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¨

martes, 18 de septiembre de 2012

Report of a case , high metabolic index . Microvascular density , lets help Mammography. Earlier Referal


63 year old Female , witha personal History more than 10 years ago of having an Stage II Infiltrating Ductal  Breast Carcinoma on her right side ,  treated with Radical Mastectomy plus standard adjuvant treatment with chemo and radiotherapy plus 5 years with oral tamoxifen.  
She presents  to oncological examination referred by a gyneocologist (November 2009)  , with a previous history of a nodule been detected by self breast examination in January 2009 and 10 months later she presents with the following clinical findings :  


Evident presence of a left breast nodule , not only palpable but visible  4-5 cm in diameter in the Upper External QUadrant of the remaining breast  . Clinically Positive Axillary Lymph Nodes around 1-2 cm  .


The nodule had  defined borders witha rubberish sensation at manipulation , obviously increased local temperature and even erythematous coloring of the skin .  

So initially , there is enough information to suspect either :  
  • Recurrent metastatic contralateral Breast Carcinoma  , with inflammatory component. OR:  
  • Primary remaining  Breast Carcinoma Cáncer de Mama Stage IIIB because of the inflammatory EC IIIB component. 


Yet ,  she presented with these previous radiological studies performed 9 months before :  

Analogic Mammogram of the remaning breast 



Complementary Ultrasound revealed 
 A solid , wider than taller  nodule , with regular borders . with out posterior enhancement or calcificacionts.  

Aproximately 2 cm in tis larger dimension. 

At DOPPLER : no considerable vascular flow .

Surprisingly : 

INITIAL DIAGNOSIS , EVEN WITH THE PERSONAL HISTORY OF BREAST CANCER WAS : 

 BIRADS II ,  WITH A BENIGN BREAST FYBROID  AS THE FIRST POSSIBILITY. 

 Evidently , a radiological appreciation error or misdiagnosis 

 YET , "MISTAKES TEND TO HAPPEN SINCE WE ARE ONLY HUMAN , OR NOT??" EMC.

Radiological Interpretation is a subjective Phenomena , with its concomitant corresponding misdiagnosis .

  l

10 months after , and after persistence and progression of the same exact lesion , the patient was referred with the following images:    


Evident radiological preogression , in size and density , yet with the same oval form. 


Complementary ultrasound now revealed a  4.6 cm nodule WIDER THAN TALLER 
Radiological Diagnosis Chaneged to : 
BIRADS V . 

 As a complemetary procedure we performed DIGITAL INFRARED ANALYSIS  with the following images and metabolic implications.  
Infrared generation by the clinically suspected lesion is more than evident  its Thermal Summit reached  33.8 centigrades with a a DT to the Peripheral Tissue of more than  de 3 degrees  (3.3) and a  of a 191 points. 

 So it is inferred a high metabolic index , an aggresive differentiation grade and or severe inflammatory component included and obviously the associated clinical consequences. 
Biopsy Results revealed: 

 Angiosarcoma of the Breast. 
High Rate Mitosis , and presence of fusiform cells , with altered nucleous and nucleoli.



With Vascular Invasion.Comment: Angiosarcoma of the Breast is a rare malignant entity  , less than 1% of the total number of cancer cases . It is derived from mesenchymal tissue , specifically from blood vessels.It carries a poor prognosis since it has a fast doubling  time demostrated by NUMBER of mitosis or duplication rate. Metastases are common , and differing from Ductal Breast Carcinoma they are hematogenous not lymphatic.This sample case exemplifies , how if IR analysis would be offered as a complementary tool after Mammogram and Ultrasound it could have helped to a BETTER DETECTION , DIAGNOSE and EARLIER REFERAL (iReferal)to an Oncologist after Biopsy.INFRARED ANALYSIS IS NOT INTENDED TO SUSTITUTE XRAY OR MAMMOGRAPHIC EVALUATION , IS A PROCEDURE WITH A METABOLIC "MEANING" SPOKEN BY HIGHLY TRAINED SPECIALISTS AROUND MASTOLOGY.
"I believe it should be thoroughly reinvestigated and prospectively researched , in a multicenter study with an standarized procedure and comparative to standards of care procedures." "There is no harm doing it after Xrays or USG , on the contrary  : It could help or reaffirm and even offer different information given by detection or morphological studies. EMC"

 


Publicado por en

No hay comentarios:

Publicar un comentario

Suscribirse a: Enviar comentarios (Atom)