Rationale and Objectives
The study aimed to determine the outcome of patients presenting for evaluation of abnormal breast thermography.
Materials and Methods
Following Institutional Review Board approval, retrospective search identified 38 patients who presented for conventional breast imaging following a thermography-detected abnormality. Study criteria included women who had mammogram and/or breast ultrasound performed for evaluation of a thermography-detected abnormality between January 1, 2000, and December 31, 2015. Patients whose mammograms and ultrasounds were initiated at an outside institution or who did not have imaging at our institution were excluded. Records were reviewed for clinical history, thermography results, mammogram and/or ultrasound findings, and pathology. Mammograms and ultrasounds were prospectively interpreted by one of 14 Mammography Quality Standards Act–certified breast imaging radiologists with 3–30 years of experience. Patient outcomes were determined by biopsy or at least 1 year of follow-up. Patient ages ranged from 23 to 70 years (mean = 50 years).
Results
Ninety-five percent (36 of 38) of patients did not have breast cancer. The two patients diagnosed with breast cancer had suspicious clinical symptoms including palpable mass and erythema. No asymptomatic woman had breast cancer. Negative predictive value was 100%. Of 38 patients, 79% (30 of 38) had Breast Imaging Reporting and Data System (BI-RADS) 1 or 2 assessments; 5% (2 of 38) had BI-RADS 3; and 16% (6 of 38) had BI-RADS 4 ( n = 5) or BI-RADS 5 ( n = 1) assessments. Two of six patients with biopsy recommendations were diagnosed with breast cancer (Positive predictive value 2 = 33.3%). All findings recommended for biopsy were ipsilateral to the reported thermography abnormality.
Conclusions
No cancer was diagnosed among asymptomatic women. The 5% of patients diagnosed with cancer had co-existing suspicious clinical findings. Mammogram and/or ultrasound were useful in accurately characterizing patients with abnormal thermography.
Introduction
Breast cancer is one of the leading causes of death among women worldwide. Screening mammography is the most thoroughly researched and widely utilized examination for breast cancer detection. Screening mammography has repeatedly been shown to contribute to decreased breast cancer–associated mortality . Supplemental screening with ultrasound, tomosynthesis, and magnetic resonance imaging (MRI) are performed as clinically indicated, especially for higher risk women; these imaging modalities have all demonstrated effectiveness and safety in the detection of breast cancer. However, patients may seek alternative breast cancer screening methods such as breast thermography. Less is known about the efficacy of thermography for breast cancer detection. Breast thermography was originally developed in the late 1950s in Canada . Thermography was implemented as a breast cancer screening study in the 1960s. In 1977, Feig et al. compared mammography and thermography screening in 16,000 women and found thermography to have a sensitivity of 39% . Based on this low sensitivity, Feig concluded that thermography was not practical as a breast cancer screening tool. Following the results of the study by Feig, breast thermography was largely abandoned .
Since that time, thermal imaging technology has improved and breast thermography is regarded as an adequate method for breast cancer screening in some medical communities, which describe it as offering earlier breast cancer diagnosis relative to conventional imaging modalities and clinical examinations . Although the US Food and Drug Administration (FDA) has not approved thermography as a stand-alone modality for breast cancer screening or diagnosis , patients concerned with mammographic radiation or compression may seek thermography in lieu of screening mammography.
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Materials and Methods
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Results
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TABLE 1
Suspicious Findings on Conventional Breast Imaging and Outcomes following Abnormal Thermography Results
Age BI-RADS Thermography Abnormality Mammogram Finding Imaging Finding Size (mm) Biopsy Method Pathology Result Clinical Symptoms 41 4 Right Right—calcifications 60 Stereotactic Fibrocystic No 54 4 Left Left—calcifications 7 Surgical Fibrocystic No 47 4 Left Left—calcifications 30 Stereotactic PASH No 68 4 Right Right—mass 9 Patient declined N/A—Mass stable for 2 years No 70 4 Right Right—mass 15 Ultrasound IDC Palpable right breast mass 48 5 Right Right—mass and calcifications Multifocal Ultrasound IDC Palpable breast mass and erythematous breast
IDC, invasive ductal carcinoma; N/A, not applicable; PASH, pseudoangiomatous stromal hyperplasia.
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TABLE 2
Conventional Breast Imaging Results and Patient Risk Factors
Patients Referred for Abnormal Thermogram
n = 38
Number and (%) of Cases BI-RADS 1 26 (68.4) 2 4 (10.5) 3 2 (5.3) 4 5 (13.2) 5 1 (2.6) First-degree family history of breast cancer Negative 35 (92.1) Positive 2 (5.3) BRCA mutation 1 (2.6) Personal history of breast cancer Negative 32 (84.2) Positive 5 (13.2) High-risk (LCIS) 1 (2.6) Menopausal status Premenopausal 19 (50) Postmenopausal 19 (50) Clinical symptoms Yes 13 (34.2) No 25 (65.8) Mammogram density_n_ = 33 Almost entirely fatty 2 (6.1) Scattered areas of fibroglandular densities 24 (72.7) Heterogeneously dense 6 (18.2) Extremely dense 1 (3)
BI-RADS, Breast Imaging Reporting and Data System; LCIS, lobular carcinoma in situ.
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Discussion
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Acknowledgments
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