Report: Breast Digital Infra-red Imaging (Thermography) and its use in Naturopathic Practice
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
The Canadian Association of Naturopathic Doctors (CAND) is the national not for profit organization
representing naturopathic doctors in Canada. The CAND Report is designed to provide an understanding of the
uses, safety and limitations of breast digital infra-red imaging, known most commonly as thermography, as it
relates to naturopathic practice in Canada.
Thermography provides an additional and unique window into the assessment of breast health and function.
Like clinical breast examination (CBE), ultrasound and mammography, thermography cannot be used as a
stand-alone technique to differentiate between benign and malignant breast conditions. Nor can it give
information about the location and size of a tumour to guide biopsy. However, when used in combination
with these other breast assessment tools, thermography has been shown to increase the sensitivity of breast
cancer detection, to assist in guiding and monitoring breast cancer treatment and to provide valuable
information with respect to prognosis. See Appendix A: Comparison of Breast Health Assessment Tools
The main value of thermography in the field of naturopathic medicine is that it provides an early warning
sign of breast health dysfunction. This early detection provides an opportunity to address early and often
subtle physiological change and to improve breast tissue functionality. As well, it provides an added impetus
for more attentive monitoring where indicated. The strengths of thermography are multi-faceted and make
it an effective tool for naturopathic doctors to use when assessing the functionality and health status of breast
tissue.
Definition
Thermology, more accurately referred to as digital infrared imaging (DII), is a patho-physiologic discipline
that is completely non-contact and involves no form of energy or radiation imparted onto or into the body.
It derives functional physiological information by measuring the temperature emanating up through tissue
to the surface of the skin. These temperature readings are taken by infrared cameras that create detailed
thermographic infrared images of the parts of the human body assessed.
Thermography relies on the principle that all objects with a temperature above absolute zero emit
electromagnetic waves. These temperature waves are emitted at wavelengths between 0.8mm and 1.0mm.
Differences in “heat” waves are highlighted when a “cold challenge” is used as part of the process. The
variances in “heat” waves demonstrate physiological differences in the body and provide information that
can be created for visualization and quantification.
History and Certification Status
The first electronic infrared sensors were developed in the 1950's for military intelligence. The early medical
thermologists worked in the fields of breast oncology, vascular medicine or neurology. The first non-military
use started in the 1960s when the application of thermography was evaluated as a breast cancer assessment
tool. What was discovered was that women with breast cancer characteristically produced thermograms
showing aberrant high-energy blood vessels overlying the tumour. More recently it was established that these
heat patterns are the result of hyperemia produced by the dysregulation of core body-temperature blood
flowing to a relatively superficial area in the female breast. Retrospective analysis has revealed that about
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 1 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
90% of cancers exhibit high vascular density and hyperthermia. The technology behind digital infrared
imaging has significantly advanced over the years. Current-day high-quality cameras have thousands of
reference points that read heat patterns simultaneously. The technology has advanced to the point that it is
possible to decipher temperature differences as little as 0.05 degrees.
The medical use of infrared imaging systems has been regulated by the US Food and Drug Administration
under Title 21, Parts 800-898 of the Code of Federal Regulations since 1976. There is a concern with this
regulation as it only requires the infrared imaging system be “substantially equivalent to devices legally
marketed in interstate commerce prior to the May 28, 1976 enactment of the Medical Devices Amendment
to the Federal Food, Drug and Cosmetic Act.” Thermography is currently not regulated in Canada.
Since the 1970s the advancements in technological developments in both the hardware and software for
infrared imaging systems has paralleled the advancements in other areas of technology such as the computer
and phone industries. While some companies have kept pace with these advances others have not. As a result
the thermographic equipment currently available ranges from those with very low standards to those that
truly qualify as a medical device under current legislation. The lack of standardization and variability of
devices is still an area of weakness within the field of thermography as some practitioners and companies are
using equipment that does not meet the standards set by The American Academy of Thermology.
Since the 1980’s, Digital Infrared Thermography has evolved and its use in human health care has expanded
to include: breast tissue physiology, cardiology/vascular physiology, chiropractic, dentistry, neurology,
occupational medicine, orthopedics and pain management. The focus of this report is its use as it relates to
breast health assessment in a naturopathic practice.
As of March 2013, certification has not yet been established in Canada. The American Academy of
Thermology (AAT - www.americanacademyofthermology.org) was founded in 1971 to provide independent
certification at a professional level with respect to the qualifications of thermography technicians and
equipment standards. Professional certified thermography / thermology includes:
• Standards with respect to approved thermography equipment (temperature regulated radiometric
cameras, specialized computers and specified computer programs) all certified for medical scanning
under regulated conditions.
• Standardized and specified preparation of the patient with exposure to regulated temperatures.
• Specified regulated conditions of the clinic where the scanning is performed.
• Cold-challenge to the autonomic nervous system incorporated in testing.
• AAT certified technician taking the scan.
• AAT certified thermologist reading the scan using the Marseilles System.
• Professional reports provided to the patient’s ND or other health professional.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 2 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
Methodology
To provide a useful, reliable and repeatable evaluation of breast health, stringent standards for patient
preparation, scanning and reading of the scans must be adhered to. The reliability of any thermography
report depends on three criteria: the quality and type of camera used, the process used for the thermographic
screening including whether or not a cold challenge is included, and the standards used to interpret the
results.
1. Camera Selection
The camera or infrared imaging system that is used determines the specificity and the information that is
acquired. Generally speaking, cameras fall into two categories: thermal imagers and radiometric infrared
cameras.
• Thermal imagers typically produce a non-calibrated (non-quantified) analog or digital output signal
based upon the level of infrared energy emitted by the body. This type of camera is limited in
functionality and is significantly less costly. It is only valuable as a speculative tool in qualitative
applications. Thermal imagers are often unreliable between calibrations due to the temperature
variations (thermal drift) that occur on an ongoing basis. Another concern is that temperature readings
are made based on comparing the energy emitted from the body to an external thermal image versus
assessing temperature differences within the body itself. There are no standards for interpreting the
results from thermal imagers. For the above reasons, thermal imagers are not recommended as part of a
naturopathic breast health assessment.
• Radiometric infrared cameras operate in a manner that is significantly different from thermal imagers.
Radiometric cameras perform the quantitative thermal measurements of a patient's emitted infrared
energy within the firmware of the camera by continuously calculating digital temperature measurements
through a large thermal span and not just scaled to two externally calibrated temperature standards.
Because radiometric infrared cameras also provide for thermal drift compensation, the temperature
measurements are stable and accurate at all points within the camera operating temperature range (i.e.
the values do not “float” as with non-calibrated imaging cameras). Therefore, radiometric infrared
cameras are the instrument of choice as they produce quantified digital temperature measurements
internally and output this data to the computer rather than requiring the computer’s software to
perform an interpolation of the temperature values measured. Additionally, results from radiometric
infrared cameras can be read using the standardized Marseille system to grade the thermology reading.
2. Thermography Process
There is a standardized process that all certified thermologists must follow in order to ensure the
accuracy of their results and to ensure that individual limitations are appropriately considered.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 3 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
For clarification of the process refer to the American Academy of Thermology
(www.americanacademyofthermology.org). Key aspects of the process include:
• Images taken. Professional digital infrared breast thermography scans need to be carried out by a
certified technician. The images taken include two bilateral and one frontal shot, then a cold-challenge
for one minute followed by taking the same three images post challenge, all under regulated conditions,
i.e. room temperature 21°C etc.
• Cold Challenge. A cold-challenge refers to the immersion of the hands into cool water (11°C) for 1
minute between the two sets of images. This “cold water challenge” has been demonstrated as a
powerful component of the quantitative and objective analysis of breast thermography.
Please note: A premise of thermology is that the heat signature of the breasts’ blood vessels reduces
normally when an autonomic nervous system challenge is evoked by a cold challenge. Normal blood
vessels contain smooth muscles controlled by the autonomic nervous system. Before a malignant
tumour forms, there are early changes in the regional blood vessels caused by the nitric oxide
production of dysplastic cells. This results in vasodilation that is resistant to normal regulation by the
autonomic nervous system. As tumours reach a certain size (perhaps as small as 3mm or 1/8”) and need
more nutrient-carrying blood to keep growing, they initiate development of neoangiogenic blood vessels
which remain hot as they do not respond to commands from the nervous system to cool. The cold
challenge used in thermography assesses whether or not the breast is cooling down normally.
Thermography results may also indicate dysregulation in normal blood vessels due to other factors such
as fibrocystic breast issues or other possible patho-physiologic changes.
3. Interpretation Standards
The pre and post scans are analyzed by certified thermologists using an established system. Currently
the Marseilles System, which has been used internationally since 1975, is the only established objective
system for interpreting results acquired from radiometric infrared cameras. This system provides for a
TH-1 – TH-5 scale as a summary based upon specific, objective and quantitative thermal features and
differential levels of infrared energy. See Appendix B for details of the Marseille Rating System. Scans are
also compared to a patient’s previous scans to assess the progress of breast health or dysfunction and a
standardized report is provided.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 4 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
Strengths and Limitations of Thermography
Strengths
The main value of thermography is that it provides an early warning sign of breast tissue dysfunction
and subtle physiological changes in breast health, signalling an added impetus for more attentive
monitoring and remedial naturopathic treatment programs.
Thermography is not affected by age and hence may provide an advantage over other assessment tools
for younger women (under the age of 50 years). Mammography, for example, has low specificity and is
not recommended for women under the age of 50.
Thermography can be used with men and for those with dense or fibrotic breast tissue as it is not
influenced by tissue density or breast size and shape.
For younger individuals (those in their 20s and 30s) where there is a concern about breast tissue
function, thermography is a safe assessment tool for watching breast tissue changes without repeated
radiation exposure.
Thermography may detect signs of neoangiogenic vessels that feed small cancers and of faster growing,
more aggressive cancers at an earlier stage than other detection modalities.
Thermography may detect tumours with a high growth rate and hence it has been proposed that
thermography may have a role to play with respect to health risk and prognosis.
Thermography has been shown to enhance the ability of other breast cancer detection modalities, which
rely on anatomical changes. Combining clinical exam and thermography with mammography and/or
ultrasound can increase accuracy of the findings.
Thermography is beneficial in the detection of breast tissue changes or dysfunction such as benign
breast lesions, including abscess, adenosis, cysts, duct stasis, fat necrosis, fibroadenomas, fibrocystic
breast disease and inflammatory breast conditions.
Limitations
Inconsistency in methodology between various styles of cameras, differences in processes followed (cold
challenge versus non-cold challenge) and a vast range of standards with respect to interpretation have
led to variations in research results and in individual studies.
The high-rate of false-positive results continues to be the greatest criticism of thermography. Yet,
follow-up studies indicate that it can take up to 10 years for other diagnostic tools, such as
mammograms, to confirm a diagnosis of breast cancer that initially showed up as an abnormal
thermoscan.
Thermography does not distinguish between cysts and benign or malignant tumours. It differentiates
between normal physiologic breast tissue and diseased tissue.
Thermography does not provide location or indicate depth or size of tumour.
Tumours without active angiogenesis, i.e., “cold” tumours, are not detectible by thermography.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 5 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
Larger, multi centre studies and meta-analyses specifically looking at thermography would assist in
guiding clinicians on how best to use thermography in practice.
The variation in equipment standards and in tight government regulations continues to hamper
thermography.
Recommended Uses for Breast Thermography in Naturopathic Practice
The main value of thermography is that it may provide an early warning sign of subtle physiological
changes to breast tissue, thus providing an added impetus for more attentive monitoring and remedial
naturopathic treatments.
Thermography may be an effective tool for assessing functional changes in breast tissue and monitoring
progression or regression of such changes as well as evaluating tissue status post biopsy, post
lumpectomy and post mastectomy.
Thermography is a safe, adjunctive assessment tool that can be used along with CBE, ultrasound and
mammography in the monitoring of breast health.
Thermography can be a useful tool during cancer treatments as the presence or absence of
hypervascularity and hyperthermia directly relates to the success of chemotherapy and the prediction of
survival rates.
Thermography may be a valuable tool for predicting several different types/stages of cancer, such as
DCIS, medullary carcinoma and infiltrating ductal carcinoma.
Appendices
Appendix A – Comparison of Breast Health Assessment Tools
Appendix B – Marseille Rating System
Thermography Task Force
Dr. Iva Lloyd, ND
Dr. Verna Hunt, ND **
Dr. Patricia Wales, ND
Dr. Nicole Daniels, ND
** Disclosure: Dr. Hunt was the co- founder and owner of Medical Thermography International (MTI) between
2001 and 2004. Since that date she has been working with MTI as their naturopathic medical advisor.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 6 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
References
1. Amalric R, Giraud D, Altschuler C, Amalric F, Spitalier JM, Brandone H, Ayme Y, Gardiol AA.
Does infrared thermography truly have a role in present-day breast cancer management? Progress in
Clinical and Biological Research. 1982;107:269-278.
2. Amalric R., Giraud D., Altschule C. Spitalier J.M. Value and interest of dynamic telethermography in
detection of breast cancer. ACTA Thermographica. 1976;1(2):89-96.
3. Amalu WC. Nondestructive testing of the human breast: the validity of dynamic stress testing in medical
infrared breast imaging. Conference Proceedings IEEE English Medical Biology Society.
2004;2:1174-7.
4. Anbar M. (1994) Quantitative Dynamic Telethermometry in Medical Diagnosis and Management.
CRC Press. Boca Raton. Ch 2, p87.
5. Arena F, B.C., DiCicco T. Use of digital infrared imaging in enhanced breast cancer detection and
monitoring of the clinical response to treatment. Engineering in Medicine and Biology Society. (2003)
Proceedings of the 25th Annual International Conference of the IEEE. 2003;2:112-1132.
6. Arora N, Martins D, Ruggerio D, Tousimis E, Swistel AJ, Osborne MP, Simmons RM. Effectiveness
of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. American
Journal of Surgery. 2008;196(4):523-526.
7. Davey JB, Greening WP, McKinna JA. Is screening for cancer worthwhile? Results from a well-woman
clinic for cancer detection. British Medical Journal. 1970;3(5724):696-699.
8. Dereniak EL, Boreman GD. (1996) Infrared detectors and systems. John Wiley & Sons, New York.
9. Dodd GD, Wallace JD, Freundlich IM, Marsh L, Zermino A. Thermography and cancer of the
breast. Cancer. 1969;23(4):797-802.
10. Draper JW, Jones CH. Thermal patterns of the female breast. British Journal of Radiology.
1969;42(498):401-410.
11. Fitzgerald A. and Berentson-Shaw J. Thermography as a screening and diagnostic tool: a systematic
review. New Zealand Medical Journal. 2012;125(1351):80-91.
12. Folkman J. Tumor angiogenesis: therapeutic implications. The New England Journal of Medicine.
1971;285(21):1182-1186. (abstract)
13. Gamagami P, Silverstein MJ, Waisman JR. Infra-red Imaging in Breast Cancer. Engineering in
Medicine and Biology Society. (1997) Proceedings of the 19th Annual International Conference of the
IEEE. 1997; 2:677-680.
14. Gautherie M, Gross CM. Breast thermography and cancer risk prediction. Cancer. 1980;45(1):51-56.
15. Gautherie M. Thermopathology of Breast Cancer: Measurement and Analysis of In Vivo Temperature
and Blood Flow. Annals of the New York Academy of Sciences. 1980;335(1):383-415.
16. Gautherie M, Haehnel P, Walter JP, Keith LG. Long-term assessment of breast cancer risk by liquid-
crystal thermal imaging. Progress in Clinical & Biological Research. 1982;107:279-301.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 7 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
17. Gautherie M, Haehnel P, Walter J, Keith LG. Thermovascular changes associated with in situ and
minimal breast cancers. Results of an ongoing prospective study after four years. Journal of Reproductive
Medicine. 1987;32(11):833-842.
18. Gershon-Cohen J, Haberman-Brueschke JD, Brueschke EE. Medical thermography: a summary of
current status. Radiologic Clinics of North America. 1965;3(3):403-431.
19. Geser HM, Boesinger P, Stucki D, Landolt C. Computer Assisted Dynamic Breast Thermography.
Thermology. 1987;2:538-544.
20. Gohagan JK, Rodes ND, Blackwell CW, Darby WP, Farrell C, Herder T, Pearson DK, Spitznagel
EL, Wallace MD. Individual and combined effectiveness of palpation, thermography, and mammography
in breast cancer screening. Preventative Medicine. 1980;9(6):713-21.
21. Head JF, Wang F, Elliott RL. Breast thermography is a non invasive prognostic procedure that predicts
tumor growth rate in breast cancer patients. Annals of the New York Academy of Sciences.
1993;698:153-158.
22. Head JF, Wang F, Lipari CA, Elliott RL. The Important Role of Infrared Imaging in Breast Cancer:
New Technology Improves Applications in Risk Assessment, Detection, Diagnosis and Prognosis. IEEE
Eng. Med. Biol. 2000;19:52-57.
23. Head JF, Lipari CA, Elliott RL. Determination of Mean Temperatures of Normal Whole Breast and
Breast Quadrants by Infrared Imaging and Image Analysis. Proc. IEEE Eng. Med. Biol. (2001)
23:666(CDROM).
24. Hoekstra PP. The autonomic challenge and breast thermology. Thermology International.
2004;(14):3,106.
25. Hoekstra PP. The Status and Future of Diagnostic Infrared Imaging for Breast Cancer. Townsend
Letter. February 2012.
26. Hoekstra PP, Steffek A. A Review of the History of Thermography in Breast Cancer: Detection-Part I:
Thermography Facts and Statistics. Thermography International. 2013:23(1).
27. Hoekstra PP, Steffek A. A Review of the History of Thermography in Breast Cancer: Detection-Part II:
Thermography Facts and Statistics. Thermography International. 2013:23(2).
28. Hofvind S, Thoresen S, Tretli S. The cumulative risk of a false-positive recall in the Norwegian Breast
Cancer Screening Program. Cancer. 2004;101(7):1501-1507.
29. Humphrey LL, Helfand M, Chan BKS, Woolf SH. Breast Cancer Screening: A Summary of the
Evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine.
2002;137(5_Part_1):347-360.
30. Isard HJ, Becker W, Shilo R, Ostrum BJ. Breast Thermography After Four Years and 10,000 Studies.
American Journal of Roentgenology, Radium Therapy, and Nuclear Medicine. 1972;115(4):811-
821. (abstract)
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 8 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
31. Isard HJ, Sweitzer CJ, Edelstein GR. Breast thermography. A prognostic indicator for breast cancer
survival. Cancer. 1988;62(3):484-488.
32. Jones, B. A reappraisal of the use of infrared thermal image analysis in medicine. IEEE Transactions on
Medical Imaging. 1998;17(6):1019-1027.
33. Kenney D, Lee T, Seely D. A Comparative Review of Thermography as a Breast Cancer Screening
Technique. Integrative Cancer Therapies. 2009;8(1):9-16.
34. Keyserlingk JR, Ahlgren PD, Yu E, Belliveau N, Yassa M. Functional infrared imaging of the breast.
IEEE Engineering in Medicine and Biology. 2000;19(3):30-41.
35. Keyserlingk JR, Ahlgren PD, Yu E, Belliveau N. Infrared Imaging of the Breast: Initial Reappraisal
Using High-Resolution Digital Technology in 100 Successive Cases of Stage I and II Breast Cancer. The
Breast Journal. 1998;4(4):245-251.
36. Koay J, Herry C, Frize M. Analysis of breast thermography with an artificial neural network. In:
Engineering in Medicine and Biology Society. (2004) IEMBS '04. 26th Annual International
Conference of the IEEE. 2004.
37. Kolb T, Lichy J, Newhouse J. Comparison of the performance of screening mammography, physical
examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient
evaluations. Radiology 2002;225(1):165-175.
38. Konerding MA & Steinberg F. Computerized infrared thermography and ultrastructural studies of
xenotransplanted human tumors on nude mice. Thermology. 1988;3:7-14.
39. Kontos M, Wilson R, Fentiman I. Digital infrared thermal imaging (DITI) of breast lesions: sensitivity
and specificity of detection of primary breast cancers. Clinical Radiology. 2011;Jun 66(6):536-9.
40. Lapayowker MS, Kundel HL, Ziskin M. Thermographic patterns of the female breast and their
relationship to carcinoma. Cancer. 1971;27:819.
41. Lawson R. Implications of surface temperatures in the diagnosis of breast cancer. Canadian Medical
Association Journal. 1956;75:309-310.
42. Lloyd-Williams K, Lloyd-Williams FJ, Handley RS. Infra-red thermometry in the diagnosis of breast
disease. Lancet. 1961;2(7217):1378-1381.
43. Lloyd Williams K, Phillips BH, Jones PA, Beaman SA, Fleming PJ. Thermography in screening for
breast cancer. Journal of Epidemiology and Community Health. 1990; 44(2):112-113.
44. Loibl, S. Buck A, String C. et al. The role of early expression of inducible nitric oxide synthase in human
breast cancer. European Journal of Cancer. 2005;41(2):265-271.
45. Ohashi Y, Uchida I. Applying dynamic thermography in the diagnosis of breast cancer. IEEE
Engineering in Medicine and Biology. 2000;19(3):42-51.
46. Ohsumi S, Takashima S, Aogi K, Usuki H. Prognostic value of thermographical findings in patients
with primary breast cancer. Breast Cancer Research and Treatment. 2002;74(3):213-220.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 9 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
47. Martin JHJ, Begum S, Alalami O, Harrison A, Scott KWM. Endothelial nitric oxide synthase:
correlation with histologic grade, lymph node status and estrogen receptor expression in human breast
cancer. Tumor Biol. 2000;21:90-97.
48. Negri S, Bonetti F, Capitanio A, Bonzanini M. Preoperative diagnostic accuracy of fine-needle
aspiration in the management of breast lesions: comparison of specificity and sensitivity with clinical
examination, mammography, echography, and thermography in 249 patients. Diagnostic
Cytopathology. 1994;11(1):4-8.
49. Ng EY, Ung LN, Ng FC, Sim LS. Statistical analysis of healthy and malignant breast thermography.
Journal of Medical Engineering & Technology. 2001;25(6):253-263.
50. Ng EY, Sudharsan NM. Computer simulation in conjunction with medical thermography as an adjunct
tool for early detection of breast cancer. BMC Cancer. 2004;4:17.
51. Parisky YR, Sardi A, Hamm R, Hughes K, Esserman L, Rust S, Callahan K. Efficacy of computerized
infrared imaging analysis to evaluate mammographically suspicious lesions. AJR. 2003;180(1):263-269.
52. Parisky YR, Skinner KA, Cothren R, DeWittey RL, Birbeck JS, Conti PS, Rich JK, Dougherty WR.
Computerized thermal breast imaging revisited: an adjunctive tool to mammography. In Engineering in
Medicine and Biology Society. (1998) Proceedings of the 20th Annual International Conference of
the IEEE.
53. Reveneau G, Arnould L, Jolimoy G, Hilpert S, JeJeune P, Saint-Giorgio V, Belichard C, Jeannin
J.F. Nitric oxide synthase in human breast cancer is associated with tumor grade, proliferation rate, and
expression of progesterone receptors. Laboratory Investigation. 1999;79(10):1215-1225. (abstract)
54. Spitalier JM, Clerc S, Levraud J, Pollet JF, Medina M, Amalric R, Fondarai J, Thermography and
future of operable breast cancers. Acta Thermographica. 1978;3:100–106.
55. Spitalier JM, Brandone H, Duarte J, El-Ghazawy IMH, Amalric R, Giraud D, Altschuler C,
Magami P, Kurtz JM. The Importance of Infrared Thermography in the Early Suspicion and Detection
of Minimal Breast Cancer, in Thermal Assessment of Breast Health (Proceedings of an International
Conference). MTP Press Ltd. 1983, 173-179.
56. Stark A. The value of risk factors in screening for breast cancer. European Journal of Surgical
Oncology. 1985;11(2):147-150. (abstract)
57. Stark AM, Way S. The use of thermovision in the detection of early breast cancer. Cancer.
1974;33(6):1664-70.
58. Sterns EE, Curtis AC, Miller S, Hancock JR. Thermography in breast diagnosis. Cancer.
1982;50(2):323-325.
59. Sterns EE, Zee B, SenGupta S, Saunders FW. Thermography. Its relation to pathologic characteristics,
vascularity, proliferation rate, and survival of patients with invasive ductal carcinoma of the breast.
Cancer. 1996;77(7):1324-1328.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 10 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
60. Thomsen LL, Miles DW, Happerfield L, Bobrow LG, Knowles RG, Moncada S. Nitric oxide
synthase activity in human breast cancer. British Journal of Cancer. 1995 July;72(1):41-44.
61. Threatt B, Norbeck JM, Ullman NS, Kummer R, Roselle PF. Thermography and breast cancer an
analysis of a blind reading. Annals of the New York Academy of Sciences. 1980;335:501-527.
62. Ulmer HU, Brinkmann M, Frischbier HJ. Thermography in the follow-up of breast cancer patients
after breast-conserving treatment by tumorectomy and radiation therapy. Cancer. 1990;65(12):2676-80.
63. van Dam PA, van Goethem ML, Kersschot E, Vervliet J, Van den Veyver IB, De Schepper A,
Buytaert P. Palpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions.
Radiology. 1988;166(2):435-439. (abstract)
64. Wishart GC, Campisi M, Boswell M, Chapman D, Shackleton V, Iddles S, Hallett A, Britton PD.
The accuracy of digital infrared imaging for breast cancer detection in women undergoing breast biopsy.
European Journal of Surgical Oncology. 2010;36(6):535-540.
65. Yahara T, Koga T, Yoshida S, Nakagawa S, Deguchi H, Shirouzu K. Relationship between microvessel
density and thermographic hot areas in breast cancer. Surgery Today. 2003;33(4):243-248.
66. US Food and Drug Administration. Code of Federal Regulations: Medical Devices Amendment to the
Federal Food, Drug and Cosmetic Act. (1976) Title 21, Parts 800-898.
Report: Breast Digital Infra-red Imaging (Thermography) & use in Naturopathic Practice May 2013 11 of 11Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
Appendix A: Comparison of Breast Health Assessment Tools
The following Table outlines the pros and cons of the main breast health assessment tools.
Testing Methods Uses Pros Cons
Self Breast Exam Monitor breast tissue changes Consistent monthly monitoring Women who do not know what
(SBE) individually. helps women be familiar with they are looking for can evoke
their breasts and changes that anxiety. 1
occur routinely.
Clinical Breast Exam Recommended every three years Low cost, easily repeatable, part of Only effective after a lesion has
(CBE) for women 18 – 39 years old, and annual physical medical exam. grown large enough to be
every year for women 40 and old. 2
palpable.
No standardized method of
Sensitivity: ~40 to 70% 2 charting findings.
Specificity: ~85 – 95%2
Digital Infra-red Uses infrared sensors to detect heat No radiation. No contact. Non- Does not differentiate between
Imaging and increased vascularity invasive, low cost, easily & safely benign and malignant
(Thermography) (angiogenesis). repeatable. conditions. 9
Sensitivity: ~80 to 85% 3 Not influenced by tissue density, Cannot provide specific location
breast size and shape, age, breast 9
Specificity: ~65% to 80%3 or size of a tumor.
implants. Can identify lesions of
all sizes. 4 High false positive rate (caveat:
may be an early warning sign). 10
Early warning sign. Indicates
functional changes in breast tissue Cold and slow growing tumors
before other methods detect may be missed. 11
pathology. 5
Ability to detect fast-growing,
aggressive tumours. 6
May provide an indicator of high
risk patients, tumor growth rate,
prognosis, survival rate and
probable success of
chemotherapy. 7
Enhances other breast cancer
detection modalities. 8
Ultrasound High frequency sound waves are No radiation, non-invasive, Limited use as stand-alone test.
bounced off the breast tissue and harmless.
collected as an echo to produce an
image. Provides information on the
location and size of an
12
Sensitivity: ~80 – 85% 12 abnormality.
Specificity: ~65%12
Good at distinguishing solid
12
masses from fluid-filled cysts.
Mammograms Passes radiation through the breast Structural imaging with ability to In most women, the medial
to produce an image. locate the area of suspicious tissue upper triangle, areas next to the
chest wall, and the infra-
Recommended every two years, for Can detect tumors in the pre- mammary sulcus cannot be
women aged 50 to 74. invasive stage of mainly slow- 12
visualized with accuracy.Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
Appendix A: Comparison of Breast Health Assessment Tools
12
growing cancers.
Cannot detect exponentially
12 fast-growing tumors in the pre-
Sensitivity: 60-96%
12
~80% in women over age 50. invasive stage.
~60% in women under age 50.
12 Sensitivity is lower in women
Specificity: ~66 - 75%
~80% of all mammogram under 40 years of age and in
initiated biopsies are negative. those with large, dense or
12
fibrocystic breasts.
High false-positive rate ranging
12
from 20 to 56%.
Concern that repeated
mammograms may increase risk
of breast cancer due to repeated
12
radiation exposure.
There are a wide range of factors that impact functional and structural changes including age, menstruation,
pregnancy, lactation, menopause, breast tissue density, oral contraceptives, hormone replacement therapies,
other hormonal treatments, breast implants, previous biopsies, breast tissue density, concurrent health
concerns, inflammation and infection, type of breast pathology both benign and malignant, as well as
provider evaluation and follow-up practices. The best breast assessment tool is dependent on the factors above
and on the strengths and limitations of each technique or tool as no one tool is 100% effective at screening
for breast cancer or other breast health conditions on its own. In fact, a biopsy is the only test that can
determine if a suspected tissue area is cancerous – all other methods can only identify suspicious areas.
The goal of screening should be to use the assessment method(s) most likely to afford accurate early detection
and therefore long-term protection against development of a disease.
Sources
Medical Thermography Intl. Inc. Mammography / Thermography / US. What different information is obtained.
Accessed March 2013 www.medthermonline.com.
References
1
Humphrey (2002)
2
Davey (1970)
3
Hoekstra (2013)
4
Wishart (2010), Keyserlingk (1998), Spitalier (1983), Stark (1974), Dodd (1969)
5
Gamagami (1997), Stark (1985), Amalric (1982), Spitalier (1983), Sterns (1982), Gautherie (1980), Stark (1974)
6
Isard (1988), Gaitherie (1980)
7
Ohsumi (2002), Sterns (1996), Head (1993)
8
Parisky (2003), Ohsumi (2002), Almaric (1982), Spitalier (1978), Jones (1975), Isard (1972), Dodd (1969)
9
Hoekstra (2013), Gamagami (1997)Report: Breast Digital Infra-red Imaging
(Thermography) and its use in
Naturopathic Practice
Appendix A: Comparison of Breast Health Assessment Tools
10
Sterns (1996), Amalric (1982), Spitalier (1978), Stark (1974), Dodd (1969)
11
Ohsumi (2002), Sterns (1996), Isard (1988), Almaric (1982), Jones (1975)
12
Jackson (2009), Humphrey (2002), Kolb (2002), Keyserlingk (1998), Kerlikowske (1996)Report: Breast Digital Infra-red Imaging (Thermography) and its use in Naturopathic Practice
Appendix B: Thermography Marseille Rating System
Rating Th-1 Th-2 Th-3 Th-4 Th-5
Atypical metabolic or Positive thermogram with Very high probability of
Description Normal Functional changes significant risk for malignant disease
vascular process
malignant disease
Risk for malignancy No risk No risk Minor or equivocal risk Significant risk Very high risk
< 10- 20 % 65 – 85 % Approx. 96 %
Features No thermology signs Even, non-complex, Uneven or unusual Two or more positive Two or more thermology
associated with disease moderately hyperthermic circulatory patterns thermology signs or a single criteria
vascular-like features involving most of one breast thermology criteria.
Indicates benign changes OR defined circulatory
e.g. hormone imbalances pattern that does not cool *Need for follow up testing *Need for follow up testing
affecting breast tissue down from cold challenge. to address possible to address possible
Indicates benign changes malignant activity. malignant activity.
e.g. inflammation, acute
cysts &/or fibro-adenomas,
infection or personal variant
Modified Rating Th-1F Th-2F Th-3L or Th-3M Th-4L or Th-4M Th-5L or Th-5M
Features Some distinctly Distinct hypothermic Note: The L refers to a
hypothermic patterns patterns previous lumpectomy; the M
to a previous mastectomy.
Indicates Normal breast tissue Normal breast tissue Sustained heat at site Sustained heat at site & no Sustained heat at site & no
response. response. response to cooling challenge response to cooling challenge
Correlates to Symptoms of hormone Symptoms of hormone Surgery, radiation or Possibly indicates malignant Probable malignant disease.
changes, such as pre- changes, such as pre- chemotherapy (all produce disease. Follow-up with Follow-up with other
menstrual tenderness, lumpy menstrual tenderness, lumpy significant tissue other diagnostic testing diagnostic testing
texture or excessive feeling texture or excessive feeling inflammation, edema, recommended. recommended.
of heaviness in breast tissue. of heaviness in breast tissue. abnormal tissue metabolism,
nerve damage and regrowth
of circulatory vessels).
Medical Examination Possible referral for targeted Referral for targeted Immediate referral for
ultrasound and , if ultrasound &/or medical examination,
indicated, mammography mammography ultrasound, mammography
and possibly biopsy
Thermography Follow-up If objective evaluation does
1 year 1 year 90 – 120 days 60 – 90 days not demonstrate malignant
breast disease, recommend
repeat thermography in 60-
90 days
Reference: Amalric R, Giraud D, Altschuler C, Spitalier JM. Value and interest of dynamic telethermography in detection of breast cancer. Acta Thermographica 1976;1(2):89-97.You can also read
