While some centers may choose to conduct image analysis internally, most outsource to specialized infrared interpretation labratories. Analysts at these facilities use highly refined techniques and software tools to conduct diagnostic analysis and document findings.

Currently the standard for objective analysis is the Marseilles system, which was named after its early pioneers, a group of researchers at Pasteur university in Marseilles France who, in 1974 conducted one of the most influential diagnostic studies of thermology ever known. While the system has been refined by enhanced knowledge of basic science and increased clinical experience it remains the basis for diagnostic Breast thermology to this day.

The Marseilles Analytic System

Developed at the famed Institute Pasteur in Marseilles, France, this analytic method for the diagnostic evaluation of Infrared Mammography defines a 1-5 scale (TH-1 - TH5) based upon a correlation of specific, objective and quantitative thermal features and pathological determinations of breast cancer. Thermal features are divided into signs and criteria based upon the statistical association with established breast disease. Since the introduction of the Marseilles Analytic System in 1975 there has been considerable development and refinement of this system based upon a greater understanding of physiology, basic science, improved equipment and more clinical experience. Thermology signs are:

• Asymmetric and hyperthermic vascular patterns;
• Focal patterns of +2.5° C differential;
• Asymmetric and atypical complexity of a vascular pattern;
• Asymmetric and diffusely hyperthermic (+2° C differential) patterns involving the peri-areolar area or entire breast;
• Localized heat along an abnormal physical contour (edge sign);
• Lack of an adaptive response to an autonomic challenge procedure.

Thermology criteria are:

• Anarchic or complex vascular features;
• Hyperthermic focal patterns greater than 3° C differential;
• Asymmetric and abnormal complexity of a vascular pattern;
• Asymmetric and abnormal physical contour of more than one quadrant of a breast;
• Any combination of the thermology signs.

A positive Infrared Mammogram is not a diagnosis of malignant disease. A positive Infrared Mammogram provides, as does any other objective means of evaluation, a specific indication of risk for malignant disease and the need for comprehensive evaluation. The abnormal thermal features specific to malignant breast disease do not enable a location of a tumor that is sufficiently precise for biopsy. As the current paradigm of treating malignant disease depends heavily on the surgical removal of a tumor, Infrared Mammography complements rather than competes with structurally-based imaging methods, such as X-Ray Mammography, Magnetic Resonance Imaging (MRI) and Ultrasound. Clinical experience indicates targeted Ultrasound as the single most effective means of following-up an abnormal Infrared Mammogram study. In the truest sense, a diagnosis of malignant disease is not possible until a pathologist performs a histological evaluation from a biopsy.

Infrared Mammography has a very high sensitivity (conservatively 88%) but is less specific as inflammation or infection may cause false-positive findings, especially on initial studies of an individual. Women may also have vascular malformations in their breasts' thermal character as a consequence of mastitis or personal variant that may cause a false-positive Infrared Mammogram. However, the stability of an Infrared Mammogram featured in repeated studies over time is usually sufficient to attribute them to personal variant and distinguish them from malignant disease. False-negative errors are rare and usually a consequence of lag-stages in the development of a malignant tumor.

Infrared Mammography is most effective on a population of women for whom X-Ray Mammography (film-based or digital) is rather insensitive. This includes pre-menopausal, pregnant or lactating women as well as women with dense breast tissue, fibro-cystic disease, prosthetic augmentation, surgical reduction, previous biopsies and large breasts. This also includes post-menopausal women taking hormone replacement therapy. Clinical studies have demonstrated a strong correlation between the highest thermology markers and an aggressive character of the malignant tumor. Infrared Mammography can also select the best sentinel lymph node in the determination of metastasis. Infrared Mammography has real value in monitoring post-surgical patients following a baseline study. In addition Infrared Mammography has demonstrated application in evaluating the need for and the effectiveness of anti-angiogenic therapies. Infrared Mammography regularly provides specific indications of malignant breast disease five to eight (5-8) years before specific features are detected by X-Ray Mammography.