Paper Title (Use Style: Paper Title) s47

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 1 Primary Health Care Zagreb – Center, Department of Radiology, Zagreb, Croatia 2 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 [email protected]

Abstract - Early diagnosis of breast cancer has increasingly approach [5]. The usual preoperative examination of breast resulted in more conservative surgical approach to the disease. carcinoma includes mammography and ultrasound (US) [6]. Conservative surgical approach demand preoperatively exclusion of multicentric - multifocal carcinomas. Multifocal-multicentric However, sensitivity of mammography for detecting tumors of the breast are defined by the presence of two or more multiple malignant foci is less than 50% and sensitivity of US physically separate neoplasm in the same breast. In fact, is not much better and is about 53% [7]. Introduction of multifocal and/or diffuse breast cancer comprises the majority of preoperative magnetic resonance imaging (MRI) have raised breast cancers in every size range. However in pathology- sensitivity to 80% with specificity of approximately 65-79% controlled studies, multifocal (one quadrant involved) or [8]. The sensitivity and specificity of MRI rises with tumor multicentric (two or more quadrants involved) cancer occurs with a frequency ranging between 54% and 82%. The sensitivity aggressiveness. Generally, only in a few reports the and specificity of usual diagnostic procedures sensitivity and specificity of this method was compared with (mammography, ultrasound and MRI) in preoperative manner the whole breast pathologic examination as a gold standard range from 50-80%. Multifocality/ multicentriciy are negative [8]. Data support the hypothesis that multifocal/multicentric prognostic factors, independent of tumor size, although their tumors may have a worse biological behavior and that the effects become more significant with increasing tumor size. The presence of multiple foci should be considered in planning aim of this study was to investigate the ability of thermography adjuvant treatments [9]. to detect multicentric and/or multifocal breast carcinomas in preoperative setting. We compared our results with In the last few decades we haven t been faced with any pathological specimen findings after mastectomy. It was found respectable and statistically proven diagnostic method which out that the thermography is a highly sensitive method for could had predicted breast cancer potential, nor outcome of detection of multifocal/multicentric breast carcinoma. potentially relapses after breast cancer conservative surgical treatment, even mastectomy. Keywords - Multifocal/multicentric breast carcinoma; Breast cancer; Thermography; Preoperative diagnostic tool Thanks to the many years of intensive scientific research and clinical data, the problem is mainly addressed to the I. INTRODUCTION nowadays well known lack of sensitivity of the main two Breast cancer is the frequently diagnosed cause of death brightly used, widely available and as the standards accepted from cancer in women worldwide, the second leading cause of diagnostic methods, mammography and ultrasound. In death from cancer in women worldwide, and the leading cause addition to the two well established, but frailly enough of death from cancer in women in developed countries, where sensitive diagnostic methods, MR leads to a respectably higher a high proportion of women presents with advanced disease, diagnostic sensitivity, but is connected with the much higher which leads to a poor prognosis [1, 2, and 3]. Almost 500.000 financial as well as health risks costs. women die from it yearly and breast cancer is a principal The need for new and more sensitive additional diagnostic cause of deaths from cancer among women globally [4]. methods is greater than ever. In the last few years data is Relapses after conservative surgery frequently arise due to accumulating on thermography as the method which could undetected malignant foci, so searching for multifocal and meet all of the priorities of the modern diagnostic science. multicentric breast tumors is necessity for a conservative 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 Figure 1. Thermographic image of the left breast in women with confirmed from 8 µm to 14µm with temperature range from - 40°C to seven different malignant foci. 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. 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 for detecting pathological foci was 100%. 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 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 Figure 4. ThermoMED, 3D thermal image of the same women. 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 Figure 5. Thermal image of the right breast of women with three different in breast cancer is planned and conducted. malignant foci.

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