Wednesday, October 22, 2008

First Post on the New Blog Site

To our entire Medical Tactile Community,


Since I first joined MTI a few months ago, I have heard several stories of successes concerning the SureTouch system. I have also been asked many questions on it usage, support and findings.

This is the first in a series of ongoing articles on the SureTouch system. I hope to publish regular updates to the site to help keep everyone informed of issues and events occurring with the SureTouch and Medical Tactile.

Invite you all to write in with your comments, questions and thoughts. If you want to be able to post comments and articles on this site, please send me an email at denis@medicaltactile.com and I will add you to the contributor's list.

I thank you all for your dedication and continuing support of our system

Best regards,
Denis O'Connor
CEO, Medical Tactile




Imaging Fibrocystic Breast Tissue with the SureTouch II System


Fibrocystic change of the breasts is characterized by lumpiness on physical exam and symptomatic discomfort in one or both breasts. It is a common benign problem for many women. It is estimated that over 50% of women have some sign of fibrocystic change and the condition typically diminishes after menopause. However, some women with benign breast disease are at higher risk for breast cancer.


Fibrocystic changes are often tender to touch and moveable to palpation. Lumpiness can vary in size and shape and can occur focally in one breast but are more often multiple and in both breasts. The nodularity often occurs in the upper outer area of the breast, but may be found throughout the breast. The cyclic tenderness and increased lumpiness that characterizes the fibrocystic breast condition usually becomes more evident one week to a few days before a menstrual cycle, and then decreases once flow has begun. The best time to perform a Clinical Breast and a SureTouch examination is a few days after a period as fluid-filled cysts and distended breast tissue typically will have decreased in size and be less tender.


Because of the dense nature of the fibrocystic breast, mammography (right) is less sensitive and effective in women with this condition. Although breast ultrasound (far right) does a better job of imaging cysts, it is more complex to use, documents only the cystic component of fibrocystic change, has a limited field of view and oftentimes is not readily available to clinicians performing clinical breast examinations


The SureTouch scan, in conjunction with a clinical breast examination, offers an objective method to establish baseline findings and document and monitor these changes in fibrocystic patients. The SureTouch exam may assist the physician in discerning fibrocystic patterns from other significant breast lesions. However due to the increased hardness and lumpiness of the breasts, it presents a challenge to differentiate firm fibrocystic change from true nodules. A modified SureTouch scanning technique needs to be employed for the fibrocystic breast.


Scanning Technique


Although this glandular tissue is lumpy and irregularly firmer than normal breast tissue, it is important to note that fibrocystic tissue will typically have a lower hardness profile from potential malignant lesions. It takes a more subtle review of the images to interpret the differences between benign lumpiness and potential malignancy. To that end, it is important as a first step that one achieves a baseline of the lumpiness of the breast by comparing it to the tissue of the opposite breast.


Keep in mind the women’s age and menopausal state when interpreting the SureTouch exam. It is unlikely that women will have multiple sites of breast cancer in both her breasts. Comparing the findings of both breasts for overall “lumpiness” is an important component to the SureTouch evaluation.


A common error in examining the fibrocystic breast is applying too much force (>1kg) during the examination and setting the color map too low (such as <20 style=""> When these occur the SureTouch image may look very concerning with high peaks and red images scattered over the entire breast. Multiple peaks in multiple areas suggest fibrocystic change and a need to re-adjust the SureTouch exam settings. For these cases, the examiner only needs to apply enough pressure such that the entire set of transducer sensors are in contact with the breast tissue. With this lower level of force, the examiner should look for peaks that stand out. The color map may need to be set to 25-35kPa to obtain a satisfactory image. Adjust the color map so that you don’t see diffuse red with such fibrocystic tissue so that when there is something harder than fibrocystic change, it’ll be easier to identify.


When a cancer is seen, it will be noticeable as a dominant peak and it will register hardness much different than the surrounding fibrocystic change. Examination of several patients with fibrocystic change will allow the examiner to gain familiarity with this particular type of breast tissue.

10 comments:

  1. Hi Denis; great initiative and I am hopeing we can use this blog to extend our knowledge of SureTouch and learn from each others successes and mistakes.

    ReplyDelete
  2. Troels,

    Thank you. Please invite other clinicians and interested parties to review, comment and author articles for the site. If you have interested parties, have them forward their email addresses to me and I will include them on the author list.

    ReplyDelete