BIRADS III Biopsiar o No Biopsiar......

Buena semana después de Carnaval ..!

Pues bien Anoche estuve revisando las Estadísticas de este Blog ....

Los números indican que el CASO EJEMPLAR con mayor Numero de Hits es el de : 

BIRADS III  e Infrarrojo , Implicaciones Metabólicas.

Asumo con esta conclusión que una parte de los que revisan este blog son compañeros de profesión ( aunque no dejen comentario alguno , no los culpo , es un tema tan controversial y desacreditado que es difícil hablar en publico , pueden esbozar una sonrisa en casa u oficina .....ja) 

Así que al público lo que pida....... ( Oncólogos , Ginecólogos. Radiólogos y especialistas en Mama ) .......o público en general: 

Es probable que el convenio futuro de negociación para la aceptación de la imagen infrarroja para la mente simple y normativa sea el BIRADS III

Clasificación probablemente Benigna con Probabilidad Baja para Cáncer de Mama Cierto?

Aquí es donde legalmente se utiliza en la mayoría de las veces el criterio clinico para la decisión en toma de Biopsia.

Personalmente Yo he escuchado a Radiológos Expertos decir lo siguiente: 

" Puede ser un BIRADS II , quizás es un III , mejor lo Clasifico como Un BIRADS IVa y me quito de problemas , no vaya a ser mi familiar"

El resultado es un NICHO DE DIAGNOSTICO INDETERMINADO  e INCERTIDUMBRE , con una posibilidad baja de exclusión para un cáncer de mama.

Pues bien sigan conectados .........en estos días compartiré uno de esos casos ejemplares BIRADS III

BiopsaiR o No BiopsaiR .......esa es la Pregunta.

Les comparto la actualización en Inglés , una disculpa pero creo que vale la pena : promesa de traducción la próxima semana.
Buen fin de semana ...............

A promise is a debt : 
A few year ago a 40 years of age asymptomatic  patient of mine underwent an screening mammogram and  handled this images:

Medio Lateral Oblique view , evident density assimetry in the upper outer right quadrant.

Close up : No Microcalcifications are seen , yet I might agree retrospectively you can argue architectural distorsion and irregular profile. BIRADS 0 went to a complementary Ultrasound: 

An heterogeneous Morphological Lesion is found , with cystic and solid components almost circular in its form no posterior "shadow" is seen .

FINAL RADIOLOGIC DIAGNOSE BIRADS III , close follow up right? 

I WOULD THINK SOME MAY ARGUE AN ERRONEOUS OR MISTAKEN DIAGNOSIS , YET IT HAPPENED. 

Then she attended 3 months later to a SECOND Opinion.

So this are her DIRA images:

 

Basal DIRA series , anterior and oblique views , upfront as any NEW language or Unknown one there should be a little doubt an distrust.

If you look up closely actually there is a little assimetry that depends on the upper outer quadrant of the Right Breast what we might call  THE INTEREST AREA or IA.

After cold challenge the Functional or Physiological series were taken. No obvious difference for the UNTRAINED eye. 

Yet with the Software "Isotherm" application a Slight difference is then seen in comparison to the left side (ARROW) it actually is coincidental to the  physical finding of an "irregularity" zone at palpation . 

Same image but different color option.

So now I am thinking :" there is a HIGH METABOLIC area that is coincidental with my MORPHOLOGICAL findings by standard mammogram and ultrasound. Not to mention that this area by incidence is the highest for a Breast Cancer to appear." EMC

Recommendation : I think you should perform not in 6 months but
 as soon as possible a Mammography  and corresponding ultrasound. 

These are the images taken :

Cefalocaudal view , density assimetry now is evident.

Oblique view , confirm previous findings.

Close up : Highly suspicious Microcalcifications are NOW EVIDENCED

Corresponding Ultrasound Images : NOW MORPHOLOGICAL CLEAR CHANGES ARE SEEN AND DOPPLER DEMONSTRATES INCREASED VASCULAR FLOW.

BIRADS V .....

Most would argue that based on experience diagnosis could have been different previously. Better yet if there is a Close Surveillance the same diagnostic algorithm would have been done. And even if DIRA proofs a benefit in helping DIAGNOSIS and DETECTION , prognosis would be the same.

Reality : BIRADS III is based on INDIVIDUAL RADIOLOGIST Criteria , Follow up sometimes cannot be achieved. 

And BIRADS II was another possibility for the first classification.

The ecuation is simple:

"BIRADS III (even IVa) Morphologically proven , DIRA coincidental for HIGH METABOLIC ACTIVITY Plus ONCOLOGICAL experience : Recommend for SURE to Biopsy."EMC

These are the images taken in the OR , a possible next level.

Keep in touch.............

 

The idea is to gather BIRADS III lesions internationally , I will creat this next blog for those who would like to participate......
But now I am going to celebrate my Boy´s Birthday so I guess we will see you around next week.

http://birads3infraredproject.blogspot.mx/

Hipotesis.....

Eventualmente si estoy en lo correcto y se construye evidencia suficiente con su ayuda: 

"La Mastografia en la POBLACIÓN DE RIESGO NORMAL " sólo se autorizará ANUALMENTE  si y sólo si el ADIR o análisis digital infrarrojo de la mama sufrió un cambio suficiente para recomendar otro  estudio  Radiológico " 

Totalmente fuera de contexto , irreal , ilógico y hasta demente ?
Bueno Einstein decía:

 " Para una idea que al principio no parece ser Insana , no existe esperanza"

“For an idea that does not first seem insane, there is no hope.”

― Albert Einstein

Buen día .......

Tiro al Arco , analogía e introduccion de la i en AiRco

Blog publicado en advancedbreastthermography.blogspot.com 
Lo comparto previa traducción
Buen día:
How can we compare ARCHERY to BREAST CANCER DETECTION?
Well , I guess you may have an Idea......

 Highly Trained Specialists aiming at the center of the same targets at the same distance in similar conditions,
Hours , days and years of training with the best equipment possible , best trainers and 




professors , facilities and will.


Team work , teaching and learning side by side , supervision , confidence building  , tips and experience. Decision Making and Responsability.

Complementary procedures and positions that aid eventually in an accurate shot or view to try and hit the smallest , centrical target.

 And Practice and Practice and more Practice

"ArcheiRy" Breast Cancer Detection TNM Score :

We all aim to hit the MILIMETRICAL X ring Center :T1a , we are obsessed in trying to find those lesion.

Microcalcifications are Highlightened , signaled and classified.

And as far as the arows hits from the center Score of Detection is SMALLER and prognosis is Worst.

Detected Milimetrical , Lobular Carcinoma  in association to microcalcifications. 

Density , calcified structures , quality equipment , human resources , dedication experience , along with cultural , economical and scientific variables play along side by side to identify these lesions.

"In my world fewer than 3% of the cases...................and probably yours Low Income or Resource Countries"


In Developed ones maybe 15 to 30% ( yet subclinical pool maybe the same and never translate to a diseased state ....hard to know which will advance right?)

Optimal Archery Score all within the yellow circles

Yet in real scenarios : Arrows or attempts will hit most of the times by highly trained professionals within the yellow and red circles.

That would be : Usual Breast Cancer Detection usually hits lesions around

1 or 2 cm :T1

And even in several THOUSANDS SHOTS BY THE HIGHEST STANDARDS THEY WOULD EVENTUALLY HIT THE EXACT CENTER.

For example , after 20 years of being a Surgical Oncologist , you can imagine the Number of patients , one of my professors made a comment of a SINGLE case of a 0.8 mm invasive ductal carcinoma.

Question is the relationship of THOUSANDS and maybe 25 years of experience a positive COST-BENEFIT one?

In the past 2012 Olympics  in the Archery Event , Highest Ranked qualified professional archers aiming at the X center probably Thousands of times and .....

 ONLY :  Khatuna Lorig started with a dead center ten that shattered the camera, but was unable to hold off Avitia (From Mexico ) who took the bronze medal with a 6-2 victory, giving Lorig a fourth place finish and making her the USA's highest individual finisher for the second Olympic Games in a row

"So that means that it really does not matter whether you hit the exact center but how many times you approach to it in order to win " EMC

Get the idea? 

Now Curious Fact : Im Dong from S.Korea holds the world record almosto 700 points and he is "Legally Blind"

"That is amazing and it means that there is something else that cannot be measured , cannot be learned or Teached  and it is mastered only by a few. Instinct and Intention are human and Medicine holds an Artistic Character difficult to define and extraordinary in a daily basis."

Infrared Digital Analysis of an Asymptomatic High Risk Patient and the corresponding standard detection Mammogram and Ultrasound:

Size eventually turned out to be 1.2 centimeters

PRETTY GOOD FOR SOMETHING THAT HOLDS NO USE CURRENTLY DON´T YOU THINK?

Comment: 

Breast Cancer Detection should be accurate enough to hit the smallest size or target lesion. Mammography is still the gold standard for detection in some cases and ages , but it is a complicated an expensive procedure for most countries. 

Its frequency and age of first mammogram are in constant review and currently under fire. 

The cost benefit ratio is in doubt.

And the survival benefit because of SOLELY the Mammographic detection is Challenged mainly because now we have a better treatment.

For me : Infrared Imaged , digital and renewed holds promise to possibly detect lesions where Xray has its inherent difficulties or is unavailable for whatever reason.

Detection requires experience , equipment teachers , facilities resources and practice. 

Yet art and innovation even if Infrared is considered Nearsighted or legally blind for breast cancer  , may actually help and "break" current records and statistics.....EMC

To target the center is great , but if all the lesions where found UNDER the RED CIRCLES , at least my country Score and Prognosis would be Higher and Better  than it actually is.

Would you like to join?

Can we bring the i into Archery ?  and turn it into ArcheiRy?

Imagen Hibrida Rayos X Infrarroja : XiR de un Carcinoma Ductal Infiltrante T1.

La siguiente imagen representa una visión personal de el efecto SINERGICO  de ambas informaciones Mastografía e Infrarrojo pudiera ser en un futuro.....

Les confieso de antemano , alguno de ustedes se pueden sentir incómodos , insultados y quizás hasta enojados por el solo hecho de la integración de ambas imágenes..... Si es así les pido una disculpa. 

Fué presentado en nuestra reunión anual nacional en mastologia mas de un año atrás . Mas de uno de mis compañeros Oncólogos y Radiólogos expresaron una cierta mirada de desconcierto.

Observar algo por nuevo por primera vez , desconocido y casi de manera desafiante causa un sismo en los cimientos de la jerarquía que ofrecen años de experiencia..........

La detección estaría cubierta con la mastografía y el ultrasonido como en la mayoría de los casos que conocemos.

Y aunque al mencionar Cáncer de Mama esta implícita en nuestra menta  la palabra  detección y por ende las imágenes estandar 

La imagen infrarroja tiene un significado ya que representa la interpretación óptica de un fenómeno Físico y Biológico : El Cáncer de Mama. (Por lo menos alguno de sus tipos......)

Yo creo que las imágenes XiR son posibles y pueden ser introducidas para ofrecer un angulo diferente con significado para ser utilizados correctamente....

Ojalá y pueda vivir para verlo.

Tengan ustedes una gran semana.........