Contrast-Enhanced MR Angiography of The Breast

This is an abstract copied from PubMed. Am I the only one that wonders how vessel density on MR and not the vessel density on a therm is accurate? True: thermography measures skin blood flow by temp - but more vascularity usually means more blood flow -- ????? Am I missing something?

Contrast-Enhanced MR Angiography of the Breast: Evaluation of Ipsilateral Increased Vascularity and Adjacent Vessel Sign in the Characterization of Breast Lesions Sibel Kul1 Aysegül Cansu1 Etem Alhan2 Hasan Dinc1 Abdulkadir Reis3 Gamze Çan4 Kul S, Cansu A, Alhan E, Dinc H, Reis A, Çan G 1Department of Radiology, Karadeniz Technical University, School of Medicine, Farabi Hospital, 61080 Trabzon, Turkey. Address correspondence to S. Kul (sibel_ozy@yahoo.com). 2Department of General Surgery. Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 3 Department of Pathology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 4 Department of Public Health, Karadeniz Technical University, School of Medicine, Trabzon, Turkey. 􀀷􀁏􀁍􀁅 􀁎 􀀇􀁓 􀀀 􀀩􀁍􀁁 􀁇 􀁉 􀁎 􀁇 􀀀 􀁳 􀀀􀀯 􀁒 􀁉 􀁇 􀁉 􀁎 􀁁 􀁌 􀀀 􀀲 􀁅 􀁓 􀁅 􀁁 􀁒 􀁃 􀁈

AJR 2010; 195:1250–1254 0361–803X/10/1955–1250 © American Roentgen Ray Society

MRI is the most accurate method of detection of invasive breast cancer, having nearly 100% sensitivity. The specificity, however, is only moderate (72% overall specificity in 44 studies) and varies widely across studies of the diagnostic performance of breast MRI related to cancer prevalence and the criteria used to differentiate malignant and benign lesions [1]. Developments in MRI systems, image acquisition protocols, and image interpretation methods are continuing to improve specificity. The results of previous studies have shown an association between breast cancer and ipsilateral increased blood flow at laser Doppler imaging [2] and PET [3]. It is possible to obtain MR angiograms of the breast with postprocessing of 3D dynamic contrast-enhanced MR images. Maximum-intensity-projection (MIP) reconstruction of subtracted dynamic MR images shows enhancing lesions and the breast vasculature at the same time. Increased vascularity adjacent to breast cancer lesions and in the ipsilateral breast as a whole has been found Keywords: breast, contrast-enhanced MRI, MR angiography, MRI, vascularity DOI:10.2214/AJR.10.4368

Received January 28, 2010; accepted after revision March 25, 2010. W O M E N ’ S I M A G I N G

􀀯􀀢􀀪􀀥􀀣􀀴􀀩􀀶􀀥􀀎 The purpose of this study was to investigate the role of evaluation of breast vascularity with contrast-enhanced MR angiography in the differentiation of malignant from benign lesions. 􀀭􀀡􀀴􀀥􀀲􀀩􀀡􀀬􀀳􀀀􀀡􀀮􀀤􀀀􀀭􀀥􀀴􀀨􀀯􀀤􀀳􀀎

Contrast-enhanced 3D MR angiograms of the breasts of 102 patients with unilateral and histopathologically confirmed breast lesions were evaluated retrospectively. All images were evaluated for both ipsilateral increased vascularity and adjacent vessel sign, and the values of these signs in the diagnosis of malignancy were assessed. 􀀲􀀥􀀳􀀵􀀬􀀴􀀳􀀎

Histopathologic analysis of 102 patients revealed 50 malignant and 52 benign results. In 31 of the 50 patients with breast cancer and in 11 of the 52 patients with benign lesions, ipsilateral breast vascularity was increased. The resulting sensitivity and specificity of ipsilateral increased vascularity were 62% and 79%. The adjacent vessel sign was present in 37 of the 50 patients with breast cancer and six of the 50 patients with benign lesions. The resulting sensitivity and specificity of the adjacent vessel sign were 74% and 89%. The overall accuracies of ipsilateral increased vascularity and the adjacent vessel sign were 71% and 81%. 􀀣􀀯􀀮􀀣􀀬􀀵􀀳􀀩􀀯􀀮􀀎

Both ipsilateral increased vascularity and the adjacent vessel sign were found to be associated with breast cancer in a significant percentage of patients. The adjacent vessel sign is more practical and generally applicable. There is a borderline significance in favor of the higher accuracy of the adjacent vessel sign in comparison with ipsilateral increased vascularity (p = 0.043).

ARE YOU LIVING IN FEAR OF BREAST OR OTHER CANCER?

Fear is beneficial (as far as I'm concerned) in acute life-threatening situations; tigers (outside the bars), mad dogs, men with weapons etc. Fear of the unknown or fear of possibility is the worst -- as it is the ongoing stress hormones that are secreted by this type of fear that can cause or accelerate disease.

I personally believe that we create our problems and diseases with our thoughts. Unfortunately those thoughts (negative) create the very thing we fear or do not want. We become what we focus on --- if you focus on illness then wellness isn’t the outcome.

The body is an incredible work of art. It is SO complex. But everything in the body begins with chemistry. You don’t lift a finger or a foot to run unless the chemistry directs the action. Very complicated and immediate discharges of cellular transmitters start all activities (that’s where the hormones of fear come into play ....) If you truly have a fear of cancer – then the chemistry is probably in action. Getting structural tests such as mammography show the changes long after the chemistry has been in play. I encourage you to save your pennies and get a Cancer Profile study from American Metabolic Laboratory. Specifically request or include the addition of thymidine kinase levels in the test.

This is taken from Wiki’s information on TK1 Clinical chemistry[edit]Thymidine kinase is a salvage enzyme that is only present in anticipation of cell division. The enzyme is not set free from cells undergoing normal division where the cells have a special mechanism to degrade the proteins no longer needed after the cell division.[10] In normal subjects, the amount of thymidine kinase in serum or plasma is therefore very low. Tumour cells release enzyme to the circulation, probably in connection with the disruption of dead or dying tumour cells. The thymidine kinase level in serum therefore serves as a measure of malignant proliferation, indirectly as a measure of the aggressivity of the tumour.

If the fear of cancer drives you --- then this is the way to go. Your practitioner probably doesn’t know about this test – and won’t recommend anything that isn’t in the “Betty Crocker recipe book for finding and treating cancer”. They only follow algorithms. If A then B – If B then........ . They can’t practice any other way – or they get some type of oversight...

This is what I suggest – but if you’re of the mind to wait and see.............

Caveat emptor - Radiology is NOT Thermography and Thermography is NOT Structural

What Do Thermal Indicators Mean?

Infrared thermal imaging determines if abnormal or asymmetric thermal patterns, consistent with abnormal physiology, are detectable in the breast tissue. This procedure is used as an adjunctive diagnostic procedure in addition to structural tests, not in place of those tests. Thermal imaging is an ideal marker to indicate your level of RISK for breast cancer and also can assist as an indicator of “activity” if a cancer is present. The higher the tissue temperature -- the greater the cellular activity.

Not all ‘cancers’ emit a thermal signal. “DCIS, LCIS and Atypia” are considered cancerous or precancerous on mammography and MAY NOT demonstrate a thermal signal at this time. Additionally – thermal signals can be present within one or both breasts – but may not be located adjacent to a cancer; blood supply is called to a tumor and is not initiated at the tumor. Mammography may locate a cancer in the opposite breast. This is a physiological signal NOT a structural test. A normal TH factor does not rule out the possibility of cancer detectable by mammogram.

Thermal Indicator: TH-1 Symmetric Bilateral – Non-Vascular (normal) TH-2 Symmetric Bilateral – Vascular (normal) TH-3 Equivocal – One Thermal Factor Present (equivocal) TH-4 Abnormal – Two Factor Present (abnormal) TH-5 Suspicious - Three Factors Present (suspicious for malignancy) ,

Your recall period is based on your Thermal Risk indicators. Tumor doubling time averages 150 days. A 3-month recall will determine if your TH Factors are stable or require additional investigation by structural study. Follow-up studies of 6 – 12 months are considered Standard. Recall procedure is important to monitor breast health and to follow any demonstrated changes in either the Risk Index or Thermal Indicator Scale. Statistics have demonstrated that abnormal serial scans demonstrate a greater potential (higher RISK) for conversion than other RISK markers.

DAMNED IF YOU DO ---- NOW DAMNED IF YOU DON"T HYPERPLASIA LEADING TO LUMPECTOMY

New data contradict current recommendations for management of breast biopsy abnormalities

This study challenges current understanding that atypical ductal hyperplasia (ADH), a type of breast tissue abnormality, leads to breast cancer in the same breast while atypical lobular hyperplasia (ALH), another type of breast tissue abnormality, may not be a direct precursor of breast cancer, but may indicate equal risk of breast cancer across both breasts.

“Most have considered ADH a direct precursor to breast cancer, arguing that it requires complete surgical excision while others have maintained that ALH serves as an indicator of heightened and equal risk of breast cancer across both breasts and does not need complete surgical removal,” explained Hartmann. “Moreover, some experts have argued that women with atypia develop ‘better risk’ breast cancers, meaning low-grade cancers with a good prognosis.”

IT IS NOW RECOMMENDED THAT WOMEN HAVE LUMPECTOMIES WITH ADH - or ATYPICAL DUCTAL HYPERPLASIA. Isn't this comparable to having a hysterectomy if you have an abnormal PAP?

Its challenging enough that DCIS has been advanced to "cancer" when it was considered a watch and wait for many years. Now atypia will lead to lumpectomy just as DCIS. This seems as if they aren't making enought money with the current population -- that now they want to advance the surgical intervention in hyperplasia. I don't know what you think ---- but I think this is really pushing the limits.......

ADH, cytologically, architecturally and on a molecular basis, is a low-grade ductal carcinoma in situ (DCIS);[1] however, it has a limited extent, i.e. is present in a very small amount (< 2 mm). ADH is not considered breast cancer,[2] but recognized as a risk for breast cancer. The usual treatment is lumpectomy to exclude the presence of breast cancer

I'd rather have a simple blood test to see if there is a elevation of enzymes present with active cancer -- before I submit to lumpectomy for atypia...

Look for Cancer Profile - American Metabolic Laboratory -- and determine your actual risk.

DAMNED IF YOU DO --- NOW DAMNED IF YOU DON'T : Breast ATYPIA will lead to Lumpectomy

New data contradict current recommendations for management of breast biopsy abnormalities

This study challenges current understanding that atypical ductal hyperplasia (ADH), a type of breast tissue abnormality, leads to breast cancer in the same breast while atypical lobular hyperplasia (ALH), another type of breast tissue abnormality, may not be a direct precursor of breast cancer, but may indicate equal risk of breast cancer across both breasts.

“Most have considered ADH a direct precursor to breast cancer, arguing that it requires complete surgical excision while others have maintained that ALH serves as an indicator of heightened and equal risk of breast cancer across both breasts and does not need complete surgical removal,” explained Hartmann. “Moreover, some experts have argued that women with atypia develop ‘better risk’ breast cancers, meaning low-grade cancers with a good prognosis.” IT IS NOW RECOMMENDED THAT WOMEN HAVE LUMPECTOMIES WITH ADH - or ATYPICAL DUCTAL HYPERPLASIA. Isn't this comparable to having a hysterectomy if you have an abnormal PAP? Its challenging enough that DCIS has been advanced to "cancer" when it was considered a watch and wait for many years. Now atypia will lead to lumpectomy just as DCIS. This seems as if they aren't making enought money with the current population -- that now they want to advance the surgical intervention in hyperplasia. I don't know what you think ---- but I think this is really pushing the limits of malpractice.

How Accurate Is Thermography?

The challenge today is that women want to monitor breast health without mammography. They believe that choosing thermography will provide them with a non-contact, non-invasive way to detect early changes and not need mammography at all. I'm sorry -- but that is not the truth, regardless of how hard we want to believe that thermography is the answer, it is only one way to look at the breast changes over time. Thermography is physiology and physiology is ever-changing. Mammography is structure - and once the structure changes - its visible by x-ray, which is the energy level that mammography measures. The 'efficacy of detection with thermography is 87-92%' based on the current meta-analysis. Mammography is 75% - 95% accurate based on the meta-analysis of studies. But BEWARE - they are NOT comparable tests.

Recently I've had a few clients, who regularly participate in thermography and mammography, come back with diagnoses of cancer in what we reported as a stable or negative thermogram. They are told that "thermography is wrong and dangerous” that only mammography will find early cancer." This statement can be true and false. False in that thermography is wrong and dangerous. The body does not lie. If there is a thermal abnormality there is something happening. Thermography finds changes that are related to the physiological stimulus of blood flow in the region. Many things besides cancer can stimulate changes in blood flow - including hormones and medications. Mammography detects the dead cells - or castings of cells that are left. This can be DCIS - in the duct, spiculations in the tissue, or changes in the tissue density. Often they will report you as having "cancer" with DCIS - as the common practice in medicine is to remove DCIS because it CAN be transformed into invasive cancer and they don't know if or when. Thermally - DCIS is most often not chemically active. It will not exhibit a thermal signal. Additionally - we often find the opposite breast is demonstrating signals of suspicious change and the mammogram finds nothing in the stimulated breast, but suspicious changes in the opposite breast. Why is this? We are one body. Chemistry is not isolated. The breasts operate together. There is a commone blood supply and connecting blood and lymph. Also, DCIS is frequently found in multiple sites and has a high probability of being in both breasts. Years ago they usually did a mirror biopsy in the contra lateral breast of DCIS or invasive breast cancer - because the statistics of that cancer being in the opposite breast are higher than not. That is not done as often today. Standard medical practitioners believe that mammography is sensitive enough to see the contra lateral change. But why the thermal signal in the contra lateral breast? Because radiologist won't use thermography to monitor change - we don't have recent comparative studies to say the signal came and went prior to the structural change. We do know that enzymes in the tissue contribute to the conversion of normal to invasive cells and that that is early in the process of cancerous change -- and it is postulated that thermography is catching the chemical reaction that is taking place prior to the structural change. Without comparative studies we will not get that answer. What we do know from studies conducted - and those studies include large population of thousands of patients - is that thermography is the best indicator of RISK. Serial (or changes over time) thermograms demonstrate a higher RISK than the presence of Family History of breast cancer, and other statistical factors. Watching non-invasively can help make shifts in lifestyle (cancer causes are known to be 85% lifestyle) and help postpone or avoid future changes to cancer. But your medical doctor will not have the time, or the desire to help you do this. Changing lifestyle is an individual responsibility. So is thermography wrong and mammography right? This depends on what you intend. Do you want to monitor yourself JUST for breast cancer? Then mammography is your test. It will not detect the chemistry, or the hormone shifts, or the changing blood flow of disease. Mammography usually detects a cancer that is already growing. PERIOD.

If you want to do any preventative action – then monitoring hormone changes and risk with thermography will improve your outcome. So it’s a big decision. If you don’t want to initiate lifestyle changes – maintaining appropriate body mass index for your size, and age, monitoring for influence of endocrine imbalance, and other physiological changes, then a mammogram every two years should be done. Don’t waste your time and money with thermography. But you must also realize that thermography – just like mammography, will not detect EVERY cancer. Thermography will not detect DCIS. So educate yourself on how you want to deal with a breast cancer IF you were to receive that diagnosis. Understanding the choices you have BEFORE is very important. Otherwise you’ll be making very difficult choices in a VERY SHORT TIME. Medical doctors will want you to have a biopsy and surgery within days of a questionable mammogram. The faster they get you to the table the less time you have to think about it and back out. So better to understand options before you’re under the knife. Many women regret getting pushed into surgeries and treatment without having prior understanding of outcome and possibly damaging results they can’t UNDO after the fact. Don’t be intimidated. Do not be rushed. Understand the choices you have and the potential of the outcome EITHER WAY.

Thermography is a non-invasive way to monitor physiologic changes and change over time. Mammogram examines the structure. Apples and oranges -- these two tests CAN NOT BE COMPARED.

I make a point to educate every woman who comes for thermography about the risk and benefits of both tests. I provide information and education. So basically it becomes a choice of how much do you want to know, when do you want to know it, and how will you make choices IF or WHEN you receive a diagnosis of breast cancer – whether its DCIS (which historically was NOT a true cancer - only hyperplasia) or another more challenging aspect of the disease.

CONFIRMATION OF ABNORMAL SERIAL SCANS

Often women who have a consistently abnormal thermal scan are resistant to getting a mammogram when a structural test is needed. For whatever reason - be it the physician, the radiologist or the insurance company - getting an Ultrasound as the next step it usually difficult or impossible. Ideally an Ultrasound could be performed on the breast or the area of concern noted by the infrared exam. When the technician switches the imaging mode to Doppler - in order to analyze the blood flow during the exam - it helps to identify the suspicious blood flow detected by the thermogram. Doppler can determine if the circulation is consistent with normal blood vessels (by directional flow or the pulse due to heart beat) or if the flow is chaotic and abnormal, indicating a potential change in normal circulation.

The thermogram identifies changes in metabolism and the resulting change in circulation. A structural test is needed to determine if an abnormal growth is already present - or if thermography is detecting a metabolic change in advance of the structural tissue change. This is one reason that thermography and mammography act together to increase the efficacy of early detection. A serial positive thermogram with a negative mammogram warrants close observation. MRI with and without contrast is currently the ideal test to identify the neoangiogenesis associated with breast cancers. But again, the roadblock is in place to prohibit MRI unless a significant family history is present or the patient has a history of multiple biopsies and abnormal mammograms with negative biopsies. Cost of this test is one reason that insurance companies usually withhold precertification when it is requested. Even if a patient wanted to self-pay for the test it is withheld.

For these reasons – I’ve been encouraging women with repeatedly abnormal thermal scans to consider another option for early detection. This option is not medical imaging, but the detection of very significant protein markers found in the Cancer Profile exam (blood and urine analysis) conducted by American Metabolic Laboratory of Hollywood Florida. This very sensitive test can identify multiple markers – that when elevated indicate the presence of cancer in the body. Having consistently abnormal thermal scans and abnormal cancer markers help the women determine how aggressive she must be in seeking medical intervention. Additionally – with negative cancer markers – the abnormal thermogram can be followed and diet and lifestyle can be altered to change hormone influence on the breasts (although this is usually the first step following abnormal thermal scans.)

Dr. Emil Schandl, Ph.D. of AML has developed and structured this analysis (Cancer Profile Plus) to find the human growth hormones associated with early cancer and other proteins and enzymes, including serum thymidine kinase – which aid in the replication of cancer cells and the metastasis of the cells to distance sites. This test is highly accurate and detects cancer in the earliest stages – usually before structural imaging detects the multiplication of abnormal cells into a tumor. Mammograms detect cancer when the cells have sufficient doubling to measure at least 200 cells. The Cancer Profile needs only 4-6 doublings (about 12-16 cells) for cells to emit enough metabolic enzymes (MMPs) for detection.

For anyone facing cancer concern via thermography or not the Cancer Profile Plus is your next step. www.americanmetaboliclaboratories.net