Analysis of mammography: a blind interpretation of BCDDP radiographs.

An ROC curve analysis of mammography is presented. This study is based on a blind interpretation of radiographs of patients who underwent screening during the Oklahoma Breast Cancer Detection Demonstration Project (BCDDP). In particular, we evaluated the accuracy of mammography based on 38 incidence cancer cases. Incidence cases are those that develop in a patient after an initial visit and at least one additional annual visit before a biopsy is performed. Using 40 normal subjects, a sensitivity of 72% was attained at a 28% false positive rate. We also evaluated the contribution of viewing radiographs of both breasts (right and left) simultaneously as compared with viewing radiographs of the individual breasts singly. In cases on the threshold of detectability, the breast that did not result in the cancer diagnosis was occasionally identified as the most suspicious for cancer. When mammograms of the two breasts were compared, the false positive rate was lower. These results can be used to assess various screening strategies and to yield a more realistic accuracy estimate of mammography on a rescreened population than is currently available.

Criteria for obtaining and interpreting breast thermagrams.

The thermal and graphic criteria which should be used to evaluate breast thermograms are outlined. Thermograms are then categorized as normal, suspicious, or abnormal on the basis of the criteria outlined. It is hoped that these criteria can be used widely to standardize breast thermographic evaluation.

Abdominal thermography in infantile and childhood liver disease.

Thermography provides an indication of the infrared energy emitted from various skin surfaces and, usually, reflects heat conveyed there from underlying organs. We have used abdominal thermography to study 62 infants and children with acute and chronic liver disease. Thirty-four healthy infants and children were studied as controls. Thermograms were abnormal in 96% of all patients with liver disease. The most common pattern was diffuse heat emission over the liver area, either alone or in combination with vascular and/or mottled patterns. A mottled pattern was more common in chronic liver disease. Although follow-up thermograms were obtained in 28 patients, the data obtained for different types of liver disease are as yet insufficient to warrant conclusions. However, it appeared that reversal of an abnormal thermogram to normal was associated with improvement of liver function and histologic findings in two patients with acute viral hepatitis. On the other hand, persistence of abnormal thermographic records was always associated with persistent hepatic disease as determined by histology and tests of liver function.

Thermography.

As thermographic equipment is improved and as physicians gain experience in its use, thermography gradually is gaining importance as a diagnostic aid in a wide range of disease processes. The technic is finding increasing acceptance in diagnosis of breast disease particularly as an adjunct to mammography. The American Cancer Society and the National Cancer Institute are in the process of establishing 20 demonstration centers for breast cancer detection using thermography, mammography, and physical examinations. Although all of the centers are not at present fully staffed with personnel experienced in thermographic interpretation, the project promises to give a better basis for cost estimates for screening with the thermography as compared to present systems. The technologic knowledge exists for the development of improved scanning infrared cameras with magnetic tape storage and dynamic display. These systems will lend themselves to quantitative measurements and semiautomatic interpretation which can improve the accuracy and reduce the cost of mass screening for breast cancer. Although additional clinical research is necessary, thermography has numerous applications in a variety of disease states. In the future, total body thermography may well become an important part of medical screening examinations.