The TAS "Report of Breast Thermography Evaluation" is a comprehensive recording and interpretation of the breast thermography examination logically divided into eight sections. Much of the report is self-explanatory; however, it is essential that the practitioner understand the metaphor representing quantitative data.
Breast Thermography Evaluation Program — Understanding the Report
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I. REPORT HEADER
As a convenience to the practitioner, there are different report headers depending on whether thermograms are interpreted by the practitioner or by the TAS reading service. Practitioners using the software generate reports with the following format:
Practice Name Printed Here
Practice address is printed here
REPORT OF BREAST THERMOGRAPHY EVALUATION
Patient: Jane Doe
Examination Date: 05/26/07
Practitioner: Practitioner's name is printed here
Analysis performed: 05/26/07
Practitioners using the TAS Reading Service receive reports with the following header:
Thermogram Assessment Services, LLC
904 Silver Spur Rd., St 451, Rolling Hills Est., CA 90274 USA
REPORT OF BREAST THERMOGRAPHY EVALUATION
Patient: Jane Doe
Examination Date: 05/26/07
Practitioner: Practitioner's name is printed here
Analysis performed: 05/28/07
Practice: Referring practice name is printed here
II. PATIENT PRESENTATION
Presentation:
Patient presents symptomatic with a pain in the upper half of the right breast. Patient reports health issues regarding the left breast; however, symptoms are unspecified.
The Patient Presentation Section records the patient's stated purpose for undergoing the thermographic examination. The Section excludes any clinical findings.
III. PRE-EXAMINATION CONDITIONS
Pre-Examination:
The examination was performed in the morning outside the patient's menstrual window of activity. The patient was partially disrobed and underwent thermal equilibration for 10 - 15 minutes with the temperature of the examination room 68°F - 72°F. Examination performed consistent with recommended protocol for thermal breast examinations.
The data for this examination were acquired using an infra-red-sensitive camera. Views of the breasts consisted of a frontal image, including the sternum, and lateral images that included the axillary regions.
The data for this examination were acquired using an infra-red-sensitive camera. Views of the breasts consisted of a frontal image, including the sternum, and lateral images that included the axillary regions.
Knowledge of pre-examination conditions is an important aid to understanding images of the instant examination, and it's an important data reference for future and serial thermographic examinations, which should be performed under the same [acceptable] conditions.
The data presented in the Pre-examination Conditions Section reflect the practitioner's preferences selected in the Register New Account process, modified if necessary, when completing the Examination Information Form.
IV. SUMMARY
Summary: This thermographic examination of the breasts is seen with classical evidence of severe thermal abnormality.
There is a clear difference between the thermal patterns of the right breast and the left breast.
The right breast is significantly more thermally symptomatic than the left breast.
The Right breast is Intensely Abnormal (Very High Risk) with Thermal Risk Factor TH5. The Left breast is Normal (Low Risk) with Thermal Risk Factor TH1.
The Summary abbreviates examination findings, but employs adjectives to key words for increasing statement weight consistent with increased severity of examination results.
When neither breast presents as exceeding Normal (THI) Classification, the statement is generated, 'This thermographic examination of the breasts is seen without evidence of thermal abnormality.' If, however, either breast exceeds Classification THI, but neither exceeds Borderline Normal (THII) Classification, the keyword 'without' is replaced by the keyword 'with', e.g., 'This thermographic examination of the breasts is seen with evidence of thermal abnormality.'. This statement is further modified depending on the severity of examination findings.
If either breast presents as, but neither breast exceeds Borderline Abnormal (THIII) Classification, the keyword evidence is amplified to classical evidence. Similarly, if either breast presents as Abnormal (THIV) or Severely Abnormal (THV), the phrase thermal abnormality is qualifed with the adjective 'severe' to read severe thermal abnormality. Consequently, the statement, 'This thermographic examination of the breasts is seen with classical evidence of severe thermal abnormality' serves to inform the practitioner that the patient's examination result indicates serious abnormality.
The statement 'There is a clear difference between the thermal patterns of the right breast and the left breast' arises when either the analyst mandates it by analyst response, or when the program detects significant differences in the thermal signatures of the two breasts.
The message 'The right/left breast is more thermally symptomatic than the left/right breast' appears when one breast's thermal score exceeds the thermal score of the other breast. If the difference in thermal score exceeds a preset threshold, the modifier 'significantly' precedes 'more thermally symptomatic,' e.g., 'The right/left breast is significantly more thermally symptomatic than the left/right breast
V. EXAMINATION AND OBSERVATIONS
Examination and Observations:
Vascularity:
A thermovascular network is seen on the upper half of the right breast.
It exhibits slight (1°C) vascular hyperthermia relative to the same area on the contralateral left breast, and slight (1°C) intensity relative to the mean temperature of the ipsalateral right breast.
A uniform thermal pattern is seen on the left breast.
Hyperthermia:
A minimal (1°C) local/regional hyperthermia is noted on the upper-outer quadrant of the right breast.
There is mild total hyperthermia of the right breast relative to the mean temperature of the left breast and relative to the temperature of the adjacent sternal region.
Hypothermia:
A severe (-4°C) localized hypothermia with significantly reduced temperature relative to the mean temperature of the right breast is identified on the lower-outer quadrant of the right breast.
Nipple/Areola Region:
The temperature of the nipple/areola region of the right breast is mildly elevated (1°C) relative to the contralateral left breast nipple/areola.
The nipple/areola region of the right breast is slightly elevated (1°C) relative to the mean temperature of the ipsilateral right breast.
The nipple/areola region of the left breast is slightly elevated (1°C) relative to the mean temperature of the ipsilateral left breast.
Distorted Mammory Contour ("Edge-Sign"):
A distorted thermal outline is identified on the lower-outer quadrant the right breast.
The Examination and Observations section of the Breast Thermography Report offers amplified insight to the condition of the patient's breast health. It serves to document the analyst's observations, which is especially useful in the context of serial thermograms. In furtherance of assisting this important procedure, the Gautherie interpretation protocol upon which this program is based is augmented to record a thermographic history of the patient's examinations.
By way of review, Gautherie assigns a thermal score to situations where a variable exceeds a specific threshold. For example, a local hyperthermia exceeding 2.5°C contributes 30 'points' to the total thermal score of the breast exhibiting the hyperthermia. If a hypertheria is less than 2.5°C, no points are contributed.
TAS has augmented the Gautherie technique by remarking on observations that would not be otherwise noted using Gautherie's scoring thresholds, and by computing an "Augmented Thermal Score" based on fractional scoring that is dependent on the observation. In the example case, a 2.0°C hyperthermia, approximately 63% of Gautherie's threshold, would contribute about 20 points to an Augmented Thermal Score.
If no abnormality is observed or noted by the program, no statement is given. Five categories delineate the level of importance of observed thermal signs. They, or with similar labels, and their respective statistical break points, are characterized with different keyword modifiers. They also include recording of pertinent temperature for future reference. The five categories of observed thermal signs are:
- Slight: The word 'slight' refers to a thermal marker that is greater than zero, but less than the lowest temperature difference contributing points to the total thermal score. This is generally 50% of Gautherie's scoring threshold.
- Mild: A 'mild' category observed temperature difference falls between 50% and 63% of Gautherie's scoring threshold temperature difference. It contributes 50% of Gautherie's score to the Augmented Thermal Score. This sign should not be overlooked, as it, along with other signs, may indicate a breast disorder.
- Moderate: 'Moderate' category remarks indicate the observed thermal sign exceeds 63% and is below 82% of Gautherie's scoring threshold temperature difference. It contributes 63% of Gautherie's score to the Augmented Thermal Score. This sign should not be overlooked, as it, along with other signs, may indicate a moderately serious breast disorder.
- Borderline Severe: Observations characterized 'Borderline Severe' exceed 82% of Gautherie's scoring threshold temperature difference. These are close to contributing to Gautherie's total scoring, and contribute 82% of Gautherie's score to the Augmented Thermal Score. This sign, along with other signs, may indicate a moderately serious breast disorder.
- Severe: Observation remarks in the 'Severe' category equal or exceed the Gautherie protocol threshold and thus contribute 'points' to the Total Thermal Score using Gautherie's protocol, as well as the Augmented Thermal Score. Again, this sign, along with other signs, may indicate a moderately serious breast disorder.
Note: Observations in the Severe Category are characterized with the word 'severe' and scored 100% in conformity with the Gautherie interpretation protocol.
VI. IMPRESSIONS
Impressions: INTENSELY ABNORMAL BREAST THERMOGRAM. TH5 [VERY HIGH RISK] CLASSIFICATION.
The right breast is seen at very high risk for the development of breast cancer, presenting a Thermal Classification TH5.
This is Intensely Abnormal (Very High Risk). This thermal finding statistically indicates the presence of significant pathology. Immediate attention is recommended.
The left breast is seen at low risk for the development of breast cancer, presenting a Thermal Classification TH1.
This is a Normal (Low Risk) breast thermogram.
Note: A negative thermal finding does not preclude the possible presence of significant pathology.
VII. PATHOLOGY
Pathology:
The right breast is seen with multiple indications of severe abnormality. Notwithstanding any other possible pathology, this very high risk TH5 Classification is generally characteristic of most cystosarcoma phyllodes, inflammatory mastitis, acute abscesses, mature micro-invasive carcinomas (≤ 5mm), T1 carcinomas, modullary cancers, and carcinomatous mastitis.
The left breast appears without thermopathological evidence.
Impressions and Pathology are seperate, but closely related sections of the Breast Thermography Report. The Impressions section speaks to the program's assessment of the patient's breast health condition and risk of developing breast cancer. The Pathology Section speaks to the pathologies typically seen for such impressions.
VIII. RECOMMENDED FOLLOW-UP
Recommended Follow-up:
[TH5] If a clinical finding, e.g., palpable mass, is present, an MRI followed by a biopsy is indicated. If clinical finding is negative a baseline MRI should be considered if it has not been obtained previously. If MRI is positive, a biopsy is indicated. If negative, a repeat thermal and physical examination should be performed in 3- to 6-months. If the repeat thermogram as well as repeat physical examination is negative, routinely examine patient every 6- to 12-months. If the repeat thermogram remains abnormal or changes, especially if it worsens, the MRI should be repeated. If it changes, a biopsy should be performed. Mandatory follow-up is essential since a significantly higher percentage of carcinomas are present in patients with this TH5 Thermographic classification.
The Recommended Follow-up section serves only as a guideline to what appropriate procedures to follow depending upon thermographic impressions. Note that other acceptable diagnostic modalities should never be ruled out for symptomatic patients, even when thermographic results are negative. A negative thermal finding does not preclude the possible presence of significant pathology.