Infrared Breast Thermography is another diagnostic tool we offer for our Greenville, Spartanburg, and Anderson area patients. It is a safe, non-ionizing, non-contact study of breast skin temperature that is useful as a breast health risk assessment. It has particular utility in monitoring the effects of breast hormone therapy. It is also useful as in the detection of physiologic changes such as hormonal imbalance, lymphatic edema, ductal congestion, chest wall pain syndromes, and angiogenesis. Internationally peer reviewed Guidelines for Breast Thermography have been developed by the American Academy of Thermology in 2012 and restated in 2013. These guidelines support breast thermal imaging as a breast risk assessment, not unlike high blood pressure screening for vascular disease.
Thermography measures, images and maps microcirculatory shunting associated with breast circulatory changes in the skin. Sex hormones, in particular estrogen and progesterone, can affect breast physiology and circulation. Serial studies are helpful in monitoring the effects of hormone replacement therapy and the treatment of fibrocystic disease. There are several musculoskeletal applications that impact breast lymphatics, health and associated pain as well.
While breast thermography can play a useful role in monitoring treatment effects, as with most physiologic studies the results of anatomic testing (such as mammography or MRI) may not correlate or may not even be present despite the presence of physiologic change (physiologic findings tend to predate structural findings). Thermography can however play an important adjunctive role in clinical diagnosis and in distinguishing between benign, early, advanced, and progressive disease. The role of Thermography in cancer detection is frequently misunderstood and deserves special attention.
Angoiogensis has been called a breast risk health assessment as cancer cells need increased blood flow (angiogenesis) in order to “take” over surrounding breast tissue. They also have an increased metabolic rate, which translates into an increase in temperature compared to surrounding normal tissue. By studying breast tissue with infrared imaging early changes in blood flow can be detected and progressive changes can be assessed over time.
In 1997 Gamagami, Silverstein & Waisman published that
- Angiogenesis was the first sign appearing on mammography before the appearance of image of breast cancer, predicting in 91 % of the cases which breast might develop breast carcinoma. This is an important finding in the detection of the early stages of breast cancer development.
- Infrared imaging goes hand in hand with mammography. Hypervascularity and hyperthermia could be shown in 86% of non-palpable breast cancer. In 15% it helped to detect the cancer upon an unsuspicious image on mammography.
- Infrared imaging was found to be the only test showing the efficiency of chemotherapy in inflammatory breast carcinoma.
While Breast Thermography is not a stand alone tool in the diagnosis of breast cancer no screening tool (including X-ray mammography and Ultrasound) provides excellent predictability when used by itself. A combination of tools that incorporates Infrared Thermography has been shown to boost both sensitivity and specificity.
Authors of a 4-year, five-institution study published in the American Journal of Radiology (2003) concluded that Infrared Mammography is a safe noninvasive procedure that is valuable as an adjunct to X-Ray Mammography in determining whether a lesion is benign or malignant. While acceptance of findings remains controversial this study reported that there was 97% sensitivity when identified lesions were biopsied, however only a 14% specificity. This means that Infrared Mammography is very sensitive at detection, however identified lesions are most often not cancer (usually they are microcalcifications).
There was also a 95% negative predictive value, and a 24% positive predictive value. It has been argued that this means if an Infrared Mammogram is negative there is a 95% chance that there is no cancer and that if it is positive than there is a 24% chance that cancer may later be discovered.
To this day, with the exception of the American Academy of Thermology’s Internationally peer reviewed Guidelines for Breast Thermography conclusion that Breast Thermology is a breast risk health assessment, the role of breast thermography in cancer detection is still debated. In 2008 The American Journal of Surgery (pages 523-526) published that Infrared Mammography identified 58 of 60 malignancies, with 97% sensitivity, 44% specificity, and 82% negative predictive value. The authors concluded that Infrared Mammography is a valuable adjunct to X-ray mammography and ultrasound, especially in women with dense breast tissue. Other indications include small breasts, post implant breasts, post mastectomy breasts, those looking for additional information, and to follow the effects of treatment.
Thermal imaging is an examination of physiology that is complimentary to anatomical imaging techniques. Although proven to be highly accurate, thermal imaging is an adjunctive procedure; and as such, it is not intended to replace anatomic studies such as mammography, ultrasound, MRI, CT, X-ray, or others.
Example Breast Thermography Protocol Images:
Dr. Schwartz is President of the American Academy of Themology