The POSITIVE side of a NEGATIVE predictive Value. Peace of Mind

Question to you all :

Is there a positive side of a NEGATIVE PREDICTIVE VALUE?

In previous studies published by Dr. Rache Simmons in NY and Professor Gordon Wishart in Cambridge it is mentioned that te Digital Infrared Analysis has a High Negative Predictive Value.
Personally I proved this same statement. That is :

A SUSPICIOUS LESION "NEGATIVE" OR WITH A VERY LOW SCORE IN THE INFRARED SPECTRUM IT IS MOST LIKELY TO BE NEGATIVE FOR CANCER ON THE FINAL PATHOLOGY REPORT. 

Standard recommendations based on the BIRADS system define that a biopsy should not be delayed or postponed specifically in BIRADS IV and V. 

BIRADS IV is the most "tricky" from 5%-90% possibilities of being positive. It is the least specific for breast cancer. And yet that is how we proceed.

And even ONLY with a CLINICAL suspicion regardless of the image studies is ENOUGH to recommend a Biopsy.

So then , WHY SHOULD I PERFORM AN "EXTRA" procedure if my suspicion is enough to recommend an Histological Confirmation or BIOPSY?

THE ANSWER IS SIMPLE : BECAUSE INFRARED IMAGE HAS A MEANING AND A PREDICITIVE VALUE.

Case : 38 year old Female , being surveilled for an Upper External Right Breast Nodule known for about 18 months 
No previous or personal History relevant for Breast Cancer ( As  90% of the patients assisting to a Breast Clinic)
on PE:it is defined clearly a palpable lesion around 1.5 cm , hard that moves easy , no skin signs , no nipple discharge , ipsilateral  negative axillae.

Previous Conventional Standard Diagnostic Images:

Bilateral Mammogram : Dense Breasts : 38 year old patient

( Tough Detection ) , yet with an upper signal pointing out the clinically suspicious area. 

Close Up : Undefined Dense Nodule 

BIlateral Inflammatory Lymph Nodes 

Ultrasound :1.1 cm lesion , irregular in one view and with augmented vascularity on Doppler .

 

Now the Radiology Diagnosis is a BIRADS IVa Lesion ( previously BIRADS II ) , enough to recommend a biopsy (Low probability) Yet her ObGyn performed a FNAB : 
ATYPICAL NEOPLASTIC CELLS.

Patient is refered to Oncology WITH a clear idea of being dealing with a BREAST CANCER.

Related Stress facing a BIRADS IV or V  is a COMMON CLINICAL SCENARIO in the Breast Clinic. Even some patients present an Important   Psycological Trauma. 

As a complement study : Digital Infrared Analysis was performed previous to Biopsy , with the following findings. 

Comparative Analysis of Both Breasts. Arrow: Clinically PALPABLE lesion , "invisible" for the INFRARED. 
Negative Predictive Value : PEACE OF MIND. 

Symetrical highest Fucntional Hyperthermias after the Cold Stress Test ( Cold Air) , Lesion at 9hrs of the right Breast : Absent or Invisible.

For some "negative" for the infrared analysis , for me a IR Score less than 100. 

Final statment in my practive : Although we have enough (Clinical , Radiological and from Citology )information for a complete removal of the lesion  we do know that your nodule is LOW in METABOLISM , LOW in AGGRESIVENESS even if positive for breast cancer , and MOST LIKELY : NEGATIVE FOR BREAST CANCER.(85% or more chances)

"So independently of the final results , you should be OK , you will be OK because the Odds are with you"

Comment : Final Pathology report : Simple Ductal Hyperplasia and a Benign Fibroadenoma. 

The Best ANATOMICAL image procedures in Breast are and probably will ever be : MAMMOGRAM(Rx) and ULTRASOUND  , the routine combination of both offers an adequate detection (when properly recommended).

Frequency and Initial Age for Screening are constantly being reviewed and are different for different Organizations and even differ between Countries. 

ANATOMICAL definition  depends on individual THRESHOLDS , and sometimes it is not clear enough in DIAGNOSIS , that is suspicion for Cancer : BIRADS IV(a,b or c) has the widest range of probability for breast cancer : 5-95% 

And even FNAB results : in this case Atypical Neoplastic , for some pathologist could represent POSITIVE for Breast Cancer .
And abscence of malignitiy in a FNAB does not rules out 100% Malignancy.
That is why some centers do not recommend it.

A PHYSIOLOGICAL  study like the Digital Infrared Analysis of the Breast offers aditional useful information of the clinically interest area.

Its NEGATIVE PREDICTIVE VALUE : Low score or "invisible" , non identified in the infrared specturm is strongly related to Abscence of Malignancy , or better yet  as a complementary study means in this case :

LOW or NULL  METABOLIC RATE

Clinically , a negative IR gives "irPeace of Mind" before Final Pathology Report ( In some centers , specially in developing countries this might take weeks)

"The DIRA of the Breast Shoul Be Routinely performed as a complementary Metabolic Procedure to Anatomical Standard Images and restricted to Certified Specialists in Breast Pathology : Oncologists , Radiologists , Breast Surgeons and Oncological ObGyn."

"Prospective controlled protocols would confirm this findings. "

EMC

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.

Note the high vascular content , demonstrated by the large amount of red blood cells.

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"