Thermography Articles 1

© 2011

Thermography Based Breast Cancer Detection Using Texture Features and Support Vector Machine

            (Acharya, Ng et al. 2010) Download

Breast cancer is a leading cause of death nowadays in women throughout the world. In developed countries, it is the most common type of cancer in women, and it is the second or third most common malignancy in developing countries. The cancer incidence is gradually increasing and remains a significant public health concern. The limitations of mammography as a screening and diagnostic modality, especially in young women with dense breasts, necessitated the development of novel and more effective strategies with high sensitivity and specificity. Thermal imaging (thermography) is a noninvasive imaging procedure used to record the thermal patterns using Infrared (IR) camera. The aim of this study is to evaluate the feasibility of using thermal imaging as a potential tool for detecting breast cancer. In this work, we have used 50 IR breast images (25 normal and 25 cancerous) collected from Singapore General Hospital, Singapore. Texture features were extracted from co-occurrence matrix and run length matrix. Subsequently, these features were fed to the Support Vector Machine (SVM) classifier for automatic classification of normal and malignant breast conditions. Our proposed system gave an accuracy of 88.10%, sensitivity and specificity of 85.71% and 90.48% respectively.

Amalu 2002 - A Review of Breast Thermography

         International Academy of Clinical Thermography

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Thermography: a holistic approach to breast screening

            (Anderson 2010) Download


Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer

            (Arora, Martins et al. 2008) Download

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.

The benefits and harms of screening for cancer with a focus on breast screening

            (Brodersen, Jorgensen et al. 2010) Download

The balance between benefits and harms is delicate for cancer screening programs. By attending screening with mammography some women will avoid dying from breast cancer or receive less aggressive treatment. But many more women will be overdiagnosed, receive needless treatment, have a false-positive result, or live more years as a patient with breast cancer. Systematic reviews of the randomized trials have shown that for every 2000 women invited for mammography screening throughout 10 years, only 1 will have her life prolonged. In addition, 10 healthy women will be overdiagnosed with breast cancer and will be treated unnecessarily. Furthermore, more than 200 women will experience substantial psychosocial distress for months because of false-positive findings. Regular breast self-examination does not reduce breast cancer mortality, but doubles the number of biopsies, and it therefore cannot be recommended. The effects of routine clinical breast examination are unknown, but considering the results of the breast self-examination trials, it is likely that it is harmful. The effects of screening for breast cancer with thermography, ultrasound or magnetic resonance imaging are unknown. It is not clear whether screening with mammography does more good than harm. Women invited to screening should be informed according to the best available evidence, data should be reported in absolute numbers, and benefits and harms should be reported using the same denominator so that they can be readily compared.


Predicting the cumulative risk of false-positive mammograms

            (Christiansen, Wang et al. 2000) Download

BACKGROUND: The cumulative risk of a false-positive mammogram can be substantial. We studied which variables affect the chance of a false-positive mammogram and estimated cumulative risks over nine sequential mammograms. METHODS: We used medical records of 2227 randomly selected women who were 40-69 years of age on July 1, 1983, and had at least one screening mammogram. We used a Bayesian discrete hazard regression model developed for this study to test the effect of patient and radiologic variables on a first false-positive screening and to calculate cumulative risks of a false-positive mammogram. RESULTS: Of 9747 screening mammograms, 6. 5% were false-positive; 23.8% of women experienced at least one false-positive result. After nine mammograms, the risk of a false-positive mammogram was 43.1% (95% confidence interval [CI] = 36.6%-53.6%). Risk ratios decreased with increasing age and increased with number of breast biopsies, family history of breast cancer, estrogen use, time between screenings, no comparison with previous mammograms, and the radiologist's tendency to call mammograms abnormal. For a woman with highest-risk variables, the estimated risk for a false-positive mammogram at the first and by the ninth mammogram was 98.1% (95% CI = 69.3%-100%) and 100% (95% CI = 99.9%-100%), respectively. A woman with lowest-risk variables had estimated risks of 0.7% (95% CI = 0.2%-1.9%) and 4.6% (95% CI = 1. 1%-12.5%), respectively. CONCLUSIONS: The cumulative risk of a false-positive mammogram over time varies substantially, depending on a woman's own risk profile and on several factors related to radiologic screening. By the ninth mammogram, the risk can be as low as 5% for women with low-risk variables and as high as 100% for women with multiple high-risk factors.

Thermography

            (Clark 1983) Download

Ten-year risk of false positive screening mammograms and clinical breast examinations

            (Elmore, Barton et al. 1998) Download

BACKGROUND: The cumulative risk of a false positive result from a breast-cancer screening test is unknown. METHODS: We performed a 10-year retrospective cohort study of breast-cancer screening and diagnostic evaluations among 2400 women who were 40 to 69 years old at study entry. Mammograms or clinical breast examinations that were interpreted as indeterminate, aroused a suspicion of cancer, or prompted recommendations for additional workup in women in whom breast cancer was not diagnosed within the next year were considered to be false positive tests. RESULTS: A total of 9762 screening mammograms and 10,905 screening clinical breast examinations were performed, for a median of 4 mammograms and 5 clinical breast examinations per woman over the 10-year period. Of the women who were screened, 23.8 percent had at least one false positive mammogram, 13.4 percent had at least one false positive breast examination, and 31.7 percent had at least one false positive result for either test. The estimated cumulative risk of a false positive result was 49.1 percent (95 percent confidence interval, 40.3 to 64.1 percent) after 10 mammograms and 22.3 percent (95 percent confidence interval, 19.2 to 27.5 percent) after 10 clinical breast examinations. The false positive tests led to 870 outpatient appointments, 539 diagnostic mammograms, 186 ultrasound examinations, 188 biopsies, and 1 hospitalization. We estimate that among women who do not have breast cancer, 18.6 percent (95 percent confidence interval, 9.8 to 41.2 percent) will undergo a biopsy after 10 mammograms, and 6.2 percent (95 percent confidence interval, 3.7 to 11.2 percent) after 10 clinical breast examinations. For every 100 dollars spent for screening, an additional 33 dollars was spent to evaluate the false positive results. CONCLUSIONS: Over 10 years, one third of women screened had an abnormal test result that required additional evaluation, even though no breast cancer was present. Techniques are needed to decrease false positive results while maintaining high sensitivity. Physicians should educate women about the risk of a false positive result from a screening test for breast cancer.

Breast thermography and cancer risk prediction

            (Gautherie and Gros 1980) Download

Thermography makes a significant contribution to the evaluation of patients suspected of having breast cancer. The obviously abnormal thermogram carries with it a high risk of cancer. This report summarizes the results of patients with questionable or stage Th III thermograms. From approximately 58,000 patients, most of whom had breast complaints, examined between August 1965 and June 1977, the conditions or a group of 1,245 women were diagnosed at initial examination as either normal or benign disease by conventional means, including physical examination, mammography, ultrasonography, and fine needle aspiration or biopsy, when indicated, but nevertheless categorized as stage Th III indicating a questionable thermal anomaly. Within five years, more than a third of the group had histologically confirmed cancers. The more rapidly growing lesions with shorter doubling times usually show progressive thermographic abnormalities consistent with the increased metabolic heat production associated with such cancers. Thermography is useful not only as a predictor of risk factor for cancer but also to assess the more rapidly growing neoplasms.

Mammography, thermography and xerography

            (Gershon-Cohen 1967) Download

Is screening for breast cancer with mammography justifiable?

            (Gotzsche and Olsen 2000) Download

BACKGROUND: A 1999 study found no decrease in breast-cancer mortality in Sweden, where screening has been recommended since 1985. We therefore reviewed the methodological quality of the mammography trials and an influential Swedish meta-analysis, and did a meta-analysis ourselves. METHODS: We searched the Cochrane Library for trials and asked the investigators for further details. Meta-analyses were done with Review Manager (version 4.0). FINDINGS: Baseline imbalances were shown for six of the eight identified trials, and inconsistencies in the number of women randomised were found in four. The two adequately randomised trials found no effect of screening on breast-cancer mortality (pooled relative risk 1.04 [95% CI 0.84-1.27]) or on total mortality (0.99 [0.94-1.05]). The pooled relative risk for breast-cancer mortality for the other trials was 0.75 (0.67-0.83), which was significantly different (p=0.005) from that for the unbiased trials. The Swedish meta-analysis showed a decrease in breast-cancer mortality but also an increase in total mortality (1.06 [1.04-1.08]); this increase disappeared after adjustment for an imbalance in age. INTERPRETATION: Screening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmo trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality.

The present status of mammary thermography

            (Haberman 1968) Download

Breast thermography is a noninvasive prognostic procedure that predicts tumor growth rate in breast cancer patients

            (Head, Wang et al. 1993) Download

Our recent retrospective analysis of the clinical records of patients who had breast thermography demonstrated that an abnormal thermogram was associated with an increased risk of breast cancer and a poorer prognosis for the breast cancer patient. This study included 100 normal patients, 100 living cancer patients, and 126 deceased cancer patients. Abnormal thermograms included asymmetric focal hot spots, areolar and periareolar heat, diffuse global heat, vessel discrepancy, or thermographic edge sign. Incidence and prognosis were directly related to thermographic results: only 28% of the noncancer patients had an abnormal thermogram, compared to 65% of living cancer patients and 88% of deceased cancer patients. Further studies were undertaken to determine if thermography is an independent prognostic indicator. Comparison to the components of the TNM classification system showed that only clinical size was significantly larger (p = 0.006) in patients with abnormal thermograms. Age, menopausal status, and location of tumor (left or right breast) were not related to thermographic results. Progesterone and estrogen receptor status was determined by both the cytosol-DCC and immunocytochemical methods, and neither receptor status showed any clear relationship to the thermographic results. Prognostic indicators that are known to be related to tumor growth rate were then compared to thermographic results. The concentration of ferritin in the tumor was significantly higher (p = 0.021) in tumors from patients with abnormal thermograms (1512 +/- 2027, n = 50) compared to tumors from patients with normal thermograms (762 +/- 620, n = 21). Both the proportion of cells in DNA synthesis (S-phase) and proliferating (S-phase plus G2M-phase, proliferative index) were significantly higher in patients with abnormal thermograms. The expression of the proliferation-associated tumor antigen Ki-67 was also associated with an abnormal thermogram. The strong relationships of thermographic results with these three growth rate-related prognostic indicators suggest that breast cancer patients with abnormal thermograms have faster-growing tumors that are more likely to have metastasized and to recur with a shorter disease-free interval.

Technology as a force for improved diagnosis and treatment of breast disease

            (Holloway, Easson et al. 2010) Download

Increasing numbers of women are seeking evaluation of screen-detected breast abnormalities, and more women with breast cancer are living with the consequences of treatment. Improved technologies have helped to individualize diagnostic evaluation and treatment, improve efficacy and minimize morbidity. This article highlights some of these technologies. Superior imaging techniques have improved breast cancer screening and show promise for intraoperative surgical guidance and postoperative specimen evaluation. Digital mammography improves the sensitivity of mammography for women younger than 50 years with dense breasts, and tomosynthesis may improve specificity. Magnetic resonance imaging provides sensitive delineation of the extent of the disease and superior screening for women with a greater than 25% lifetime risk of breast cancer Minimally invasive techniques have been developed for the assessment of intraductal lesions, biopsy of imaging abnormalities, staging of the axilla and breast radiotherapy. Ductoscopy facilitates intraductal biopsy and localization of lesions for excision, sentinel lymph node biopsy is becoming standard for axillary staging, and intraoperative radiotherapy has the potential to reduce treatment time and morbidity. Three-dimensional imaging allows correlation of final histology with preoperative imaging for superior margin assessment. Related techniques show promise for translation to the intraoperative setting for surgical guidance. New classifications of breast cancers based on gene expression, rather than morphology, describe subtypes with different prognoses and treatment implications, and new targeted therapies are emerging. Genetic fingerprints that predict treatment response and outcomes are being developed to assign targeted treatments to individual patients likely to benefit. Surgeons play a vital role in the successful integration of new technologies into practice.

Breast thermography after four years and 10000 studies

            (Isard, Becker et al. 1972) Download

Cancer in the "cold" breast thermogram

            (Isard 1976) Download

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.

False-positive results in the randomized controlled trial of mammographic screening from age 40 ("Age" trial)

            (Johns and Moss 2010) Download

BACKGROUND: False-positive recall is a recognized disadvantage of mammographic breast screening, and the rate of such recalls may be higher in younger women, potentially limiting the value of screening below age 50. METHODS: Attendance and screening outcome data for 53,884 women in the intervention arm of the U.K. Age trial were analyzed to report observed false-positive recall rates during 13 years of trial fieldwork. The Age trial was a randomized controlled trial of the effect of mammographic screening from age 40 on breast cancer mortality, conducted in 23 National Health Service screening centers between 1991 and 2004. Women randomized to the intervention arm were offered annual invitation to mammography from age 40 or 41 to age 48. RESULTS: Overall, 7,893 women (14.6% of women the intervention arm and 18.1% of women attending at least one routine screen) experienced one or more false-positive screen during the trial. The rates of false-positive mammography at first and subsequent routine screens were 4.9% and 3.2%, respectively. The cumulative false-positive rate over seven screens was 20.5%. Eighty-nine percent of women who had a false-positive recall at their previous screen attended their next invitation to routine screening. CONCLUSIONS: The rates of false-positive recall in the Age trial were comparable with the national screening program; however, the positive predictive value of referral was lower. Experiencing a false-positive screen did not seem to lessen the likelihood of re-attendance in the trial. IMPACT: The question of greatly increased false-positive rates in this age group and of their compromising re-attendance is refuted by the findings of this study.

A comparative review of thermography as a breast cancer screening technique

            (Kennedy, Lee et al. 2009) Download

Breast cancer is the most frequently diagnosed cancer of women in North America. Despite advances in treatment that have reduced mortality, breast cancer remains the second leading cause of cancer induced death. Several well established tools are used to screen for breast cancer including clinical breast exams, mammograms, and ultrasound. Thermography was first introduced as a screening tool in 1956 and was initially well accepted. However, after a 1977 study found thermography to lag behind other screening tools, the medical community lost interest in this diagnostic approach. This review discusses each screening tool with a focus brought to thermography. No single tool provides excellent predictability; however, a combination that incorporates thermography may boost both sensitivity and specificity. In light of technological advances and maturation of the thermographic industry, additional research is required to confirm the potential of this technology to provide an effective non-invasive, low risk adjunctive tool for the early detection of breast cancer.

Digital infrared thermal imaging (DITI) of breast lesions: sensitivity and specificity of detection of primary breast cancers

            (Kontos, Wilson et al. 2011) Download

AIM: To determine the sensitivity and specificity of digital infrared thermal imaging (DITI) in a series of women who underwent surgical excision or core biopsy of benign and malignant breast lesions presenting through the symptomatic clinic. MATERIALS AND METHODS: DITI was evaluated in 63 symptomatic patients attending a one-stop diagnostic breast clinic. RESULTS: Thermography had 90 true-negative, 16 false-positive, 15 false-negative and 5 true-positive results. The sensitivity was 25%, specificity 85%, positive predictive value 24%, and negative predictive value 86%. CONCLUSION: Despite being non-invasive and painless, because of the low sensitivity for breast cancer, DITI is not indicated for the primary evaluation of symptomatic patients nor should it be used on a routine basis as a screening test for breast cancer.


Hot fat in a cool man: infrared thermography and brown adipose tissue

            (Lee, Ho et al. 2011) Download

Predicting the risk of a false-positive test for women following a mammography screening programme

            (Njor, Olsen et al. 2007) Download

OBJECTIVES: The objectives of this study was to provide a simple estimate of the cumulative risk of a false-positive test for women participating in mammography screening. To test the method, we used data from two well-established, organized mammography screening programmes offering biennial screening to women aged 50-69 years in Copenhagen and Fyn, Denmark. METHODS: We defined the outcome from a screen as being either a false-positive test or not a false-positive test. We then tested whether the outcomes from subsequent screens were independent, and afterwards estimated the risk over 10 screens of a false-positive test, i.e. the risk of getting at least one false-positive test for a woman participating in all 10 screens typically offered in Europe. RESULTS: The outcomes of subsequent screens were found to be independent. After completion of screening rounds 3-5, the risk of a false-positive test over 10 screens was predicted to be 15.8-21.5% for a woman participating in the programme in Copenhagen, and 8.1-9.6% for a woman participating in the programme in Fyn. CONCLUSIONS: Our study showed that a relatively robust prediction of the risk of a false-positive test over 10 screens can be calculated in a simple way relatively early after the start of a mammography screening programme.

Thermography, a Canadian invention finding wider applications

         (Oliver 1977) Download

Efficacy of computerized infrared imaging analysis to evaluate mammographically suspicious lesions

            (Parisky, Sardi et al. 2003) Download

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.

Emerging controversies in breast imaging: is there a place for thermography?

            (Plotnikoff and Carolyn 2009) Download

The potential role of dynamic thermal analysis in breast cancer detection

            (Salhab, Keith et al. 2006) Download

BACKGROUND: It is presently well accepted that the breast exhibits a circadian rhythm reflective of its physiology. There is increasing evidence that rhythms associated with malignant cells proliferation are largely non-circadian. Cancer development appears to generate its own thermal signatures and the complexity of these signatures may be a reflection of its degree of development. The limitations of mammography as a screening modality especially in young women with dense breasts necessitated the development of novel and more effective screening strategies with a high sensitivity and specificity. The aim of this prospective study was to evaluate the feasibility of dynamic thermal analysis (DTA) as a potential breast cancer screening tool. METHODS: 173 women undergoing mammography as part of clinical assessment of their breast symptoms were recruited prior to having a biopsy. Thermal data from the breast surface were collected every five minutes for a period of 48 hours using eight thermal sensors placed on each breast surface [First Warning System (FWS), Lifeline Biotechnologies, Florida, USA]. Thermal data were recorded by microprocessors during the test period and analysed using specially developed statistical software. Temperature points from each contra-lateral sensor are plotted against each other to form a thermal motion picture of a lesion's physiological activity. DTA interpretations [positive (abnormal thermal signature) and negative (normal thermal signature)] were compared with mammography and final histology findings. RESULTS: 118 (68%) of participating patients, were found to have breast cancer on final histology. Mammography was diagnostic of malignancy (M5) in 55 (47%), indeterminate (M3, M4) in 54 (46%) and normal/benign (M1, M2) in 9 (8%) patients. DTA data was available on 160 (92.5%) participants. Using our initial algorithm, DTA was interpreted as positive in 113 patients and negative in 47 patients. Abnormal thermal signatures were found in 76 (72%) out of 105 breast cancer patients and 37 of the 55 benign cases. Then we developed a new algorithm using multiple-layer perception and SoftMax output artificial neural networks (ANN) on a subgroup (n = 38) of recorded files. The sensitivity improved to 76% (16/21) and false positives decreased to 26% (7/27) CONCLUSION: DTA of the breast is a feasible, non invasive approach that seems to be sensitive for the detection of breast cancer. However, the test has a limited specificity that can be improved further using ANN. Prospective multi-centre trials are required to validate this promising modality as an adjunct to screening mammography especially in young women with dense breasts.

Thermography as a predictor of prognosis in cancer of the breast

            (Sterns and Zee 1991) Download

Although thermography is generally considered to lack sufficient sensitivity to be a useful in diagnosis of cancer of the breast, the association of a thermal abnormality with some breast cancers cannot be discounted. Breast cancers demonstrating such a thermographic abnormality have been reported to be associated with decreased survival when compared with patients with no such change. In a study of 214 patients confirmed to have breast cancer without distant metastases, 121 were found to have a thermographic abnormality. Patients whose tumors were thermographically abnormal had significantly larger primary lesions and a higher proportion of metastatic axillary lymph nodes. However, both the 5-year survival and the 5-year disease-free survival were not significantly different from patients who had no thermographic abnormality.

Thermography. Its relation to pathologic characteristics, vascularity, proliferation rate, and survival of patients with invasive ductal carcinoma of the breast

            (Sterns, Zee et al. 1996) Download

BACKGROUND: The reason for the thermal abnormality associated with some breast cancers is unclear. We previously reported that a thermographic abnormality is associated with tumor size and lymph node involvement. Despite this association, we were unable to demonstrate an independent association between an abnormal thermogram and survival. METHODS: To expand our previous findings, we assessed patients undergoing liquid crystal (contact) thermography (LCT) to identify a basis for the thermal abnormality and its relationship to survival. We assessed 420 women with invasive ductal carcinoma (IDC) followed for a mean of 6.2 years. In a consecutive series of 181 patients from the overall group, vascularity was assessed using a Doppler ultrasound (US) and microvessel density (MVD) by immunohistochemical staining with Factor VIII-related antigen. The tumor proliferation rate was measured immunohistochemically using Ki-67 monoclonal antibody. RESULTS: An abnormal thermogram was found in 18.6% of patients with IDC. A significant association was demonstrated between an abnormal LCT and age, stage, lymph nodal status, size, grade, and estrogen receptor status. We found no association between a LCT abnormality and MVD or proliferation rate. There was a significant relationship with US-demonstrated vascularity. In multivariate analysis, we found that LCT abnormality was not an independent prognostic variable for either overall or disease free survival. CONCLUSIONS: An abnormal thermogram is associated with large tumor size, high grade, and lymph node positivity but not proliferation rate or MVD. It also may be associated with relatively large regional vessels that can be identified by US. However, thermography is not an independent prognostic indicator.

Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study

            (Wang, Chang et al. 2010) Download

BACKGROUND: The study was conducted to investigate the diagnostic performance of infrared (IR) imaging of the breast using an interpretive model derived from a scoring system. METHODS: The study was approved by the Institutional Review Board of our hospital. A total of 276 women (mean age = 50.8 years, SD 11.8) with suspicious findings on mammograms or ultrasound received IR imaging of the breast before excisional biopsy. The interpreting radiologists scored the lesions using a scoring system that combines five IR signs. The ROC (receiver operating characteristic) curve and AUC (area under the ROC curve) were analyzed by the univariate logistic regression model for each IR sign and an age-adjusted multivariate logistic regression model including 5 IR signs. The cut-off values and corresponding sensitivity, specificity, Youden's Index (Index = sensitivity+specificity-1), positive predictive value (PPV), negative predictive value (NPV) were estimated from the age-adjusted multivariate model. The most optimal cut-off value was determined by the one with highest Youden's Index. RESULTS: For the univariate model, the AUC of the ROC curve from five IR signs ranged from 0.557 to 0.701, and the AUC of the ROC from the age-adjusted multivariate model was 0.828. From the ROC derived from the multivariate model, the sensitivity of the most optimal cut-off value would be 72.4% with the corresponding specificity 76.6% (Youden's Index = 0.49), PPV 81.3% and NPV 66.4%. CONCLUSIONS: We established an interpretive age-adjusted multivariate model for IR imaging of the breast. The cut-off values and the corresponding sensitivity and specificity can be inferred from the model in a subpopulation for diagnostic purpose. TRIAL REGISTRATION: NCT00166998.

Thermography in screening for breast cancer

            (Williams, Phillips et al. 1990) Download

STUDY OBJECTIVE: The aim of the study was to determine whether thermography could be used to identify women with breast cancer or women at risk of developing the disease within five years. DESIGN: Women were screened for breast cancer and a documentary follow up was conducted five years later through general practitioner records. SETTING: The project involved Women resident in the Bath District Health Authority area, who were invited to attend a breast screening clinic. SUBJECTS: 10,238 women aged between 40 and 65 were screened. Of these, 4284 accepted personal letters of invitation from their general practitioners and 5954 volunteered to take part in the project in response to publicity; 9819 (96.5%) were traced after five years. MEASUREMENTS AND MAIN RESULTS: All the women had a thermographic and clinical examination of their breasts. If either examination was abnormal they were referred for mammography. Sensitivity of thermography was found to be 61% and specificity 74%. A documentary follow up of each woman was conducted five years later, when it was found that 71.6% of the women who developed breast cancer had had a normal thermogram at the time of examination, as did 73% of those who did not. CONCLUSIONS: Thermography is not sufficiently sensitive to be used as a screening test for breast cancer, nor is it useful as an indicator of risk of developing the disease within five years.


References

Acharya, U. R., E. Y. Ng, et al. (2010). "Thermography Based Breast Cancer Detection Using Texture Features and Support Vector Machine." J Med Syst.

Anderson, J. (2010). "Thermography: a holistic approach to breast screening." Beginnings 30(1): 12-3.

Arora, N., D. Martins, et al. (2008). "Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer." Am J Surg 196(4): 523-6.

Brodersen, J., K. J. Jorgensen, et al. (2010). "The benefits and harms of screening for cancer with a focus on breast screening." Pol Arch Med Wewn 120(3): 89-94.

Christiansen, C. L., F. Wang, et al. (2000). "Predicting the cumulative risk of false-positive mammograms." J Natl Cancer Inst 92(20): 1657-66.

Clark, R. M. (1983). "Thermography." CA Cancer J Clin 33(6): 370-2.

Elmore, J. G., M. B. Barton, et al. (1998). "Ten-year risk of false positive screening mammograms and clinical breast examinations." N Engl J Med 338(16): 1089-96.

Gautherie, M. and C. M. Gros (1980). "Breast thermography and cancer risk prediction." Cancer 45(1): 51-6.

Gershon-Cohen, J. (1967). "Mammography, thermography and xerography." CA Cancer J Clin 17(3): 108-12.

Gotzsche, P. C. and O. Olsen (2000). "Is screening for breast cancer with mammography justifiable?" Lancet 355(9198): 129-34.

Haberman, J. D. (1968). "The present status of mammary thermography." CA Cancer J Clin 18(6): 315-21.

Head, J. F., F. Wang, et al. (1993). "Breast thermography is a noninvasive prognostic procedure that predicts tumor growth rate in breast cancer patients." Ann N Y Acad Sci 698: 153-8.

Holloway, C. M., A. Easson, et al. (2010). "Technology as a force for improved diagnosis and treatment of breast disease." Can J Surg 53(4): 268-77.

Isard, H. J. (1976). "Cancer in the "cold" breast thermogram." AJR Am J Roentgenol 127(5): 793-6.

Isard, H. J., W. Becker, et al. (1972). "Breast thermography after four years and 10000 studies." Am J Roentgenol Radium Ther Nucl Med 115(4): 811-21.

Johns, L. E. and S. M. Moss (2010). "False-positive results in the randomized controlled trial of mammographic screening from age 40 ("Age" trial)." Cancer Epidemiol Biomarkers Prev 19(11): 2758-64.

Kennedy, D. A., T. Lee, et al. (2009). "A comparative review of thermography as a breast cancer screening technique." Integr Cancer Ther 8(1): 9-16.

Kontos, M., R. Wilson, et al. (2011). "Digital infrared thermal imaging (DITI) of breast lesions: sensitivity and specificity of detection of primary breast cancers." Clin Radiol 66(6): 536-9.

Lee, P., K. K. Ho, et al. (2011). "Hot fat in a cool man: infrared thermography and brown adipose tissue." Diabetes Obes Metab 13(1): 92-3.

Njor, S. H., A. H. Olsen, et al. (2007). "Predicting the risk of a false-positive test for women following a mammography screening programme." J Med Screen 14(2): 94-7.

Oliver, C. (1977). "Thermography, a Canadian invention finding wider applications." Can Med Assoc J 117(6): 680, 683-5.

Parisky, Y. R., A. Sardi, et al. (2003). "Efficacy of computerized infrared imaging analysis to evaluate mammographically suspicious lesions." AJR Am J Roentgenol 180(1): 263-9.

Plotnikoff, G. and T. Carolyn (2009). "Emerging controversies in breast imaging: is there a place for thermography?" Minn Med 92(12): 37-9, 56.

Salhab, M., L. G. Keith, et al. (2006). "The potential role of dynamic thermal analysis in breast cancer detection." Int Semin Surg Oncol 3: 8.

Sterns, E. E. and B. Zee (1991). "Thermography as a predictor of prognosis in cancer of the breast." Cancer 67(6): 1678-80.

Sterns, E. E., B. Zee, et al. (1996). "Thermography. Its relation to pathologic characteristics, vascularity, proliferation rate, and survival of patients with invasive ductal carcinoma of the breast." Cancer 77(7): 1324-8.

Wang, J., K. J. Chang, et al. (2010). "Evaluation of the diagnostic performance of infrared imaging of the breast: a preliminary study." Biomed Eng Online 9: 3.

Williams, K. L., B. H. Phillips, et al. (1990). "Thermography in screening for breast cancer." J Epidemiol Community Health 44(2): 112-3.