Thermographic Visualization of Multicentric
Breast Carcinoma
Svetlana Antonini 1*, Darko Kolarić 2, Željko Herceg 3, Tomislav Kuliš 4, Željko Ferenčić 5,
Jadranka Katančić 6, Danijela Tomić Štorga 7, Marko Banić 8
Primary Health Care Zagreb – Center, Department of Radiology, Zagreb, Croatia
Ruđer Bošković Institute, Centre for Informatics and Computing, Zagreb, Croatia
3
University Hospital Sestre Milosrdnice, Division of Radiology, Zagreb, Croatia
4
University Hospital Rebro, Department of Urology, Zagreb, Croatia
5
Children's Hospital Srebrnjak 100, Zagreb, Croatia
6
University Hospital Rebro, Department of Anaesthesiology Reanimatology and Intensive care, Zagreb, Croatia
7
Ingvit d.o.o., Zagreb, Croatia
8
University Hospital Dubrava, Division of Gastroenterology, Zagreb, Croatia
doktorica.a@gmail.com
1
2
Abstract - Early diagnosis of breast cancer has increasingly
resulted in more conservative surgical approach to the disease.
Conservative surgical approach demand preoperatively exclusion
of multicentric - multifocal carcinomas. Multifocal-multicentric
tumors of the breast are defined by the presence of two or more
physically separate neoplasm in the same breast. In fact,
multifocal and/or diffuse breast cancer comprises the majority of
breast cancers in every size range. However in pathologycontrolled studies, multifocal (one quadrant involved) or
multicentric (two or more quadrants involved) cancer occurs
with a frequency ranging between 54% and 82%. The sensitivity
and
specificity
of
usual
diagnostic
procedures
(mammography, ultrasound and MRI) in preoperative manner
range from 50-80%. Multifocality/ multicentriciy are negative
prognostic factors, independent of tumor size, although their
effects become more significant with increasing tumor size. The
aim of this study was to investigate the ability of thermography
to detect multicentric and/or multifocal breast carcinomas in
preoperative setting. We compared our results with
pathological specimen findings after mastectomy. It was found
out that the thermography is a highly sensitive method for
detection of multifocal/multicentric breast carcinoma.
Keywords - Multifocal/multicentric breast carcinoma; Breast
cancer; Thermography; Preoperative diagnostic tool
I.
INTRODUCTION
Breast cancer is the frequently diagnosed cause of death
from cancer in women worldwide, the second leading cause of
death from cancer in women worldwide, and the leading cause
of death from cancer in women in developed countries, where
a high proportion of women presents with advanced disease,
which leads to a poor prognosis [1, 2, and 3]. Almost 500.000
women die from it yearly and breast cancer is a principal cause
of deaths from cancer among women globally [4]. Relapses
after conservative surgery frequently arise due to undetected
malignant foci, so searching for multifocal and multicentric
breast tumors is necessity for a conservative approach [5]. The
usual preoperative examination of breast carcinoma includes
mammography and ultrasound (US) [6].
However, sensitivity of mammography for detecting
multiple malignant foci is less than 50% and sensitivity of US
is not much better and is about 53% [7]. Introduction of
preoperative magnetic resonance imaging (MRI) have raised
sensitivity to 80% with specificity of approximately 65-79%
[8]. The sensitivity and specificity of MRI rises with tumor
aggressiveness. Generally, only in a few reports the
sensitivity and specificity of this method was compared with
the whole breast pathologic examination as a gold standard
[8]. Data support the hypothesis that multifocal/multicentric
tumors may have a worse biological behavior and that the
presence of multiple foci should be considered in planning
adjuvant treatments [9].
In the last few decades we haven t been faced with any
respectable and statistically proven diagnostic method which
could had predicted breast cancer potential, nor outcome of
potentially relapses after breast cancer conservative surgical
treatment, even mastectomy.
Thanks to the many years of intensive scientific research
and clinical data, the problem is mainly addressed to the
nowadays well known lack of sensitivity of the main two
brightly used, widely available and as the standards accepted
diagnostic methods, mammography and ultrasound. In
addition to the two well established, but frailly enough
sensitive diagnostic methods, MR leads to a respectably higher
diagnostic sensitivity, but is connected with the much higher
financial as well as health risks costs.
The need for new and more sensitive additional diagnostic
methods is greater than ever. In the last few years data is
accumulating on thermography as the method which could
meet all of the priorities of the modern diagnostic science.
There is no report investigating the ability of thermography to
detect multifocal/multicentric breast carcinomas. In this study
we had retrospectively analyzed preoperative thermography
findings with the whole breast pathology examination after
mastectomy.
II. MATERIALS AND METHODS
The study was performed from June 2010 to December
2011 and was approved by the Ethics Committee, of Clinical
hospital “Sestre milosrdnice” and all patients have signed an
informed consent. During this period 51 mastectomy where
done with the average patient age of 62, 51 years. The average
tumor size in this group was 23, 27 mm and in 15 patients the
pathologist confirmed multifocal/multicentric carcinomas.
Imaging was done in real time using infrared camera
Thermo Tracer TH7012 (NEC, Japan). This camera system
contains an uncooled focal plane array detector with geometric
resolution of 240x320 pixels (76.500 pixels). Spectral range is
from 8 µm to 14µm with temperature range from - 40°C to
120°C. The minimum detectable temperature resolution is 0,
07°C at 30°C (normal mode) and spatial resolution is 0, 48
mm at measuring distance of 30 cm.
Figure 1. Thermographic image of the left breast in women with confirmed
seven different malignant foci.
Numerical and graphical analysis of the recorded thermal
images was performed using the software package
ThermoMED [10]. During the thermography performing
patients were asked to position their hands on the top of their
head and remain still. From each patient we obtained five
pictures – frontal, right and left semi-oblique and right and left
oblique. The pictures were taken from distance of 0, 9 m. The
room temperature was kept at 23°C.
III. THERMOGRAPHY IMAGES AND RESULTS
In this paper we present the thermography images and
thermal
analysis
of
three
different
cases
of
multicentric/multifocal breast carcinomas.
Figure 2. ThermoMED, 3D thermal image of the same women.
 Total number of patients N=51.
 Number of patients with multifocal/ multicentric
carcinomas N=15.
 Total number of cancer foci found on pathology
examination in these patients was 47.
 The number of foci in one breast ranges between 2 and
8.
 The minimal size of lesion was 2 mm and maximal
was 55 mm.
 The thermographic sensitivity
pathological foci was 100%.
for
detecting
The graphical representation of conducted thermal analysis
is shown in Figures 1-6.
Figure 3. Thermal image of the right breast of women with multicentric breast
carcinoma
Figure 4. ThermoMED, 3D thermal image of the same women.
Figure 5. Thermal image of the right breast of women with three different
malignant foci.
(mammography and US) ranges between 50 – 60 %.
Therefore, it is not surprising that the postoperative
complications are not infrequent. Although the chemo and
radiation therapy play an important roles in managing
malignant foci, the fact that these foci are not surgically
removed may lead to an increased local recurrences and lower
survival [5]. The main advantages of thermography are: the
method is cheap, most sensitive to the slightest changes of the
tissue basic physiology, has not only an excellent and high
patient compliance but also emotionally very positive patient
acception and response which is not connected to any fear or
pain and, as most important, not connected to any potential
risks nor sideffects, as solely simply mechanical breast tissue
damage to the potentially cancerous loci which could be
caused by, for example mammography.
We do point out the great potential and importance of
thermography, in the meantime well established, coexisting
diagnostic method, as the first choice and/or additional routine
breast cancer diagnostics as well as for elucidating
differentiential diagnosis of breast cancer, in particular for
multiple loci cancer.
We suggest the following procedure:
 Women under 40 years of age – thermography,
USound.
 Women under 55 years of age – thermography,
USound, MRI.
 Women after 55 years of age – thermography, USound,
mammography, MRI.
Thus, there is a critical need for a tool than can better
assess the spread of cancer in the breast before surgery. Our
results indicate that thermography has the necessary sensitivity
that can effectively and inexpensively provide such
assessment. Given the great impact of these findings, it is
urgent that multicentric, well controlled study of thermography
in breast cancer is planned and conducted.
REFERENCES
Figure 6. Thermal curve with two thermal peaks which enable to
differentiate two malignant foci.
IV. DISCUSSION
The increasing tendency to perform conservative, sparing
breast surgery demands precise preoperative staging of breast
carcinoma. The sensitivity of standard preoperative methods
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