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The role of infrared imaging in the detection of cancer
עמוד 1/8


In order to determine the value of infrared imaging, two viewpoints must be considered: first, the sensitivity of Thermograms taken preoperatively in patients with known breast carcinoma; and second, the incidence of normal and abnormal Thermograms in asymptomatic population (specificity) and the presence or absence of malignancy in each of these groups.

In 1965, Gershon – Cohen, a radiologist and researcher from the Albert Einstein Medical Center, introduced infrared imaging to the USA [35]. Using a Barns thermograph, he reported on 4000 cases with a sensitivity of 94% and a false positive rate of 6%. This data was included in a review of the then current status of infrared imaging published in 1968 in California – A Cancer Journal for Physicians [36].

In prospective studies, Hoffman first reported on thermography in gynecologic practice. He detected 23 carcinomas in 1924 patients (a detection rate of 12.5 per 1000), with an 8.4% false negative (91.6% sensitivity) and 7.4% false positive (92.6% specificity) rate [37].

Stark and way screened 4621 asymptomatic women, 35% of whom women were under 35 years of old age, and detected 24 cancers (detection rate of 7.6 per 1000) with a sensitivity and specificity of 98.3 and 93.5% respectively [38].

In a study comprising 25,000 patients screened and 1878 histologically proven breast cancers, Amalric and Spitalier reported on their results with infrared imaging. From this group, a false-negative and false positive rate of 9% (91% sensitivity and specificity) was found [39].

In a mobile unit examination of rural Wisconsin, Hobbins screened 37,506 women using Thermography.
He reported the detection of 5.7 cancers per 1000 women screened with a 12% false-negative and 14% false positive rate. His findings also corroborated with others that Thermography is the sole early initial signal in 10% of breast cancers. [17, 40].

Reporting his Radiology division’s experience with 10,000 thermographic studies done concomitantly with mammography over a 3 year period, Isard reiterated a number of important concepts including the remarkable thermal and vascular stability of the infrared image from year to year in the otherwise healthy patient and the importance of recognizing any significant change. (41) . In his experience, combining these modalities increased the sensitivity rate of detection by approximately 10%; thus, underlining the complementarity of these procedures since each one did not always suspect the same lesion.
It was Isard’s conclusion that, had there been a preliminary selection of his group of 4393 asymptomatic patients by infrared imaging, mammography examination would have been restricted to the 1028 patients with abnormal infrared imaging, or 23% of this cohort. This would have resulted in a cancer detection rate of 24.1 per 1000 combined infrared and mammographic examinations as contrasted to the expected 7 per 1000 by mammography screening alone. He concluded that since infrared imaging is innocuous examination, it could be utilized to focus attention upon asymptomatic women who should be examined more intensely. Isard emphasized that, like mammography and other breast imaging techniques, infrared imaging does not diagnose cancer, but merely indicates the presence of an abnormality.

Spitalier and associates screened 61,000 women using thermography over 10 year period. The false negative and false positive rate was found to be 11% (89% sensitivity and specificity). Thermography also detected 91% of the non palpable cancers (grade T 0: tumors less than 1 cm in size). The authors noted that of all the patients with cancer, thermography alone was the first Alarm in 60% of the cases [42]. Two small scale studies by Moskowitz (150 patients) [43] and Treatt (515 patients) [44] reported on the sensitivity and reliability of infrared imaging. Both used unknown experts to review the images of breast cancer patients. While Moskowitz excluded unreadable images, data from Threatt’s study indicated that less than 30% of the images produced were considered well, the rest being substandard. Both of this studies produced poor results; however, this could be expected considering the lack of adherence to accepted imaging methods and protocols. The greatest error in these studies is found in the methods used to analyze the images. The type of image analysis consisted of the sole use of abnormal vascular pattern recognition. At the time these studies were performed, the accepted method of infrared image interpretation consisted of a combined vascular pattern and quantitative analysis of temperature variation across the breasts. Consequently, the data obtained from theses studies is highly questionable. Their findings were also inconsistent with numerous previous large scale multi center trials. The authors suggested that for infrared imaging to be truly effective as a screening tool, there needed to be a more objective means of interpretation and proposed that this would be facilitated by computerized evaluation. This statement is interesting considering that recognized quantitative and qualitative reading protocols (including computer analysis) were being used at the time.
In a unique study comprising 39,802 women screened over a 3 year period, Haberman and associates used thermography and physical examination to determine if mammography was recommended. They reported 85% sensitivity and 70% specificity for thermography.


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