[Show abstract][Hide abstract] ABSTRACT: The role of regional nodal ultrasound (US) has been questioned since publication of the American College of Surgeons Oncology Group (ACOSOG) Z0011 data. The goal of this study was to determine if imaging and clinicopathologic features could predict the extent of axillary nodal involvement in breast cancer.
Annals of Surgical Oncology 05/2014; · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE. The purpose of this article is to describe the use of transoral sonography in the diagnosis, fine-needle aspiration (FNA) biopsy, and intraoperative localization of retropharyngeal masses. MATERIALS AND METHODS. We reviewed images and data for eight patients with a retropharyngeal mass identified on CT, MRI, or PET/CT as being suspicious for a metastatic Rouviere node. Transoral ultrasound was performed using a commercially available endorectal or endovaginal transducer. Transoral ultrasound-guided FNA biopsy was performed using a needle guide attached to the transducer shaft. Color and power Doppler imaging were used to identify the internal carotid artery and jugular vein and to plan the safest path to the targeted mass. The mass was intraoperatively localized by marking the mucosa with a permanent marker or by injecting methylene blue. RESULTS. There were six patients with a history of thyroid cancer (five papillary cancers and one medullary cancer), one patient with a history of esthesioneuroblastoma, and one patient with no history of cancer. Transoral ultrasound imaging was successful in all eight patients. Transoral ultrasound-guided FNA biopsy was performed in four patients, and a satisfactory cytologic diagnosis was obtained in all cases, although in one of those four cases, an additional core biopsy with an 18-gauge needle was performed to completely rule out lymphoma. Six patients underwent a transoral resection of the lesion. In three of them, the lesion was localized intraoperatively by making a mark on the mucosa and in one case by adding transoral ultrasound-guided injection of methylene blue. CONCLUSION. Transoral ultrasound can be used to visualize, sample, and localize abnormal masses in the retropharyngeal space, such as metastatic Rouviere nodes in patients with a history of head and neck cancer.
American Journal of Roentgenology 05/2014; 202(5):W481-6. · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the past few decades, the surgical treatment of early breast cancer has evolved from radical mastectomy to breast conservation surgery and the current practice of segmental mastectomy and radiotherapy. As these less invasive techniques have gained acceptance with excellent long-term rates of local-regional control, there has been a growing interest in the surgical community in techniques to ablate the primary tumor percutaneously with the ultimate goal of omitting the need for surgical excision of the primary tumor.
Technology in cancer research & treatment 11/2013; · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To review our institutional experience in using second-look ultrasound (SLUS) to identify breast lesions initially detected on MR imaging that were indeterminate or suspicious for malignancy.
This Health Insurance Portability and Accountability Act compliant retrospective review included 83 women with 131 lesions initially identified as indeterminate or suspicious for malignancy on MR imaging from February 1, 2008 through July 31, 2009. An SLUS correlate was confirmed on the basis of concordant location, size, and morphologic features. The detection rate of SLUS was determined. Patients' demographics, lesion size, and MR imaging morphologic features (focus, mass, non-masslike) were reviewed to identify which factors led to successful detection on SLUS. Likelihood ratio χ(2) tests were used for statistical analysis.
SLUS correlates were found for 88 of 131 (67%) lesions initially detected on MR imaging; 27 of 88 (31%) were malignant. SLUS detected foci (67%) and masses (73%) more frequently than it did non-masslike lesions (54%). The detection rate of SLUS was independent of lesion size on MR imaging. Malignant lesions were not more likely than benign lesions to be detected on SLUS (61% versus 70%).
SLUS provides value in the clinical workup of breast lesions that are indeterminate or suspicious for malignancy. It identified two thirds of the MR-detected lesions evaluated and permitted performance of US-guided needle biopsy on 70 of 88lesions. The likelihood of finding MR-detected lesions on SLUS was significantly higher for foci and masses than for non-masslike lesions (P < 0.05).
Journal of Clinical Ultrasound 03/2011; 39(3):115-21. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was in vitro sonographic-pathologic correlation of findings in dissected axillary lymph nodes from breast cancer patients undergoing axillary lymph node dissection and classification of the sonographic appearance of the nodes on the basis of cortical morphologic features to facilitate early recognition of metastatic disease.
High-resolution sonography was used for in vitro examination of 171 lymph nodes from 19 axillae in 18 patients with unknown nodal status who underwent axillary lymph node dissection for early infiltrating breast cancer. The images were evaluated by two blinded observers, and discordant readings were referred to a third blinded observer. Each lymph node was classified as one of types 1-6 according to cortical morphologic features. Types 1-4 were considered benign, ranging from hyperechoic with no visible cortex to thickened generalized hypoechoic cortical lobulation. Type 5 (focal hypoechoic cortical lobulation) and type 6 (hypoechoic node with absent hilum) nodes were considered metastatic. The reference standard for metastatic disease was histopathologic evaluation of sectioned nodes by a single pathologist blinded to sonographic findings. Largest nodal diameter also was measured.
Interobserver agreement was 77% for classification of nodal morphology (types 1-6) and 88% for characterization of a node as benign or malignant. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of cortical shape in prediction of metastatic involvement of axillary nodes were 77%, 80%, 36%, 96%, and 80%. Type 4 nodes had the most false-negative findings (four of 36). Node size ranged from 0.2 to 3.8 cm, and subcentimeter nodes of all types were detected.
In breast cancer, axillary lymph nodes can be classified according to cortical morphologic features. Predominantly hyperechoic nodes (types 1-3) can be considered benign. Generalized cortical lobulation (type 4) is uncommonly a false-negative finding, but metastasis, if present, is invariably detected at sentinel node mapping. The presence of asymmetric focal hypoechoic cortical lobulation (type 5) or a completely hypoechoic node (type 6) should serve as a guideline for universal performance of fine-needle aspiration for preoperative staging of breast cancer. This classification, when verified with larger samples, may serve as a useful clinical guideline if proven with results of in vivo studies.
American Journal of Roentgenology 10/2008; 191(3):646-52. · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the sonographic characteristics of intramammary lymph node metastasis (ILNM) in patients with breast cancer and to assess the value of sonography and sonographically guided fine needle aspiration biopsy (FNAB) in their diagnosis.
We retrospectively reviewed the charts and films of 19 women with biopsy-documented ILNM who were seen in our breast diagnostic center between December 1999 and July 2003. The sonographic appearance of the nodes was analyzed and correlated with clinical and mammographic findings and with biopsy results.
The ILNMs were clinically and mammographically occult in 7 (37%) of the 19 women. The diameter of the ILNMs was less than 1 cm in 15 (79%) cases. The volume of the central echogenic hilum was less than 50% of the total volume of the node in each of the patients. There was marked decrease in cortical echogenicity of the ILN in all cases. Metastatic involvement was established via sonographically guided FNAB in each of the 19 suspicious intramammary lymph nodes.
Sonography and sonographically guided FNAB are valuable methods of assessment for ILNM in patients with known or suspected breast cancer. The most consistent sonographic features associated with ILNM were reduction in the volume of the central echogenic hilum and marked hypoechogenicity of the node's cortex.
Journal of Clinical Ultrasound 07/2008; 36(5):279-85. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sonography (US) is routinely used in breast imaging centers as an essential complement to physical examination and mammography
in the evaluation of breast masses. US not only differentiates cystic from solid masses but also aids in discrimination between
benign and malignant solid masses. In a patient with a newly diagnosed breast cancer, US of the regional nodal basins (with
US-guided fine-needle aspiration of suspicious nodes) can significantly alter the pretherapeutic stage. US can be used to
evaluate the treated breast and to detect and diagnose local recurrence. US is routinely used at M. D. Anderson Cancer Center
to quantify the response of breast tumors and nodal metastases to neoadjuvant chemotherapy. US cannot demonstrate microcalcifications,
and its accuracy is very operator dependent. Although US can detect some nonpalpable carcinomas missed by mammography, its
efficacy in breast cancer screening remains to be proved. Because of its unique real-time capability, US has become the modality
of choice for guiding percutaneous interventional procedures on breast masses, from needle biopsy to ablation.
[Show abstract][Hide abstract] ABSTRACT: The unique growth pattern of invasive lobular carcinoma (ILC) poses a challenge for preoperative assessment of disease extent within the breast. Whether it similarly limits lymph node staging by ultrasound (US) and fine-needle aspiration (FNA) biopsy was the subject of the current study.
A total of 217 patients with ILC who underwent axillary US were reviewed. FNA biopsy was performed when US findings were suspicious or indeterminate. Findings were compared to literature reports of US in invasive ductal carcinoma (IDC) patients.
Axillary US was negative in 137 patients (63%) and suspicious or indeterminate in 80 patients (37%). FNA biopsy was positive in 62% (47/76 patients). Preoperative US and FNA biopsy identified 43 of 111 (39%) node-positive patients. Sensitivity of US with FNA biopsy correlated with primary tumor and nodal metastasis size. Similar results were seen in IDC populations.
US with FNA biopsy appears to be similarly useful in axillary staging of ILC and IDC patients.
American journal of surgery 11/2007; 194(4):450-5. · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the locoregional efficacy of multimodality treatment for breast cancer patients who present with ipsilateral supraclavicular (SCV) disease without systemic metastases.
We retrospectively reviewed the data from 71 patients with ipsilateral SCV involvement at presentation. SCV involvement in 16 patients (23%) was diagnosed by ultrasound examination only, without palpable disease. All patients were treated with curative intent using neoadjuvant chemotherapy, mastectomy or breast-conserving surgery (BCT), and radiotherapy.
The 5-year SCV control, locoregional control (LRC), disease-free survival, and overall survival rate was 90%, 77%, 30%, and 47%, respectively. Patients with persistent SCV disease after neoadjuvant chemotherapy by physical examination had a lower rate of LRC (64% vs. 86%, p = 0.026), as did those with persistent SCV disease by ultrasound examination (66% vs. 96%, p = 0.007). Of those with a complete response of SCV disease by physical examination after neoadjuvant chemotherapy, those with persistently abnormal ultrasound findings had significantly worse disease-free survival (0% vs. 55%, p = 0.03). BCT was not associated with lower rates of LRC (82% for BCT vs. 76% for mastectomy, p = 0.80).
Radiotherapy achieved excellent LRC after surgery for patients with ipsilateral SCV metastases who achieved a complete response of the SCV disease after neoadjuvant chemotherapy. For patients who achieved a complete response of the SCV disease by physical examination, ultrasonography of the SCV fossa may help assess the risk of disease recurrence. SCV involvement should not be considered a contraindication for BCT.
International Journal of Radiation OncologyBiologyPhysics 03/2007; 67(2):490-6. · 4.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postoperative monitoring of free flaps is important to minimize the risk of flap failure, but monitoring buried free flaps is difficult because the standard methods of clinical examination and surface Doppler monitoring are not possible. Buried free flaps are often monitored using an implantable 20-MHz ultrasonic Doppler probe.
The authors conducted a retrospective clinical study of buried free flaps to assess the reliability of the implantable Doppler probe in postoperative monitoring of free flaps.
During the 38-month study period, 956 free flap operations were performed at the authors' institution. Twenty (2.1 percent) of these cases involved completely buried free flaps in which an implantable Doppler probe was used for flap monitoring. Implantable Doppler probe monitoring had a 100 percent sensitivity rate in detecting loss of flap perfusion, making it a good screening test for free flap viability. However, it suffered from a high false-positive rate of 88 percent, which resulted in a high proportion of subsequent negative surgical explorations. In one case, color duplex sonography, a rapid and noninvasive test, revealed that the loss of signal from the implantable Doppler probe was a false-positive result.
The implantable Doppler probe is a sensitive method for postoperative monitoring of free flaps but is prone to false-positive signals. The use of color duplex sonography to confirm implantable Doppler probe findings may avert unnecessary surgical exploration, thereby improving postoperative monitoring of free flaps.
Plastic and reconstructive surgery 08/2006; 118(1):109-13; discussion 114-5. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the sonographic and mammographic appearance of granular cell tumors (GCTs) of the breast in 6 patients with pathological correlation.
A search was conducted of the cyto-histopathological database in a single institution from 1990 to 2004 for breast lesions given the diagnosis of GCT of the breast. Six patients with GCT of the breast who underwent mammographic or sonographic examination or both before surgery were included in this study.
The mammographic features of GCT of the breast were indeterminate in most patients, often presenting as an isodense mass with indistinct or spiculated margins. Calcifications were not a feature. The sonographic features of GCT of the breast mimicked carcinoma, including heterogeneous echotexture, indistinct margins, and hypervascularity. Hyperechogenicity was noted in 5 of 7 (71%) GCTs in this series. The cytomorphological features of GCT included sheets of large granular cells intersected by arborizing thin-walled blood vessels. The cells had round to oval nuclei, inconspicuous nucleoli, and abundant, ill-defined granular cytoplasm.
Breast imagers should be aware that GCT of the breast is an uncommon differential in a minority of neoplasms that can be mistaken for breast cancer.
Journal of Clinical Ultrasound 06/2006; 34(4):153-60. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pathologic complete remission (pCR) of primary breast tumors after primary chemotherapy (PCT) is associated with higher relapse-free survival (RFS) and overall survival (OS) rates. The purpose of this study was to determine long-term outcome in patients achieving pCR of cytologically proven axillary lymph node (ALN) metastases.
Patients with cytologically documented ALN metastases were treated in five prospective PCT trials. After surgery, patients were subdivided into those with and without residual ALN carcinoma. Survival was calculated by the Kaplan-Meier method.
Of 925 patients treated, 403 patients had cytologically confirmed ALN metastases. Eighty-nine patients (22%) achieved ALN pCR after PCT. Compared with the group without ALN pCR, 5-year OS and RFS were improved in patients achieving ALN pCR (93% [95% CI, 87.5 to 98.5] and 87% [95% CI, 79.7 to 94.3] v 72% [95% CI, 66.5 to 77.5] and 60% [95% CI, 54.1 to 65.9], respectively; P < .0001). Residual primary tumor did not affect outcome of those with ALN pCR. Combination anthracycline/taxane-based PCT resulted in significantly more ALN pCRs, although outcome after ALN pCR was not improved by taxanes. We constructed a nomogram demonstrating that patients who do not benefit from neoadjuvant anthracyclines are unlikely to benefit from subsequent taxanes.
ALN pCR is associated with an excellent prognosis, even with a residual primary tumor, pointing to biologic differences between primary and metastatic cells. ALN pCR represents an early surrogate marker of long-term outcome. Response to initial PCT has important potential as a guide to subsequent therapy.
Journal of Clinical Oncology 01/2006; 23(36):9304-11. · 18.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Microwave-based thermoacoustic tomography (TAT) and laser-based photoacoustic tomography (PAT) in a circular scanning configuration were both developed to image deeply seated lesions and objects in biological tissues. Because malignant breast tissue absorbs microwaves more strongly than benign breast tissue, cancers were imaged with good spatial resolution and contrast by TAT in human breast mastectomy specimens. Based on the intrinsic optical contrast between blood and chicken breast muscle, an embedded blood object that was 5 cm deep in the tissue was also detected using PAT at a wavelength of 1064 nm.
Technology in cancer research & treatment 11/2005; 4(5):559-66. · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Radiofrequency ablation (RFA) offers an alternative treatment in some unresectable hepatocellular carcinoma (HCC) patients with disease confined to the liver. We prospectively evaluated survival rates in patients with early-stage, unresectable HCC treated with RFA.
All patients with HCC treated with RFA between September 1, 1997, and July 31, 2002, were prospectively evaluated. Patients were treated with RFA by using a percutaneous or open intraoperative approach with ultrasound guidance and were evaluated at regular intervals to determine disease recurrence and survival.
A total of 194 patients (153 men [79%] and 41 women [21%]) with a median age of 66 years (range, 39-86 years) underwent RFA of 289 sonographically detectable HCC tumors. All patients were followed up for at least 12 months (median follow-up, 34.8 months). Percutaneous and open intraoperative RFA was performed in 140 (72%) and 54 (28%) patients, respectively. The median diameter of tumors treated with RFA was 3.3 cm. Disease recurred in 103 (53%) of 194 patients, including 69 (49%) of 140 patients treated percutaneously and 34 (63%) of 54 treated with open RFA (not significant). Local recurrence developed in nine patients (4.6%). Most recurrence was intrahepatic. The overall complication rate was 12%. Overall survival rates at 1, 3, and 5 years for all 194 patients were 84.5%, 68.1%, and 55.4%, respectively.
Treatment with RFA can produce significant long-term survival rates for cirrhotic patients with early-stage, unresectable HCC. RFA can be performed in these patients with relatively low complication rates. Confirmation of these results in randomized trials should be considered.
Annals of Surgical Oncology 09/2005; 12(8):616-28. · 4.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report a preliminary study of breast cancer imaging by microwave-induced thermoacoustic tomography. In this study, we built a prototype of breast cancer imager based on a circular scan mode. A 3-GHz 0.3~0.5-µs microwave is used as the excitation energy source. A 2.25-MHz ultrasound transducer scans the thermoacoustic signals. All the measured data is transferred to a personal computer for imaging based on our proposed back-projection reconstruction algorithms. We quantified the line spread function of the imaging system. It shows the spatial resolution of our experimental system reaches 0.5 mm. After phantom experiments demonstrated the principle of this technique, we moved the imaging system to the University of Texas MD Anderson Cancer Center to image the excised breast cancer specimens. After the surgery performed by the physicians at the Cancer Center, the excised breast specimen was placed in a plastic cylindrical container with a diameter of 10 cm; and it was then imaged by three imaging modalities: radiograph, ultrasound and thermoacoustic imaging. Four excised breast specimens have been tested. The tumor regions have been clearly located. This preliminary study demonstrated the potential of microwave-induced thermoacoustic tomography for applications in breast cancer imaging.