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¨

miércoles, 25 de enero de 2012

Case Number #3. Well differentiated breast carcinoma

Case Number 3.
71 year Old female , without any other risk factors for Breast Cancer.
History of aproximately 6 months , during self examination : asymptomatic palpable nodule in the left upper inner quadrant .
Medio Lateral Oblique View , clearly identifies a dense nodule with espiculate bordes , without any lymph nodes seen in the axillary region.
Cefalo Caudal View : same lesion is identified in the posterior and inner quadrant of the left breast.
Ultrasound Image : 2.1 cm nodule of regular profile.
DIGITAL INFRARED ANALYSIS : Basal series (right) in both glands positive hyperthermias (red) are seen , witha symmetrical pattern . Functional series ( Left) persistance after a cold simutli two of them , each in the inner quadrants (green).

The Left suspicious lesion in the Upper Inner Quadrant (palpable) is not coincident with the thermal Summit of both glands , and after the evaluation of the 15 infrared variables :

As a complementary study : Abnormal Infrared Finding for the left breast due to the alternate signs : rised vascular pattern in the interest area (UIQ) , positive pinpoint sign (vascular network that signals the lesion) with a DELTA T between basal and functional series(GAP) of only 0.4 degrees.

Translated finally to a CCan Score of 156 for the right breast and Only 47 in the left breast .

" Final Clinical , radiological and infrared diagnosis of a possibleLeft Low Grade Breast Carcinoma "


Final Pathological Report: Well Differenciated Ductal Invasive Carcinoma.

"The DIRA as a complementary procedure offers valuable information even before biopsy , and its score is associated with the biological behaviour of the suspected lesion " EMC.

In this case the initial Surgical Oncologist offered a Radical Mastectomy (previous to the biopsy result) . Finally the patient was sent to the OR where Lumpectomy 2 cm margins and selective axillary dissection (Sentinel Lymph Nodes ) were negative .

"As a complementary study , prediction of the biological behaviour of the supicious lesion COULD UNIFY CRITERIA BETWEEN BREAST SPECIALISTS."

"In other words , DIRA offers itself as a useful tool in the day by day therapeutical decisions"
Prospective essays could reafirm these initial report .

"Without a doubt : Therapeutic Decisions did not change whatsoever , yet DIRA meaning exists and could be incorporated in our current oncological Breast Scientific language" EMC.



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