B D Fornage

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (126)350.44 Total impact

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    ABSTRACT: OBJECTIVE. The purpose of this study was to determine the diagnostic value of strain elastography (SE) alone and in combination with gray-scale ultrasound in the diagnosis of benign versus metastatic disease for abnormal axillary lymph nodes in breast cancer patients. SUBJECTS AND METHODS. Patients with breast cancer and axillary lymph nodes suspicious for metastatic disease on conventional ultrasound who underwent SE of the suspicious node before ultrasound-guided fine-needle aspiration biopsy (FNAB) were included in this study. On conventional ultrasound, the long- and short-axis diameters, long-axis-to-short-axis ratio, cortical echogenicity, thickness, and evenness were documented. The nodal vascularity was assessed on power Doppler imaging. Elastograms were evaluated for the percentage of black (hard) areas in the lymph node, and the SE-ultrasound size ratio was calculated. Two readers assessed the images independently and then in consensus in cases of disagreement. ROC AUCs were calculated for conventional ultrasound, SE, and both methods combined. Interreader reliability was assessed using kappa statistics. RESULTS. A total of 101 patients with 104 nodes were examined; 35 nodes were benign, and 69 had metastases. SE alone showed a significantly lower AUC (62%) than did conventional ultrasound (92%) (p < 0.001). There was no difference between the AUC of conventional ultrasound and the AUC of the combination of conventional ultrasound and SE (93%) (p = 0.16). Interreader reliability was moderate for all variables (κ ≥ 0.60) except the SE-ultrasound size ratio (κ = 0.35). CONCLUSION. Added SE does not improve the diagnostic ability of conventional ultrasound when evaluating abnormal axillary lymph nodes.
    AJR. American journal of roentgenology. 12/2014; 203(6):1371-8.
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    ABSTRACT: To evaluate recurrence and survival for patients with occult (T0N+) breast cancer who underwent contemporary treatment, assessing outcomes for breast conservation and mastectomy.
    Annals of Surgical Oncology 09/2014; · 4.12 Impact Factor
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    ABSTRACT: OBJECTIVE. The objective of our study was to describe our technique and preliminary results of ultrasound-guided fine-needle aspiration (FNA) of indeterminate internal mammary (IM) lymph nodes in patients with a history of breast cancer. CONCLUSION. Ultrasound-guided FNA of IM nodes is feasible and is particularly useful in the staging of breast cancer.
    AJR. American journal of roentgenology. 08/2014; 203(2):W213-W220.
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    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
  • Bruno D Fornage, Beth S Edeiken, Gary L Clayman
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    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
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    ABSTRACT: LEARNING OBJECTIVES 1) Describe the equipment needed for ultrasound guided interventional breast procedures. 2) Review the basic principles of ultrasound guidance and performance of minimally invasive breast procedures. 3) Practice hands-on technique for ultrasound guided breast interventional procedures. ABSTRACT This course is intended to familiarize the participant with equipment and techniques in the application of US guided breast biopsy and needle localization. Participants will have both basic didactic instruction and hands-on opportunity to practice biopsy techniques on tissue models with sonographic guidance. The course will focus on the understanding and identification of: 1) optimal positioning for biopsy 2) imaging of adequate sampling confirmation 3) various biopsy technologies and techniques 4) potential problems and pitfalls
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
  • B D Fornage, K K Hunt
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    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
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    ABSTRACT: Fat-containing breast lesions constitute a heterogeneous group of predominantly benign tumors and non-neoplastic conditions. The role of imaging is to distinguish leave-me-alone lesions from rarely occurring malignant fat-containing tumors that require histologic analysis. Correlating mammographic findings with appearance at ultrasonography often helps in identifying lesions that do not require further work-up. MRI can be valuable to confirm the presence of fat and characterize lesions indeterminate on conventional imaging. The purpose of this multimodality imaging review is to exemplify the radiologic appearances of common and uncommon fat-containing breast lesions to facilitate accurate diagnosis, avoid unnecessary interventions, and ensure appropriate management. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound, 2013.
    Journal of Clinical Ultrasound 07/2013; · 0.70 Impact Factor
  • Basak Erguvan Dogan, Bruno D. Fornage
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    ABSTRACT: PURPOSE To evaluate the usefulness of internal mammary (IM) sonography (US) and IMUS-guided fine-needle aspiration biopsy (FNA) of ipsilateral internal mammary lymph nodes in the staging of breast cancer patients METHOD AND MATERIALS 1383 patients with ipsilateral known breast cancer or suspicious breast mass, who had undergone axillary US and IMUS as part of their routine breast US study between 09/2011 and 01 /2012 at our institution, were retrospectively reviewed. Patients with a suspicious IM lymph node (IMLN) detected at IMUS underwent US-guided FNA as clinically indicated. Patient demographics, breast cancer type and prognostic factors, and presence or absence of additional metastatic nodes in the axillary, infraclavicular and supraclavicular nodal basins were recorded. Correlation was made with CT, PET/CT, MRI findings and with the results of US-guided fine-needle aspiration. RESULTS IMLNs were identified in 31 patients, 27 (87%) of which were being evaluated for ipsilateral breast carcinoma. Median patient age was 47 (range 26-81), and mean IMLN size was 1.2 cm (range 0.4-2.8 cm). Metastatic disease was confirmed with US-guided FNA in 9 (33%) patients and by cross-sectional imaging techniques in 19 (67%). An IMLN was the only site of nodal metastasis in 7/25 (28%) patients with ipsilateral breast carcinoma, and was confirmed with US-guided FNA. IMUS and US-guided FNA upstaged the breast cancer from stage I to stage III in 3 (11%) patients and from stage II to stage III in 6 (22%) patients. Owing to IMUS findings, 5 (19%) patients were rerouted from surgery to neoadjuvant chemotherapy, 3 (12%) underwent IMLN dissection, and 12 (48%) were treated with adjuvant high-dose radiotherapy boosting. CONCLUSION IMUS provides diagnostic information that impacts patient management in breast cancer patients and should be part of the staging breast US examination. CLINICAL RELEVANCE/APPLICATION IMUS and US-guided FNA have a significant impact on staging and management decisions in breast cancer patients
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
  • Rosalind Candelaria, Bruno D Fornage
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    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
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    ABSTRACT: LEARNING OBJECTIVES 1) Describe the equipment needed for US-guided interventional breast procedures. 2) Review the basic principles of ultrasound guidance and performance of minimally invasive breast procedures. 3) Describe the equipment needed for US-guided interventional breast procedures. 4) Practice hands-on technique for US-guided breast interventional procedures. ABSTRACT This course is intended to familiarize the participant with equipment and techniques in the application of US guided breast biopsy and needle localization. Participants will have both basic didactic instruction and hands-on opportunity to practice biopsy techniques on tissue models with sonographic guidance. The course will focus on the understanding and identification of: 1) optimal positioning for biopsy 2) imaging of adequate sampling confirmation 3) various biopsy technologies and techniques 4) potential problems and pitfalls
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 11/2010
  • [Show abstract] [Hide abstract]
    ABSTRACT: LEARNING OBJECTIVES 1) Describe the equipment needed for ultrasound guided interventional breast procedures. 2) Review the basic principles of ultrasound guidance and performance of minimally invasive breast procedures. 3) Describe the equipment needed for ultrasound guided interventional breast procedures. 4) Practice hands-on technique for ultrasound guided breast interventional procedures. ABSTRACT This course is intended to familiarize the participant with equipment and techniques in the application of US guided breast biopsy and needle localization. Participants will have both basic didactic instruction and hands-on opportunity to practice biopsy techniques on tissue models with sonographic guidance. The course will focus on the understanding and identification of: 1) optimal positioning for biopsy 2) imaging of adequate sampling confirmation 3) various biopsy technologies and techniques 4) potential problems and pitfalls
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
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    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
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    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
  • Current problems in surgery 04/2008; 45(3):149-51. · 1.42 Impact Factor
  • Current problems in surgery 04/2008; 45(3):156-250. · 1.42 Impact Factor
  • Bruno D. Fornage, Beth S. Edeiken-Monroe
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    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.
    12/2007: pages 121-161;
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    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
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    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
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    ABSTRACT: Background.Lymph node metastasis from differentiated thyroid carcinoma may occur outside of the basins at greatest risk of spread, such as the lateral retropharyngeal lymph nodes. The extensive surgery of traditional approaches to the retropharyngeal space are rarely justified in the treatment of metastatic differentiated thyroid cancer. Therefore, a less invasive surgical approach is advantageous in resection of metastatic lateral retropharyngeal nodes.Methods.To assess feasibility and safety, we report transoral excision guided by preoperative ultrasonography in a series of 3 consecutive patients with differentiated thyroid cancer metastatic to the retropharyngeal space.Results.In all cases, the metastatic lateral retropharyngeal lymph node was successfully removed by transoral retropharyngotomy without complications.Conclusions.We advocate a transoral approach guided by preoperative ultrasonography for resection of differentiated thyroid cancer metastatic to the retropharyngeal lymph nodes. The approach is feasible, minimally invasive, and safe in achieving the goals in management of regionally metastatic disease. © 2006 Wiley Periodicals, Inc. Head Neck, 2007
    Head & Neck 02/2007; 29(3):258 - 266. · 2.83 Impact Factor

Publication Stats

3k Citations
350.44 Total Impact Points

Institutions

  • 1988–2014
    • University of Texas MD Anderson Cancer Center
      • • Department of Surgical Oncology
      • • Department of Pathology
      • • Department of Radiology
      Houston, Texas, United States
  • 2013
    • Texas Tech University Health Sciences Center
      El Paso, Texas, United States
  • 2011
    • St. Luke's Episcopal Health System
      Houston, Texas, United States
  • 2000
    • University of Houston
      Houston, Texas, United States
  • 1984–1988
    • Institut Jean-Godinot
      Rheims, Champagne-Ardenne, France