Unexceeded Accuracy And Objectivity Yields Credibility And Acceptance
The use of infrared imaging for the early detection of breast cancer has been on a roller coaster ride for the past six decades. It has been repeatedly demonstrated that when breast thermograms are properly acquired and analyzed, breast thermography is an unsurpassed, noninvasive technique that can detect signs of breast cancer years earlier than is possible using mammography. Why then isn't breast thermography widely accepted as the leading breast cancer risk assessment modality? Why is it instead shunned by many in the medical community?
The opposition to breast thermography has been repeatedly explained: It's early history plainly illustrates that subjective interpretation of the complicated breast thermograms yields unacceptably high error rates that too often leads to misdiagnoses. A standard, accurate and objective image interpretation method must be employed, otherwise breast thermography lacks credibility and its use is discouraged.
Breast thermography is unregulated, which means among other things, the medical community's acceptance of the technology is not necessary for a successful breast thermography practice. Medical acceptance is of prime importance in order for patients to receive insurance coverage when undergoing the procedure. But, with the blessing of the AMA, the U.S. insurance industry succeeded in diminishing the value of breast thermography, resulting in the removal of coverage by most insurance companies and substantially reducing the utilization of breast thermography. This deprives many women the benefits the technology brings.
The basis for the AMA's opposition to thermography should be understood and respected. Patients are owed the most accurate results possible, but fulfilling that obligation has, up to now, been elusive. Today's breast thermography arena too closely resembles the negative paradigm driving the medical community opinion. A standard, accurate and objective method for interpreting thermograms is of unparalleled importance if widespread use of the technology is to become a reality.
The TAS Breast Thermography Evaluation program and reading service answers the need for a credible, economical, convenient and efficient analysis technique.
In the early 1980's, after almost two decades of accumulating and analyzing clinical data on more than 100,000 breast cancer patients, Gautherie et al published an accurate and objective breast thermogram interpretation protocol based on the assessment of twenty thermopathological signs. The method quickly became the gold standard, a position it still enjoys. Shortly after the introduction of Gautherie's protocol, Jay (mentored by, and in collaboration with Gautherie) authored and published the inspiration for today's TAS Breast Thermography Evaluation program. When data was published that demonstrated the accuracy of Gautherie's protocol with the repeatability of results using the computer program, even the most vociferous opponents of breast thermography proclaimed the program as the first and only objective interpretation method.
Repeatable results connote objectivity. When multiple analysts interpret images pursuant to an objective and accurate interpretation protocol, all analysts will achieve the same accurate results. The extent of dependable uniformity of results is a measure of the protocol's objectivity and integrity.
The accuracy of Gautherie's interpretation protocol is extensively documented. Equally impressive is the objectivity of TAS's computerized version. The program was written to impart Gautherie's assessment expertise to other, less experienced individuals who would be responsible for objectively evaluating breast thermograms. Paramedical personnel have quickly become competent at replicating Gautherie's method, producing accurate results using the computerized system.
Commenting on the first computerized breast thermography evaluation program, Gautherie wrote in part:
..to assess the reliability of the results produced by the computer-assisted scoring system, a series of blind studies were carried out in our laboratory and in other breast centers.. A total of eleven analysts with different levels of experience..participated in these studies..Each analyst read two series of 500 thermograms, one..recorded with a liquid crystal system on asymptomatic patients, and the other with an infrared scanner on symptomatic patients.. Statistical processing of the data was carried out to evaluate the performance of the readers, both individually and as a group.. to measure the intra-reader reproducibility and the inter-reader agreement..
The conclusions of this study were as follows:
- ..sensitivity and specificity were..using the computer-assisted protocol...84% to 90%..and from 81% to 88%.
- ..accuracy, objectivity and reproducibility of the interpretation are greatly improved using such a computer-assisted protocol. The possibility of misinterpretation by subjective feeling or impression on the part of the reader has proven to be markedly reduced.
- ..analysts who initially had no experience in thermographic interpretation and were trained to use the computer-assisted protocol for only a short period of time were able to produce results similar to those obtained by the analysts who were using the system..for more than 3 years.
That eleven different analysts viewed the same set of 1,000 thermograms and boasted 90%+ inter-analyst repeatable results unequivocally proves the objectivity of the breast thermography evaluation program's rendering of the gold-standard Gautherie interpretation protocol. No similar claim can be made for any other interpretation method.
The TAS Breast Thermography Evaluation is the most accurate and objective interpretation method available; however, as with every other computer program, the result is limited by the quality of the information delivered to the program. As the adage goes, "Garbage in, garbage out." Appropriate patient pre-examination preparation and examination room parameters, consistent with that outlined with the (TAS Protocol), is essential to guarantee the integrity of the breast thermography examination, as is strict adherence to the instructions provided by the image recording system manufacturer.
In combination with proper patient preparation, appropriate examination conditions, and suitable image acquisition, the TAS Breast Thermography Evaluation program overcomes the medical community's objections to breast thermography by delivering unexcelled accuracy, objectivity and credibility, time after time.