is MY MOTHER.

Possible Clinical Scenarios : High Risk Patients : INTERVAL PROCEDURE (ir-interval) , and BREAST IMPLANT POSTMENOPAUSAL PATIENTS (ir-implants)





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