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¨

lunes, 25 de febrero de 2013

"Breast Thermography can predict and detect 8-10 years before than a mammogram"

Breast Thermography SUPPORTERS STATE  that:

 IR can detect changes before cancer is actually seen..................

I personally and certainly don´t think so it is very hard to believe  ( Not in our science and evidenced based world , not with previous technology or historical facts ) 

Here comes my and probably my colleagues question to this statement  :

"So , You tell me now but you prove it 8 to 10 years later? "

or 

"How can I perform a Biopsy in an absent to Ultrasound , MRI or Mammogram   Non Morphological Infrared Change ?"

SHAKY GROUNDS INDEED.

But ; regardless of what I thought or knew ...........time and patience brought to me  a case that can clearly support at least that this is actually not only possible but opens the door to RETHINK and REEXPLORE........


Female patient asymptomatic in her early forties until she felt a non painful LEFT breast nodule . BIRADS III you agree and surveiled under standard of care 6 months later , going from 5 to 1.1 cm in size 




After cold stress , the highest metabolic area in the left breast is highlightened clearly. 


 Digital Infrared Analysis , PINPOINTS the nodule (Arrow) 

 She underwent lumpectomy and Sentinel Lymph Node disection , Chemotherapy Radiotherapy and Tamoxifen as Hormotherapy , NOW : 
In follow consultation  , after feeling an irregular superior RIGHT area  I Performed DIRA and I asked for radiological mammo and ultrasound

 Self explaining 

So 2012 now present with a MORPHOLOGICAL visual change that was pinpointed or Insinuated since 2010

SERENDIPITY? 
Maybe..........................But Maybe Not 
Keep posted so we can discuss pathological findings.


miércoles, 13 de febrero de 2013

BIRADS III , To Biopsy or not to Biopsy!

Great week you all ..!
Last night I was having a look at my Blog's statistics.
And I reached the conclusion that the sample case with more hits was:

BIRADS III and Infrared......

So I must think that although you do not comment at all (who would , this issue is too controversial even to speak about it....)
I sense that the majority of my readers should be breast cancer specialists ( radiologists , oncologists, Gynecologists or breast surgeons)

If I am right you can have a smile at home!!!!

Well keep in touch........BIRADS III , to BiRopsy or not to BiRopsy. ( Visit and or Join The BIRADS/Infrared Project)
at:
A promise is a debt : 
A few year ago a 40 years of age asymptomatic  patient of mine underwent an screening mammogram and  handled this images:



Medio Lateral Oblique view , evident density assimetry in the upper outer right quadrant.


Close up : No Microcalcifications are seen , yet I might agree retrospectively you can argue architectural distorsion and irregular profile. BIRADS 0 went to a complementary Ultrasound: 


 

An heterogeneous Morphological Lesion is found , with cystic and solid components almost circular in its form no posterior "shadow" is seen .

FINAL RADIOLOGIC DIAGNOSE BIRADS III , close follow up right? 

I WOULD THINK SOME MAY ARGUE AN ERRONEOUS OR MISTAKEN DIAGNOSIS , YET IT HAPPENED. 

Then she attended 3 months later to a SECOND Opinion.

So this are her DIRA images:



 

Basal DIRA series , anterior and oblique views , upfront as any NEW language or Unknown one there should be a little doubt an distrust.

If you look up closely actually there is a little assimetry that depends on the upper outer quadrant of the Right Breast what we might call  THE INTEREST AREA or IA.







After cold challenge the Functional or Physiological series were taken. No obvious difference for the UNTRAINED eye. 


Yet with the Software "Isotherm" application a Slight difference is then seen in comparison to the left side (ARROW) it actually is coincidental to the  physical finding of an "irregularity" zone at palpation . 


Same image but different color option.

So now I am thinking :" there is a HIGH METABOLIC area that is coincidental with my MORPHOLOGICAL findings by standard mammogram and ultrasound. Not to mention that this area by incidence is the highest for a Breast Cancer to appear." EMC

Recommendation : I think you should perform not in 6 months but
 as soon as possible a Mammography  and corresponding ultrasound. 

These are the images taken :



Cefalocaudal view , density assimetry now is evident.


Oblique view , confirm previous findings.


Close up : Highly suspicious Microcalcifications are NOW EVIDENCED







Corresponding Ultrasound Images : NOW MORPHOLOGICAL CLEAR CHANGES ARE SEEN AND DOPPLER DEMONSTRATES INCREASED VASCULAR FLOW.

BIRADS V .....

Most would argue that based on experience diagnosis could have been different previously. Better yet if there is a Close Surveillance the same diagnostic algorithm would have been done. And even if DIRA proofs a benefit in helping DIAGNOSIS and DETECTION , prognosis would be the same.

Reality : BIRADS III is based on INDIVIDUAL RADIOLOGIST Criteria , Follow up sometimes cannot be achieved. 
And BIRADS II was another possibility for the first classification.

The ecuation is simple:
"BIRADS III (even IVa) Morphologically proven , DIRA coincidental for HIGH METABOLIC ACTIVITY Plus ONCOLOGICAL experience : Recommend for SURE to Biopsy."EMC

These are the images taken in the OR , a possible next level.
Keep in touch.............





The idea is to gather BIRADS III lesions internationally , I will creat this next blog for those who would like to participate......
But now I am going to celebrate my Boy´s Birthday so I guess we will see you around next week.

http://birads3infraredproject.blogspot.mx/





lunes, 11 de febrero de 2013

Hypothesis

Eventually , if I am right  and enough evidence is built with your help:

"Mammography on NORMAL RISK POPULATION will only be authorized on a year basis if and only if DIRA or complementary  digital infrared analysis of the breast suffered a change enough to recommend another Xray exam."

Crazy enough ? 


Albert Einstein

“For an idea that does not first seem insane, there is no hope.”







ArcheiRy , Analogy to Breast Cancer Detection , could we add an "i"?


How can we compare ARCHERY to BREAST CANCER DETECTION?
Well , I guess you may have an Idea......


 Highly Trained Specialists aiming at the center of the same targets at the same distance in similar conditions,
Hours , days and years of training with the best equipment possible , best trainers and 




professors , facilities and will.


Team work , teaching and learning side by side , supervision , confidence building  , tips and experience. Decision Making and Responsability.



Complementary procedures and positions that aid eventually in an accurate shot or view to try and hit the smallest , centrical target.











 And Practice and Practice and more Practice











"ArcheiRy" Breast Cancer Detection TNM Score :
We all aim to hit the MILIMETRICAL X ring Center :T1a , we are obsessed in trying to find those lesion.
Microcalcifications are Highlightened , signaled and classified.
And as far as the arows hits from the center Score of Detection is SMALLER and prognosis is Worst.


Detected Milimetrical , Lobular Carcinoma  in association to microcalcifications. 

Density , calcified structures , quality equipment , human resources , dedication experience , along with cultural , economical and scientific variables play along side by side to identify these lesions.
"In my world fewer than 3% of the cases...................and probably yours Low Income or Resource Countries"


In Developed ones maybe 15 to 30% ( yet subclinical pool maybe the same and never translate to a diseased state ....hard to know which will advance right?)

Optimal Archery Score all within the yellow circles


Yet in real scenarios : Arrows or attempts will hit most of the times by highly trained professionals within the yellow and red circles.

That would be : Usual Breast Cancer Detection usually hits lesions around

1 or 2 cm :T1



And even in several THOUSANDS SHOTS BY THE HIGHEST STANDARDS THEY WOULD EVENTUALLY HIT THE EXACT CENTER.

For example , after 20 years of being a Surgical Oncologist , you can imagine the Number of patients , one of my professors made a comment of a SINGLE case of a 0.8 mm invasive ductal carcinoma.

Question is the relationship of THOUSANDS and maybe 25 years of experience a positive COST-BENEFIT one?





In the past 2012 Olympics  in the Archery Event , Highest Ranked qualified professional archers aiming at the X center probably Thousands of times and .....

 ONLY :  Khatuna Lorig started with a dead center ten that shattered the camera, but was unable to hold off Avitia (From Mexico ) who took the bronze medal with a 6-2 victory, giving Lorig a fourth place finish and making her the USA's highest individual finisher for the second Olympic Games in a row

"So that means that it really does not matter whether you hit the exact center but how many times you approach to it in order to win " EMC

Get the idea? 

Now Curious Fact : Im Dong from S.Korea holds the world record almosto 700 points and he is "Legally Blind"


"That is amazing and it means that there is something else that cannot be measured , cannot be learned or Teached  and it is mastered only by a few. Instinct and Intention are human and Medicine holds an Artistic Character difficult to define and extraordinary in a daily basis."

Infrared Digital Analysis of an Asymptomatic High Risk Patient and the corresponding standard detection Mammogram and Ultrasound:



Size eventually turned out to be 1.2 centimeters
PRETTY GOOD FOR SOMETHING THAT HOLDS NO USE CURRENTLY DON´T YOU THINK?

Comment: 

Breast Cancer Detection should be accurate enough to hit the smallest size or target lesion. Mammography is still the gold standard for detection in some cases and ages , but it is a complicated an expensive procedure for most countries. 

Its frequency and age of first mammogram are in constant review and currently under fire. 

The cost benefit ratio is in doubt.

And the survival benefit because of SOLELY the Mammographic detection is Challenged mainly because now we have a better treatment.

For me : Infrared Imaged , digital and renewed holds promise to possibly detect lesions where Xray has its inherent difficulties or is unavailable for whatever reason.

Detection requires experience , equipment teachers , facilities resources and practice. 

Yet art and innovation even if Infrared is considered Nearsighted or legally blind for breast cancer  , may actually help and "break" current records and statistics.....EMC


To target the center is great , but if all the lesions where found UNDER the RED CIRCLES , at least my country Score and Prognosis would be Higher and Better  than it actually is.

Would you like to join?

Can we bring the i into Archery ?  and turn it into ArcheiRy?