Role of dynamic thermography in diagnosis of nodal involvement in patients with breast cancer: A pilot study

•The existing standard method of axillary nodal staging is sentinel lymph node biopsy.•Neoplastic cells release nitric oxide and cause neo-angiogenesis.•Digital infrared thermal imaging offers non-contact, radiation free analysis.•Metastatic lymph nodes can be detected by thermal imaging.•Dynamic thermography is a promising technique in detection of axillary nodal disease. The existing standard method of axillary nodal staging in breast cancer is sentinel lymph node biopsy using tracing agents such as blue dye or radioisotope. However, there are some drawbacks to using these agents such as skin tattooing and adverse reactions caused by blue dye and radiation risk posed by radioisotopes. Considering tumor biology, digital infrared thermal imaging may aid in detecting metastatic lymph nodes and staging axillary nodal disease while refraining from these disadvantages. In this pilot study, 26 patients with invasive ductal carcinoma of breast were enrolled. Prior to surgical intervention, axillary region was evaluated by digital infrared thermal imaging after 2 min of cold stress. Diagnostic potential of dynamic thermography was assessed. Dynamic thermography achieved sensitivity of 83% and the false negative rate was 16%. Thermal analysis was superior to ultrasound, mammography and magnetic resonance imaging in terms of detecting metastatic lymph nodes. The proposed research protocol of dynamic thermography was found to be workable. Digital infrared thermal imaging of axillary region seems promising and can render valuable staging information in the era of minimally invasive surgery.