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, 4 de abril de 2012

Case Number # 6. Young Patient High Risk Dense Tissue. Enhancing Breast Physical Exam

Case 6: 37 year old female , with family history 2 cousins and an aunt for breast cancer.
Three previous pregnancies , age of first birth at 30 , negative breastfeeding.
Contraception use for 1 year .
Asymptomatic until she claims discovering on self breast examination during shower a palpable nodule in the right upper quadrant.
At Physical Examination , a palpable , irregular , gritty lesion is detected in the right breast.
Axillary lumph node (1 ) palpable suspicious for malignancy.
After conventional studies (mammogram and ultrasound) she was sent to my office.

Mammogram:


Cefalo Caudal View : From this particular view it is impossible to define the clinicallly suspicious lesion.

CLOSE UP.
Medio Lateral Oblique View : Density assymetry in the upper right region close to the skin , without microcalcifications and undetermined axillary lymph nodes.

CLOSE UP, UNDETERMINED NOT WELL DEFINED DENSE LESION
.
Ultrasound definition : a 2.59 cm lesion , taller in it's larger dimension , irregular and solid suspicious for breast carcinoma classified as BIRADS IVc.

"Enough evidence to suspect malignancy and recommend immediate biopsy ".

Complemet Digital Infrared Analysis and findings :
CCan score of 173 for right breast .
With two functional persistent hyperthermias in the upper outer quadrant of the right breast , with an average of 32.7 in the interest area
Thermal summit of 33.6,
DELTA to surrounding tissue of 1.7 and 1.4 to the contralateral breast location

IT CAN BE ASSUMED EVEN BEFORE BIOPSY THAT THIS LESION CORRESPONDS TO A :

HIGH GRADE MALIGNANT LESION .


Frontal Basal Study View. Evident assymetry is observed at the Outer Upper Quadrant of the Right Breast , with augmented vascular network at this site.
Thermal or infrared SUMMIT DEFINED using isothermal standard option at software analysis.

Objective analysis of the interest area with results given in centigrades.
PINPOINT sign : Digital Infrared Analysis in this patient could easily direct the exact location of the palpable lesion.


Quadrantectomy and radical axillary dissection.
Close up : a gritty , white , irrgular 2.5 lesion is observed with negative margins .
FINAL PATHOLOGICAL REPORT:

- POORLY DIFFERENTIATED INVASIVE DUCTAL CARCINOMA , WITH SOME MEDULLARY CHARACTERISTICS.

- SIZE: 2.5.x2.2x2CM

- GRADE III IN MODIFIED SBR.

- WITH HIGH GRADE INVASIVE DUCTAL CARCINOMA I , SOLID TYPE WITH DUCTAL CARCINOMA IN SITU APROXIMATELY IN 20% OF THE NEOPLASM.

- WITH VASCULAR AND LYMPHATIC INVASION.

- NO NECROSIS .

- SKIN WITHOUT NEOPLASTIC CELLS.

- SOME FIBROCYSTIC CHANGES.


AXILLARY LYMPH NODES :

- 19 OUT OF 19 LYMPH NODES , NEGATIVE FOR NEOPLASTIC CELLS , WITH FOLLICULAR HYPERPLASIA ONLY .

PENDING IMMUNOHYSTOCHEMICAL RESULTS.

Comment:

40 years old or less patients and probably younger than 50 (depending on race and populations) , are condemned to FAILED early detection screening results based on mammogram because of physiologic DENSE TISSUE at this age , hence most of them will seek medical attention only after the lesion is clearly palpable either by self examination or by a trained health professional.

Even if the patient has a personal or familiar high risk background , this scenario usually repeats.

So current recommendations include earlier conventional studies ( 10 years or more earlier than the age for the Breast Cancer Relative (sister , mother , grandmother and second line ones , in this case cousins and aunt) .

HYPOTHESIS : IF DIGITAL INFRARED ANALYSIS OF THE BREAST DEPENDS ON METABOLIC , SIZE , AND PROBABLE DEPTH LOCATION OF THE NEOPLASTIC LESION .

AN ASSYMETRY SUCH AS THE ONE THIS CASE DEMONSTRATES COULD PROBABLE DETECT HIGH GRADE LESION AROUND 2 CM OR LESS : T1

YOUNG HIGH RISK PATIENTS YOUNGER THAN 40 (OR EVEN 50) COULD BE APPROACHED IN A MULTI-IMAGE MODALITY ( xRAY , ULTRASOUND AND DIRA).

DIRA COULD BE SPECIFICALLY RECOMMENDED IN THIS PATIENTS AS AN INTERVAL STUDY EVERY 6 MONTHS .

ANY EVIDENT INFRARED CHANGE COULD PROMPT FURTHER CONVENTIONAL STUDIES.

interval-hr-ir (High Risk -infrared)

AS SUCH , LESION COULD BE DETECTED NEAR A 1-2 CM IN SIZE , POSSIBLY HIGH GRADE

AND COULD BENEFIT THIS SPECIFIC POPULATION NICHE AND AT THE SAME TIME :

"ENHANCE BREAST EXAMINATION BY TRAINED HEALTH PERSONNEL."




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