Breast thermography. A prognostic indicator for breast cancer survival.

A prognostic classification for thermographic staging of breast cancer has been applied to a cohort of 70 patients from 5040 screenees enrolled in the Albert Einstein Medical Center (AEMC) Breast Cancer Detection Demonstration Project (BCDDP). A diagnosis of breast cancer was established in each case before December 31, 1980. None of the patients have been lost to follow-up which extended from a minimum of 6 to a maximum of 13 years. Survival rates for those with favorable, equivocal, and poor thermographic factors are compared with each other and with results in accordance with tumor-node-metastasis (TNM) classification. As of December 31, 1986, there have been 22 (31.4%) deaths, all attributed to breast cancer. The thermographic scoring system clearly shows shorter survival for patients with poor thermographic prognostic factors, 30% surviving at 5 years and only 20% at 10 years compared with overall survival of 80% at 5 years and 70% at 10 years.

Other imaging techniques.

Images of the breast can now be produced by five modalities: x-ray, heat, sound, light, and magnetism. X-ray mammography is generally accepted as the most accurate of these in the detection of breast cancer, and the standard by which the others are judged. Despite the obvious attraction of nonionizing techniques, the economic factor attendant on multiple studies requires consideration. Nuclear magnetic resonance (NMR) is currently being investigated in several clinics, but as yet there is no large series of documented cases. This report addresses itself to thermography, ultrasonography and diaphanography (transillumination). The unique characteristics of each and their respective roles in evaluation of the breast, particularly in the detection of breast cancer, will be discussed. When used in conjunction with mammography, potential advantages include: enhanced diagnostic accuracy, reduction of unnecessary surgery, and, in proven cases of breast cancer, prognostic capability. Thus far it has not been demonstrated that any of the nonionizing techniques can serve as a sole screening modality for breast cancer detection in asymptomatic women.

A preliminary appraisal of diaphanography in diseases of the breast.

Transillumination of the breast is a noninvasive procedure that is being tested as an imaging technique for evaluation of breast disease, differentiating benign from malignant lesions, and as a possible screening modality. The average normal breast when transilluminated in a darkened room has a reddish-yellow color that is reproduced with remarkable fidelity on infrared film. Differences of color, shading, and blood vessel caliber are criteria for the recognition of various breast lesions. The diaphanographic findings in approximately 200 women have been compared with the interpretations based upon mammography and thermography. To date the level of accuracy reported by some investigators (Di Maggio et al, Italy; Ohlsson et al, Sweden; Wallberg and Alveryd, Sweden) has not been achieved in our series of histologically proved malignant and benign lesions. Diaphanography can be useful as a complementary technique in examination of the breast, but its potential as a single screening test appears limited.

Cancer in the "cold" breast thermogram.

The hallmark of the normal breast thermogram is relative symmetry of vascular configuration and thermal content with preservation of the breast contour. Accepted criteria of abnormality are predicated upon graphic and thermal asymmetry with emphasis placed upon elevated temperature, an increase in the number of discernible vessels, and distorted vascular patterns. The association of a confirmed breast cancer and an avascular thermogram has been labeled a false negative. Avascularity ("cold" breast), particularly in the lower half, with normal vessels in the same location of the opposite breast is suggested as an additional characteristic of abnormality. Illustrative cases are presented.

Criteria for obtaining and interpreting breast thermagrams.

The thermal and graphic criteria which should be used to evaluate breast thermograms are outlined. Thermograms are then categorized as normal, suspicious, or abnormal on the basis of the criteria outlined. It is hoped that these criteria can be used widely to standardize breast thermographic evaluation.