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, 16 de enero de 2013

History and some Facts to Think About

Yesterday  , I was Surfing Through the Internet As we all do .........searching the topics we like the most.

 It suddenly reached my attention the Following In Memoriam:
Harold J. Isard MD.

Pioneer in Roentgenology , Early Breast Cancer Detection and Curiously an active Researcher of Thermography (1970,s) with:

  A VERY  INTERESTING DISCUSSION & SUMMARY.

 BUT FIRST A PERSONAL COMMENT , JUST TO MAKE IT CLEAR:
"I support the use of Mammography as the cornestone procedure for breast cancer morphological detection , its frecuency and age to do it vary greatly and depend on multiple variables and environments. 

It is indicated most certainly individualy , depending mostly on risk factors and local statistics. 

Finally clean , ethical  , expert clinical judgement after useful information after image procedures render the better understanding , certified recommendations and possible outcome. 

Thermography stands alone as a potential metabolical , vascular , inflammatory or infectious study that can help against breast cancer" EMC

Now Dr. Isard mentions :
  1. He affirms that THERMOGRAPHY Cannot diagnose cancer , but hey Only Pathology diagnoses Cancer.
  2. He states that THERMOGRAPHY can obtain ABNORMALITIES......
  3. He sustains even then that MORTALITY HAS NOT CHANGED ( And guess What , according to NEJM latest Review it Seems that AFTER 30 years of Screening with Mammography MORTALITY HAS NOT CHANGED THAT MUCH EITHER) Hard to believe but the facts have been published recently.....Controversy goes on 
  4. He suggests Thermography as a PRELIMINAR STUDY before Physical Examination and Then Mammogram ( SOUNDS REALLY CRAZY I MUST RECOGNIZE  and OUR DETECTION and DIAGNOSTIC APPROACH ALGORITHM has changed quite a bit since then.
  5. No wonder WHY THERMOGRAPHY was put aside , IMAGES were REALLY  CONFUSING , digital era may give it a new opportunity.
  6. He mentions Thermographic difficulties for specificity , REMEMBER BIRADS IV is 5-95% specific as well.
  7. He Highlights Vascular Patterns.
  8. He Remarks how CONSTANT and UNCHANGED the thermal PATTERN is.
  9. Regardless of the Date During The Menstrual Cycle , the "patient" or volunteer could be EASILY RECOGNIZED and Hence abnormalities also could be defined.... and monitored.
  10. Guess what : he mentions that the Thermal Image is RELATED to the BIOLOGICAL BEHAVIOUR of the SUSPECTED LESION........I constantly repeat this statement through my blog
  11. He identified IN SITU  lesions as well as Metastatic. I will show you some of this later .....future cases.
  12. "The DEVELOPMENT of an ABNORMAL PATTERN  when compared to a normal baseline study must ALWAYS be viewed with extreme suspicion" I have a sample case....
  13. Emphasizes Clinical JUDGEMENT to reduce UNNECESARY SURGERIES ( of course we now have minimal invasive procedures that can be applied) yet interesting point.
  14. Thermography was DIVIDED into POSITIVE or NEGATIVE ONLY , I believe its meaning is METABOLIC then its contribution has to be METABOLIC ALSO . 0 or 1 seems too simple.
  15. Thermography ALONE Cannot Beat MAMMOGRAPHY.......That is very clear for me and for everyone no controversy on that.....(specificaly on morphological meaning.....)
  16. Yet he mentions :"Since Thermography  and Mammography did not always suspect the SAME lesion , the USE OF BOTH studies INCREASED ACCURACY to 92% when either or both examinations were POSITIVE.How about that....
  17. Thermography ACTUALLY IMPROVED Clinical Examination, now if we still Recommend Clinical Examination CAN WE REINTRODUCE Thermography during the Highly Specialized Breast Physical EXAM????
  18. BACK then CONTRALATERAL CLINICALLY NEGATIVE BIOPSIES were Performed , astonishingly some of them Positive for Beast Cancer...........so CANCERS EXIST but they do no harm EVER? Back to NEJM recent DATA.}
  19. With Thermology Technology in Those days  : 61% of asymptomatic patients with cancer were identified , I wonder if now Digital Infrared Analysis of the Breast Can do Better?
  20. Thermography Improves DIAGNOSTIC ACCURACY , for me only used by and reserved for  ONCOLOGISTS.
  21. Could EMERGE as a preliminary Screening Procedure .....Uuuffffff.....SHAKY GROUNDS indeed : Heavy evidence against this proposal , greater economical interests and maybe Political as well. Not to mention Status Quo and Orthodox Mentalities....
  22. Mammography detects around 1-6 cases per 1000 of screened women , I believe this ratio is still the same . But if I am wrong please do not hesitate to correct me.
  23. Mammography PLUS Thermography 7.3-1000 ( Can THIS SINERGY be Better  Nowadays?)
  24. Here comes the TRICKY NUMBERS if USED as a PRELIMINARY STUDY that is BEFORE MAMMOGRAPHY:   21 cases per 1000 mammograms. This would mean BETWEEN 3 to 20 Times FEWER mammograms done. (uupppssss    oh oh  do the NUMBERS please)
  25. BUT  : 10 cancers were NOT DETECTED By IR , and that is the reason for NON STOP MASSIVE MAMMOGRAPHIC XRAY SCREENING , I think these 10 cancers would have a BETTER prognosis even if undetected , I suspect LOW METABOLIC HEAT and a "Benign" Biological Behaviour........sounds reasonable? In other words maybe those not identified do not actually kill anyone.......interesting.
  26.  And finally he states the INHERENT difficulties for an OPTIMAL MAMMOGRAPHY SCREENING PROGRAM.


 In my real world (and 95% of the world "screenable"population ) Optimal Screening is far from standard recommendations , coverage is practicaly ZERO , and we are loosing the battle as epidemiologists state , tumor size is around 5cm or more and detection campaigns throw breast cancer patients into the "system" and regretfuly they receive attention 6 months later , at best.

 Reality Bites.......

Can we focus attention in Female Patients with Suspicious PATTERNS?

Can we Define this PATTERNS AGAIN PROSPECTIVELY? With the help of Mammography? 

 After all the common enemy is BREAST CANCER , right?

I am not a professional editor , I will try to do my Best......

 Hope you like it and probably some one Open Minded  Enough could be Professionally and Prospectively Re-interested.

 BOY!!!!!!  

  I MISS THIS KIND OF RADIOLOGISTS , Do you happen to know ONE?






















Hope you enjoyed it as much as I did......
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