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, 26 de marzo de 2014

Infrared Analysis of the Breast Can Help Biopsy site and better diagnosis

Living in a Low or Middle income country gives a clinitian a different perspective and experience than those main stream drs from Developed ones.
Access , economics , geography , resources cultural or even educational variables play a definite role in any Kind of Cancer Diagnosis and treatment.

So as a personal journey , and being an Oncologist , I started back in 2009 scanning women with clinical or radiological suspicion fro breast cancer , with a last generation IR detector.


 55 year old woman , non specific symptoms in her left breast  , sent to Mammo and ultrasound with the following images: 






 Simple and easy , T1 lesion less than 2 cm , multiple microcalcifications with intraductal extension No doubt : BIRADS V ,  95% chance of Breast Cancer right?
As an independent research and  as a Oncololical Clinitian I scanned this patient with the following images :










After more than 100 cases I personally developed a Method or Interpretation Language based on 18 variables that can be identified from the images you just saw , with the following report and result:


After more that 5 years of performing IR analysis in Breast Patients , what this procedure meant back then is : 

" A highly metabolic area , coincidental with morphological tests , of a fast duplication rate or inflammatory component" 

Severe assymmetry in this case 204 vs 10 and ALL of the "subjective" variables being POSITIVE in the Side of clinical Interest means that : More Severe Oncological Therapeutical Decisions Need to be made.

Independently as standards of care demand: 

An Ultrasound Guided Biopsy was scheduled with the following pathologic result :



Surprinsingly : A SIMPLE INTRADUCTAL HYPERPLASIA WAS DIAGNOSED.

Medical Practice fortunately will always be an ART , practised by trained skilled highly specialized humans . 

We should not rely ONLY in what some images or results might conclude.

Experience and Innovation or correct applicability of Logical Statements need to be introduced and supported till the end....

I SCHEDULED an open biopsy , introduced the IR system to the OR with the following images: 


Makes sense to me , coincidental with morphological and clinical suspicion , this INTRAOPERATIVE IR image gave me the area where I should take a biopsy.......

IR Assisted Breast Biopsy: To all the main stream Drs. That think Thermography is an Absolute Fraud I apologize I had to do it .......I kindly suggest that you give it a try in controlled prospective clinical trials......would you dare?




Some might feel even angry or daunted , believe I was too , special procedures in special clinical scenarios , in special hands with special minds produce : Better Diagnosis , since we can embrace different kinds of information of a biological phenomena......... Same result : different algorithm : It really does not matters how you or I identify a Cancer , as long as it is detected....

STAY TUNED , HAVE A GREAT WEEKEND NEXT MONDAY : FINAL PATHOLOGY RESULT AND Follow up of this patient.


EMC.

jueves, 6 de febrero de 2014

Breast Thermography CANNOT DETECT Clear Mamographical Microscopic Breast Carcinomas ,

Breast Thermography CANNOT DETECT Clear Mammographical Microscopic Breast Carcinomas , yet (Biological information as a complement is important in the Doctor-Patient Relationship. And offers predictive biological behaviour of the lesion prior to biopsy , useful for both.) EMC 

Would you like to see an Example??

Early 40´s asymptomatic woman , first mammography screening.
On Physical Examination after the images an irregular "soft" lump was felt on her right inner upper quadrant......






Anatomically Clearer than this , is Impossible and that is why detection is supported on MORPHOLOGY.

Makes more than sense....

So would you perform an Infrared Complementary Procedure???

Vast Majority : will say ABSOLUTELY NOT....Right?


Well I did , why : 

 BECAUSE EVEN BEFORE BIOPSY I HAVE USEFUL INFORMATION FOR THE PATIENT TO GIVE.......

METABOLIC INFORMATION....Makes sense to me .....( and to tell you the truth it is brainstimulating......)

"EMPATHY , PREDICTION , COMPLIANCE , STRESS , AND IN SOME CASES EVEN THERAPEUTIC DECISIONS CAN BE SUPPORTED BY AND INFRARED IMAGE." 
EMC.

I believe you should learn it TOO.... don´t you think so ???

To see the IR images Keep posted OK??? , have a great week......

lunes, 20 de enero de 2014

Breast Thermography Lacks Exact Tumor Positioning , but could it at least ORIENT?

Breast Infrared Image , Lacks Exact Tumor Positioning.

And that is why Fellow Radiologists will not ever consider to explore this technology again.

At least as an Screening procedure......

As We (main stream Drs)   learn mostly from ANATOMICAL studies ,  then we  do not understand biological infrared  spectrum meaning of the images it produces.

It is an unknown boundary..........a black hole.

Considered by all as useless.....

One Question : Since when does any MEANING is useless???

So a lady in her 80´s after feeling a lump in her left breast attends consultation with the following images: 




So , no doubt BIRADS V 95% chance of having a Breast Cancer in this case several foci and quadrants involved.

NO QUESTION ABOUT IT , MAMMOGRAPHY WILL EVER BEAT ANY OTHER ANATOMICAL APPROACH , since it is the more reasonable physically speaking way to investigate BREAST ANATOMY...... and that is that .

So does it makes sense at all to screen a lady in her 80´s??? Most will say no .......

And , if this is it , does it makes sense doing any other complementary procedure??? Most will answer no , recommend nothing else or even deny IR as a complement....

Guess you agree.

WOULD YOU LIKE TO SEE THE DIGITAL INFRARED ANALYSIS OF THIS PATIENT , OR YOU THINK IT IS A WASTE OF TIME?



P.S.  Does anyone out there HAS A LITTLE SCIENTIFIC CURIOSITY AT ALL ?

Isn´t it right that a BREAST SPECIALIST should handle and learn every possible language  and information around breast cancer???








jueves, 16 de enero de 2014

There is no DOUBT , Mammography is the GOLD standard , but it is simply NOT ENOUGH

Happy 2014 

There is no DOUBT : Mammography is the gold standard for Breast Cancer Detection . It is the most complete and the evidence cannot be denied.

"There is only  one problem : it is NOT ENOUGH . And regretfuly it will never be." EMC.

World wide ( specially in Low and Middle Income countries ) .....and you should care since more than 90% of countries apply :
  1. 95% of breast cancers are PALPABLE
  2. Around 70% are in Stages  III or IV
  3. There are no Screening Programms , with high quality control standards
  4. Younger women seem to "escape" from any kind of early detection.
  5. And MORTALITY at least where I live is around  40%.......

I have a question :

What if it could exist a PROCEDURE :
  1. Simple
  2. Sensitive
  3. Specific for : T1 Tumors in the aggresive type (GII or GIII)

Do you think this could help SOMEONE ????

Answer :



These are the Standard diagnostic radiological images we all know , done after clinical evaluation , physical exam. ( the other way around).......




Easy  to  understand  morphology images , that we recognize and understand as  .......BIRADS V , T2 lesion with even positive axillary lymph nodes seen... Stage IIb at least.....

What if we could use Digital Infrared Image as a Clinical Support for Physical Breast Exam , and the eventually locate around 2 cm tumors with possibly the help of a Mobile ultrasound equipment????

Then : 

Mammography in some clinical and sociocultural scenarios should be reserved only for:

Diagnostic purposes.

Total Contradiction from recommended standards of care. I know , but ; 

Reality Bites: We (90% of the world)  are losing this fight.......

"I see no no other path or option in the short , middle or long term." EMC

Hypothesis

I would love to creat strong EVIDENCE in the Mainstream Medicine that Demonstrates and Proves that State of the Art Digital Infrared Image of the Breast has a Detection Potential ( inferior than mammography I already know )  .

But that it actually can identify  Lesions around 2 cm : T1 and in their aggresive form ...

This strategy could approach women from  country  X  to  DIAGNOSTIC MAMMOGRAPHY.


It would ENHANCE and OPTIMIZE radiological resources , widening COVERAGE and IMPROVE substantially current statistics.

Numbers  DO NOT LIE : Early Detection DOES NOT EXIST practically in the vast majority of countries.

There is no Budget that can handle the economics of Screening....

It is imperative to create an ADAPTATIVE STRATEGY that improves our Breast Cancer Reality....

"Awareness ......Breast Self Exam .......Infrared Optimization .....Guided Clinical Breast Exam and Ultrasound" :

T1 Detection , with better treatment options : Better 5 Year Survival .....

DO YOU THINK I AM LYING????

WHAT IF I AM NOT?????.....

At your service.

EMC: emartindelcampo@yahoo.com