64 year old female , withou any personal or familiar history or risk for breast cancer.
Self examination revealed suddenly a nodule in the inner quiadrants of the right breast , otherwise asymptomatic.
She attended to her Gynecologist and sent to perform standard radiological studies : Mammogram and Ultrasound:
Cranio Caudal View : Density assymetry , an easily identified nodule in the inner quadrants .
Medio Lateral Oblique View: Inner lower nodule defined as well . Axillary lymph nodes were classified as benign or inflammatory ones.
Close up : no architectural distorsion or microcalcifications were seen.
Ultrasound image : where the nodule revealed a "solid" component , no acoustic shadow or liquid nature . Abscense of microcalcifications.
At Doppler : with a little vascular or peripheric vessels demonstrated.
Final BIRADS diagnosis was categorized as III , thus :
- Leaving biopsy decision to clinical judgement or short surveillance period 3 to 6 months .
DIRA Performed as a complementary study :
CCan Score : 173 for the right breast and only 39 for the left.
Focused vascular span from 22. 3 to 37.8 celsius degrees. (Range where vsacular components are well defined) 37 degrees or more reveal indirectly a augmented metabolic component.
Therma Summit of 33.4 degrees that is coincident qith the clinically palpable nodule.
Surroounding Tissue Delta (DTC) of 1.6 and contralateral of 1.3.
GAP between basal and "functional" (cold challenge) studies of 0.9
Right Axilla considered negative in comparison with left.
Less than 25% of visually vasculature.
The infrared image of the basal frontal study reveals the "sulcus irregularity " ( almost a dentate line ) , and a single Hyperthermia in the Inner Quadrants (1-2hr Line B9).Coincidental of the former standard image studies.
Digital manipulation of the image improves vascular components of the original image.
Surgical specimen of the inner Quadrantectomy , tumor seems "fleshy" in nature and quite different from a fybroid appearance .
Hematoxiline and eosine , revealed a:
- Infiltrating Lobullar Carcinoma , with
- Signet Ring Cells
Immunohistochemistry:
Estrogen and Progesteron Receptors were NEGATIVE .
Her2 neu +++.
Ki 67 positive in 60%
Negative axillary lymph nodes by Sentinel Lymph Node Dissection.
To this day patient is well and currently under adjuvant systemic therapy .
Later on she will receive External Beam Irradiation.
Comment:
Breast Cancer is an heterogeneous disease with and some times INDIVIDUAL:
Clinical , Radiological , Pathological ,Immunohistochemical and almost molecular
characteristics are present.
DIRA , could help the Clinician o decide whether or not a biopsy should be performed.
And although some might classify the former lesion as a BIRADS IV one , the truth is that the threshold betweet BIRADS III and BIRADS IV depends on:
Radiologist experience and Diagnostic accuracy , but most important it could also rely on interobserver examination or "mood" after 40 or 50 read mammograms.
So:
One radiologist could diagnose it as a BIRADS III
Another one could give it a BIRADS IVa
Or even a "tired" radiologist or an unexperienced one could give these image as a BIRADS II.
" TO PERFORM OR NOT A BIOPSY SHOULD INCLUDE ALL THE INFORMATION THAT COULD BE SCIENTIFICALLY ASSESSED BEFORE IT IS ACTUALLY DONE. "
By itself DIRA , translates a higher metabolic rate in the right side , oriented to the inner quadrantes so its recommendation as an screening procedure seems possible yet quite complicated.
Possible but complicated. So detection relies on mammography , but SYNERGY SEEMS POSSIBLE.
Yet the DIRA results : score of 173 "speaks" of a high grade tumour : Signet Ring cells .
And probably can be related to the morphological Immunohistocemical characteristics
" Incorporating The INFRARED LANGUAGE to Mastology , Oncology and Breast Cancer is a MULTIDISCIPLINARY task ." EMC
"I strongly believe it should be reintroduced , reexplored and reserved only to breast and oncological specialists." EMC
