CORINNE FARRELL, M.D., JOHN D. WALLACE, A.B. and CARL M. MANSFIELD, M.D.
Our experience to date has shown that total body thermography can be an aid in the search for metastatic disease in patients with carcinoma of the breast. In our series of 126 patients, we found a true positive rate of 87 per cent, a false negative rate of 3 per cent, and the false positive rate was approximately 10 per cent. Of considerable interest were 7 false positive thermograms which were converted to true positives in 3 to 6 months after the original study.
We have found total body thermography useful in locating the site and extent of a primary lesion, a second carcinoma of the breast or recurrent anti metastatic lesions. It has also been an aid in differentiating associated benign disease. This examination is inexpensive, consumes little time, causes no patient discomfort and has the added advantage of no exposure to ionizing radiation. This technique is capable of detecting early manifestations of metastatic disease, but such manifestations of disease should be confirmed by conventional techniques at this time.
BREAST THERMOGRAPHY AFTER FOUR YEARS AND 10,000 STUDIES
HAROLD J. ISARD, M.D., WARREN BECKER, M.D., RUTH SHILO, M.D. and BERNARD J. OSTRUMM.D.
A total of approximately 10,000 breast thermograms was analyzed and further subdivided into symptomatic and asymptomatic groups of patients of 55 and 45 per cent, respectively.
Positive, or abnormal, mammatherms were recorded in 36 per cent of thesymptomatic and 23 per cent of the asymptomatic groups. Of the 306 histologically confirmed cancers, 270 were in the symptomatic group of patients and 36 were clinically occult.
Clinical accuracy was enhanced by the supplemental use of mammography and thermography. Sixty-one per cent of the occult cancers were suspect by thermography and if, in the asymptomatic group, thermography had been used as the initial screening procedure and mammography performed only on those with abnormal thermograms a yield of 21.4 cancers per 1,000 mammographic examinations would have been realized.
Thermography is an innocuous examination that can be utilized for preliminary screening of asymptomatic women to focus attention upon those who should be examined more intensively because of greater risk of breast cancer.
Efficacy of Computerized Infrared Imaging Analysis to Evaluate Mammographically Suspicious Lesions
- R. Parisky1, A. Sardi2, R. Hamm3, K. Hughes4, L. Esserman5, S. Rust6 and K. Callahan7
OBJECTIVE. The purpose of this clinical trial was to determine the efficacy of a dynamic computerized infrared imaging system for distinguishing between benign and malignant lesions in patients undergoing biopsy on the basis of mammographic findings.
SUBJECTS AND METHODS. A 4-year clinical trial was conducted at five institutions using infrared imaging of patients for whom breast biopsy had been recommended. The data from a blinded subject set were obtained in 769 subjects with 875 biopsied lesions resulting in 187 malignant and 688 benign findings. The infrared technique records a series of sequential images that provides an assessment of the infrared information in a mammographically identified area. The suspicious area is localized on the infrared image by the radiologist using mammograms, and an index of suspicion is determined, yielding a negative or positive result.
RESULTS. In the 875 biopsied lesions, the index of suspicion resulted in a 97% sensitivity, a 14% specificity, a 95% negative predictive value, and a 24% positive predictive value. Lesions that were assessed as false-negative by infrared analysis were microcalcifications, so an additional analysis was performed in a subset excluding lesions described only as microcalcification. In this restricted subset of 448 subjects with 479 lesions and 110 malignancies, the index of suspicion resulted in a 99% sensitivity, an 18% specificity, a 99% negative predictive value, and a 27% positive predictive value. Analysis of infrared imaging performance in all 875 biopsied lesions revealed that specificity was statistically improved in dense breast tissue compared with fatty breast tissue.
CONCLUSION. Infrared imaging offers a safe noninvasive procedure that would be valuable as an adjunct to mammography in determining whether a lesion is benign or malignant.
Microwave thermography in the detection of breast cancer
AH Barrett, PC Myers and NL Sadowsky
Microwave thermography, a method of sensing subcutaneous temperatures, was used in a breast cancer detection study of about 5,000 female patients. The data were taken at wavelengths of 9.1 and 23 cm. Microwave thermography at 23 cm has true-positive and true-negative detection rates of 0.8 and 0.6, respectively, comparable to those of infrared thermography (0.7) and inferior to those of xeromammography (0.9). However, a potential advantage results if microwave and infrared thermography are used together for screening, and if mammography is used only for follow-up on those patients who were positive on either the microwave or the infrared thermograms. It is then possible to obtain true-positive and true-negative detection rates of 0.9 and 0.9, respectively, while only half the number of patients need be subjected to x-rays.
Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer.
Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons RM.
BACKGROUND: Digital infrared thermal imaging (DITI) has resurfaced in this era of modernized computer technology. Its role in the detection of breast cancer is evaluated.
METHODS: In this prospective clinical trial, 92 patients for whom a breast biopsy was recommended based on prior mammogram or ultrasound underwent DITI. Three scores were generated: an overall risk score in the screening mode, a clinical score based on patient information and a third assessment by artificial neural network.
RESULTS: Sixty of 94 biopsies were malignant and 34 were benign. DITI identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value depending on the mode used. Compared to an overall risk score of 0, a score of 3 or greater was significantly more likely to be associated with malignancy (30% vs 90%, P < .03).
CONCLUSION: DITI is a valuable adjunct to mammography and ultrasound, especially in women with dense breast parenchyma.
Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence
Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H.
N Engl J Med 2012; 367:1998-2005November 22, 2012
Our study raises serious questions about the value of screening mammography. It clarifies that the benefit of mortality reduction is probably smaller, and the harm of overdiagnosis probably larger, than has been previously recognized. And although no one can say with certainty which women have cancers that are overdiagnosed, there is certainty about what happens to them: they undergo surgery, radiation therapy, hormonal therapy for 5 years or more, chemotherapy, or (usually) a combination of these treatments for abnormalities that otherwise would not have caused illness. Proponents of screening should provide women with data from a randomized screening trial that reflects improvements in current therapy and includes strategies to mitigate overdiagnosis in the intervention group. Women should recognize that our study does not answer the question “Should I be screened for breast cancer?” However, they can rest assured that the question has more than one right answer.
Screening for breast cancer with mammography
Screening with mammography uses X-ray imaging to find breast cancer before a lump can be felt. The goal is to treat cancer earlier, when a cure is more likely. The review includes seven trials that involved 600,000 women in the age range 39 to 74 years who were randomly assigned to receive screening mammograms or not. The studies which provided the most reliable information showed that screening did not reduce breast cancer mortality. Studies that were potentially more biased (less carefully done) found that screening reduced breast cancer mortality. However, screening will result in some women getting a cancer diagnosis even though their cancer would not have led to death or sickness. Currently, it is not possible to tell which women these are, and they are therefore likely to have breasts or lumps removed and to receive radiotherapy unnecessarily. If we assume that screening reduces breast cancer mortality by 15% after 13 years of follow-up and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.
Women invited to screening should be fully informed of both the benefits and harms. To help ensure that the requirements for informed choice for women contemplating whether or not to attend a screening programme can be met, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.
THE USE OF THERMOGRAPHY IN DETECTION OF METASTATIC BREAST CANCER
Read More: http://www.ajronline.org/doi/abs/10.2214/ajr.111.1.148