The Breast Thermography Journal (Digital Infrared Analysis): julio 2013

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¨

domingo, 14 de julio de 2013

Secondary Metachronic Invasive Ductal Carcinoma 23 Years After

Hi , it is me again.

Breast Cancer Survivor Women have an increased risk for developing a secondary or metachronic breast cancer either in the same gland or in the opposite one.

It has been calculated around 5-10% and it would be progressively higher as time and age goes by.

This week I attended a 65 year old woman , that when she was 42 she had LEFT Stage III Breast Cancer ....... as she managed to survived after complete treatment she has been then under follow up.

LAST YEAR AUGUST 2012 She said to feel an small asymptomatic irragularity less than 1 cm in her inner quadrant of her remaining RIGHT breast and went for her annual Mammography with these images reported :

Cefalo Caudal View and Close Up , a single Macrocalcification is seen in the INNER QUADRANTS

Slight density near it.

Medio Lateral Oblique View , moderate density , the same macrocalcification and scattered densities
Probably Benign Inflammatory Lymph Nodes

Close up : Macrocalcification associated density.

BACK THEN BIRADS II

Radiologist had no clear information to recommend a COMPLEMENTARY procedure.

NOW IF YOU WERE HER BREAST SURGEON OR ONCOLOGIST WOULD YOU CONCUR?

Ultrasound was added and final report sent :

Final Radiological Intepretacion was Compatible with Benign Fybroid , yet considering biopsy?

As a complementary procedure I performed :

Digital Infrared Images were taken with the standard protocol and interpretation , developed for the last 4 years:

Basal frontal view , area of interest , upper inner quadrant is one or IR activity easily detected and coincident for clinical findings. Directly "sepaking" of inherent metabolic activity.

After cold stress or stimuli , the same area is defined clearly as the highest peak or IR summit of the right breast.

Demonstrating : that these area "refuses" to get colder and that is the area of highest infrared radiation emmisivity....

Patient was scheduled for total excision of the nodule , with a pathologic report in the OR :

Invasive Carcinoma was diagnosed and as consented previously , Mastectomy was undertaken with Sentinel Lymph Node......

Final immunohystochemical results were realised with the following reports:

Solid Papillary Invasive Carcinoma , Grade 2
Progesterone and Estrogen Receptors +++
Ki 67 positive in about 20% of the neoplastic cells and
Her 2 Neu Negativity.

Comments :Digital IR Image can aid standard radiological , morphological procedures such as Mammography and Ultrasound.

Is safe and practical .

Gives useful information for the Breast Specialist (Oncologist or Breast Radiologist)

And actually can be related not only to its invasivity but for METABOLICAL individual Characteristics , such as final IHQ results : Hormone Receptirs , Ki 67 and Her 2 neu.

Have a good one ......