THERMOLOGY: EVALUATING THE TH SCORES

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TH-1

The first classification category in the Marseille system defines a normal thermal profile of the breasts that is devoid of any of the thermology signs or criteria associated with risk for breast cancer. All thermal features demonstrate normal and adaptive response to the autonomic challenge. Normal contours are discerned and no significantly hyperthermic focal or vascular features are presented. Some patients will demonstrate distinct and significantly hypothermic patterns that are frequently associated with established cysts and/or fibro-adenomas. This will modify the classification as a TH-1F. Annual comparative restudy is recommended.

TH-2

The second classification in the Marseille system defines a thermal profile of the breasts that features symmetrical, non-complex and moderately hyperthermic vascular patterns. All thermal features demonstrate normal and adaptive response to the autonomic challenge. The TH-2 classification indicates no thermology signs or criteria associated with breast cancer. However, while very unlikely, it is possible that some small cancerous tumors may be in a quiescent state and their vascular development could be minimal. In this event, the very minor thermal characteristics may evade discernment, especially in an initial study. The high-energy vascular patterns of the TH-2 classification are associated with benign glandular hypertrophy as may be caused by elevated blood levels of estrogens or disproportionate blood levels of estrogens to progesterones. The TH-2 classification is common during pregnancy and lactation. This thermology category is also associated with the development of cysts and fibro-adenomas. This will modify the classification as TH-2F. Annual comparative thermology restudy is recommended and more frequent restudies may be clinically indicated.

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TH-3

The third classification of the Marseille system defines a single thermology sign and indicates an atypical metabolic or vascular process associated with a minor or equivocal (<10% to 20% as specified in the individual report) risk for confirming breast cancer. This may be based upon the discernment of an asymmetric and hyperthermic vascular or focal pattern, an asymmetric, diffuse and hyperthermic pattern involving a peri-areolar area or most of one breast, a discrete area in a vascular pattern that does not attenuate from the challenge procedure or an asymmetric physical distortion with local hyperthermia. It is likely that these atypical thermal features represent benign changes such as inflammation, acute cysts and/or fibroadenoma development, infection or personal variant. A thermology restudy in 120-180 days usually provides a differentiation. Clinical correlation is indicated for an association with a mass or abnormal skin changes that would have an additive effect on the overall risk for breast cancer. Strong familial or personal factors for breast cancer are also of additive risk. Other objective means of evaluating the breasts may be indicated. Experience demonstrates a targeted ultrasound as the single most effective means of following-up on atypical or abnormal breast thermology. Blood markers such as CA 15.3, CA 27.29, TRU-QUANT, creatin-kinase-BB and even elevated ferritin may be useful and X-ray mammography may be indicated in the context of a womens overall risk profile.

TH-3 After Lumpectomy or Mastectomy

The post-surgical woman receives special abalysis as applied to the third category of the Marseille system on an initial study when any atypical thermal features are evident. The surgical procedures and radiation/chemotherapy treatments typically produce significant tissue inflammation, edema, abnormal tissue metabolism, nerve damage and revascularization that will likely impede the normal regulation of blood flow in the breast and results in artifact of the thermal patterns. These forms of artifact limit the value of thermology for approximately three months post-procedural when their influence usually has abated. Radiation treatment to the breast or mastectomy site may results in a lasting vaso-regulatory disorder that typically causes a diffuse and significantly hyperthermic artifact. Our experience indicates thermology has been a useful means of monitoring the post-surgical woman for indications of persistent or recurrent breast cancer, especially in the axillary or sternal regions. The initial study may be of limited value and its best value obtained as a baseline for comparative restudy in 90-120 days.


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TH-4

The fourth classification in the Marseille system defines two or more thermology signs or a single thermology criterion. This must be considered a positive result and represents a significant (65-85% as specified in the individual report) risk for breast cancer. Benign processes and personal variant are possible but unlikely as a basis for this abnormal classification, especially on an initial study. A clinical correlation is indicated for regional masses or abnormal skin changes and other means of objective evaluation (targeted ultrasound, X-ray mammography, MRI) are indicated. However, it must be considered that a positive thermogram may precede positive results from other objective testing by 5-8 years. Thermology restudy in 90-120 days should be an important part of a comprehensive testing panel to determine time-based evolutionary trends.

TH-5

The fifth classification in the Marseille system defines two or more thermology criteria.This classification represents a strongly positive result with a very high (approx. 96%) probability of confirming breast cancer. Benign processes or personal variant are very unlikely as a basis for the described abnormal thermology features. A clinical correlation is indicated for skin changes (discoloration or peau d`orange), regional masses and physical distortions (dimpling, bulging or flattening). Clearly, a patient with a TH-5 score is promptly indicated for a comprehensive panel of objective evaluation (targeted ultrasound, X-ray mammography and MRI). A thermology restudy in 90-120 days should be a part of this evaluation in order to determine time-based evolution if these other methods do not demonstrate breast cancer, as thermology may precede other abnormal features by 5-8 years.

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TH-6

This is a specialized and investigational classification that was not part of the original Marseille system and outside the role of thermology as a risk assessment tool for breast cancer. The TH-6 classification is applied to studies that evaluate thermology signs and criteria for women with biopsy-confirmed breast cancer without any form of surgical treatment. Increasingly, women with confirmed breast cancer are treated with various forms of adjunctive chemotherapy and/or radiation prior to surgical excision or, sometimes, without any form of surgical excision. Monitoring changes and trends in the thermology features against those seen in a baseline study can provide a useful adjunct with clinical finding and blood markers to evaluate the effectiveness of the treatment program. This feedback can also indicate the need to modify the treatment program so as not to waste precious time or resources.


BACK

References

 

  1. Amalric R, Spitalier JM, Levraud J, Altschuler C. Les images thermovisulles des cancers du sein et leur classification. Corse Mediterrane´e Medicale´ 1972;216:13-22
  2. Amalric R, Giraud D, Altschuler C, Spitalier JM. Value and interest of dymanic telethermography in detection of breast cancer. ACTA Thermographia 1976;1(2):89-96
  3. Hoekstra P. The autonomic challenge and analytic breast thermology. Thermology International 2004;14(3):106