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Biomedical subjects

B Fornage

Publications and source records attributed to B Fornage.

At least 19 recordsLinked to original sources
PubMed2001

Adverse prognostic significance of infraclavicular lymph nodes detected by ultrasonography in patients with locally advanced breast cancer.

BACKGROUND: Ultrasonography is increasingly used to evaluate the nodal status of breast cancer patients and specialized positioning permits assessment of the infraclavicular fossa. However, the incidence and significance of infraclavicular (level III) adenopathy detected sonographically in locally advanced breast cancer (LABC) has not been defined. METHODS: The study population consisted of 146 LABC patients registered in a prospective trial of induction chemotherapy between 1991 and 1996. All patients underwent ultrasound imaging before and after chemotherapy. Median follow-up was 32 months. RESULTS: Forty-two of 146 patients (29%) had suspicious infraclavicular adenopathy; all 42 had additional positive axillary lymph nodes by ultrasound. Disease-free and overall survival for the patients with suspicious infraclavicular adenopathy was significantly worse compared with patients without this feature; disease-free survival 50% versus 68% (P = 0.112); overall survival 58% versus 83% (P = 0.026). CONCLUSIONS: Nearly one third of LABC patients will have infraclavicular lymph node involvement by ultrasound imaging; this finding is a significant adverse prognostic feature, and we recommend that infraclavicular nodal evaluation become a routine component of the sonographic workup of breast cancer patients, particularly if lower axillary lymph nodes appear involved.

Adult↗
PubMed2000

Novel translational model for breast cancer chemoprevention study: accrual to a presurgical intervention with tamoxifen and N-[4-hydroxyphenyl] retinamide.

Surrogate end point biomarkers for risk assessment and efficacy of potential chemopreventive agents are needed to improve the efficiency and reduce the cost of chemoprevention trials. It is imperative to develop the best clinical breast model for translational surrogate end point biomarker studies, especially with respect to accrual feasibility. We have initiated a prospective study to develop biomarkers for tamoxifen and N-[4-hydroxyphenyl] retinamide by administering either a placebo or both drugs for 2-4 weeks to women with ductal carcinoma in situ or early invasive cancers in the interval between the initial diagnostic core biopsy and definitive surgery. The principle end point is pretreatment versus posttreatment tumor levels of Ki-67; a number of other exploratory markers will also be examined. The planned target sample size is 100 patients. Between February 1997 and February 2000, 4514 women who had either an abnormal mammogram or a diagnosed breast cancer were screened for the study. Of these 4514 screened patients, 52 (1%) were registered on the study. Major factors of nonparticipation in the remaining 4462 women were as follows: (a) no evidence of malignancy (2081 patients; 46%); (b) ineligible per protocol criteria (575 patients; 13%); (c) preoperative chemotherapy/tamoxifen (520 patients; 11%); (d) surgery scheduling conflict (360 patients; 8%); (e) outside needle biopsy (221 patients; 5%); (f) no residual disease after excisional biopsy (345 patients; 8%); and (g) second opinion only (123 patients; 3%). Other nonparticipation factors included fine needle aspiration only, refusal, tumor size > 2 cm, and estrogen replacement therapy (35 patients each; 2% each). The protocol was amended in midstudy to allow outside needle biopsy, tumor > 2 cm, and estrogen replacement therapy. Accrual to biomarker (nontherapeutic) protocols with delay in definitive cancer surgery is challenging but feasible. Although some accrual problems remain, we have nonetheless succeeded in recruiting 50% of our target sample size in a 3-year period.

Adult↗
PubMed1998

Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue?

BACKGROUND: When to do a neck dissection as part of the surgical treatment for a patient with squamous carcinoma of the oral tongue is controversial, particularly when the primary can be resected without entering the neck. If the patient who is at high risk for having occult nodal disease in the neck can be identified, node dissection with the glossectomy could be justified. To better identify patients for this procedure, we correlated various tumor and patient factors along with preoperative diagnostic studies with the presence or absence of pathologically positive nodes in a group of patients who underwent node dissection. METHODS: Ninety-one previously untreated patients with biopsy-proved squamous carcinoma of the oral tongue were prospectively studied. All patients had a glossectomy and neck dissection as their initial treatment. The pathology findings (ie, lymph nodes with squamous cancer) were correlated with many preoperative and intraoperative factors, and a statistical analysis was made. RESULTS: The use of computed tomography and ultrasound was not better than the clinical examination in determining the presence or absence of nodal metastases. The best predictors were depth of muscle invasion, double DNA aneuploidy, and histologic differentiation of the tumor. CONCLUSIONS: All patients with stage T2-T4 squamous cancers of the oral tongue should have an elective dissection of the neck. Patients with T1N0 cancer who have a double DNA-aneuploid tumor, depth of muscle invasion > 4 mm, or have a poorly differentiated cancer should definitely undergo elective neck dissection. Ultrasound and computed tomography are of little value in predicting which patients have positive nodes.

Adult↗
PubMed1997

In search of specimen adequacy in fine-needle aspirates of nonpalpable breast lesions.

Pathology-related medical malpractice claims frequently concern fine-needle aspirations (FNAs) of breast lesions, and diagnostic errors have been attributed in part to the inadequacy of the specimens. Cytologic criteria for adequate FNA specimens, specifically in cases without malignancy, have not been clearly defined. From January 1988, to August 1995, 669 ultrasonographic-guided FNAs of nonpalpable, solid breast lesions with subsequent histologic examination were performed at our institution. From these, 54 cases with cytologic diagnoses of insufficient or nonspecific benign findings were identified. All aspirates were reviewed, and the number and size of the epithelial cell groups were quantitated in each case. By using criteria for adequate aspirates of palpable breast lesions (six or more epithelial cell groups per case with a minimum of 5-10 cells per group), 23 of the 54 aspirates were deemed inadequate and 31 adequate. Eleven (48%) of the inadequate aspirates and 17 (55%) of the adequate aspirates were from histologically confirmed carcinomas (ductal carcinoma in situ, 6; invasive carcinoma, 22, of which 12 were ductal, 7, lobular, and 3, mixed ductal and lobular). For the mammographic diagnoses "probably benign," "indeterminate," and "suggestive of malignancy or malignant," the probability of malignancy in aspirates of adequate cellularity (eg, > 6 epithelial groups) was 9%, 40%, and 93%, respectively. These findings indicate that a significant proportion of breast aspirates still may yield false-negative results despite adequate to high cellularity. Although a definition of adequacy based on cellularity is useful in reducing false-negative results, cellularity alone cannot be relied on in the management of nonpalpable lesions. For mammographic findings that are indeterminate or suggestive of malignancy or malignant, nonspecific FNA findings should be followed by core or excisional biopsy to exclude carcinoma.

Adult↗
PubMed1993

Fine-needle aspiration cytology of silicone granulomas in the augmented breast.

We studied 12 aspirates from 10 patients who underwent diagnostic fine-needle aspiration cytology (FNAC) of an augmented or reconstructed breast. Six patients were augmented with silicone gel-filled implants and four patients had silicone liquid injections. FNAC indications included a painful or suspicious mass. Excisional biopsy was performed in six cases after FNAC. The findings of eight cases included modestly cellular smears composed of loosely cohesive histiocytes containing vacuoles of various sizes. Multinucleated foreign body giant cells, fragments of dense, amorphous fibrous tissue, and fibroblast nuclei stripped of cytoplasm were also present. Two patients showed a mixture of inflammatory cells characteristic of intramammary lymph nodes or lymphoid aggregates. We conclude that silicone granulomas of the breast show a characteristic set of findings on FNAC which enable a cytopathologist to render a specific diagnosis given an appropriate history of breast augmentation.

Adult↗
PubMed1993

Endoscopic ultrasonography in the quantitative assessment of response to chemotherapy in patients with adenocarcinoma of the esophagus and esophagogastric junction.

We used endoscopic ultrasonography (EUS) to clinically stage eight patients with adenocarcinoma of the esophagus and to monitor their disease after subsequent courses of experimental preoperative chemotherapy. Stage of disease (TNM), tumor area, and tumor width were determined at each session. These results were then compared with barium esophagram and histopathology from resection specimens. EUS provided a consistent interpretation of the stage of disease and accurately predicted histopathologic findings. Measurement of tumor area and maximal width did not reliably correlate with the response to chemotherapy as assessed by barium esophagram. Although this technique seems promising, it cannot yet be recommended as a means of predicting response to chemotherapy.

Adenocarcinoma↗
PubMed1990

Endoscopic ultrasonography in staging rectal cancer.

Endoscopic ultrasonography (EUS) was used to stage rectal cancer by assessing depth of invasion through bowel wall layers and/or involvement of lymph nodes. EUS findings were correlated with histopathologic findings to discern the usefulness of this modality in predicting which patients could be candidates for sphinctersaving procedures and the avoidance of abdominoperineal resection. The Olympus EU-M3 endoscopic ultrasound system was used to assess depth of penetration through rectal wall layers and to identify lymph nodes. Comparison of EUS findings to histopathologic findings was possible in 13 patients. EUS agreed with histopathology in 9 of 13 cases (69.3%) ( p = 0.07, kappa statistic). EUS agreed with histopathology as the presence or absence of lymph nodes in 9 of 13 cases (69.3%) (p = 0.07). However, the presence of lymph nodes could not necessarily predict metastatic involvement of these nodes. In one patient, invasion of vaginal cuff was correctly predicted. In nine cases, computed tomographic analysis (CT) was available for comparison to EUS in detection of penetration beyond the bowel wall. CT agreed with histopathology in 3 of 9 (33%), whereas EUS agreed with histopathology in 7 of 9 (78%).

Adenocarcinoma↗
PubMed1987

[Real-time ultrasonics: a method of hand imaging].

Seventy-five surgically soft-tissue lesions of the hand were examined prospectively by real-time ultrasound and correlated with surgical and pathological findings. The normal ultrasonic anatomy of the hand is described. The use of real time sonography allowed a reliable diagnosis of the cystic or solid nature of soft-tissue tumors, an accurate estimation of their volume and their precise three-dimensional localization. Sonography facilitates the location of foreign bodies, and appears as a new promising technique for the evaluation of tendons.

Adolescent↗
PubMed1985

[Echographic imaging of the prostate].

Progress in prostatic ultrasonography has been dramatic during the last decade, due to constant improvements in ultrasound equipment. Several ultrasonic approaches (suprapubic, perineal, transrectal or trans-urethral) are now available. The author reports its own examination technique which combines several approaches and equipments. The normal anatomy of the prostate and seminal vesicles is described, and the benefits of this new imaging method in prostatic pathology are reviewed. The size of the prostate can be accurately measured by ultrasound. The ultrasonographic patterns of benign prostatic hypertrophy, cancer, prostatitis and lithiases are described and diagnostic ambiguities are mentioned. The lack of specificity of the method is obviated by new techniques of ultrasound guided transperineal biopsy. Transrectal ultrasonography has proved effective in the assessment of local cancer invasion. The urodynamic repercussions of prostatic diseases can also be evaluated by ultrasound. Finally, this safe and harmless method should be used to evaluate the response of prostatic carcinomas to conservative treatments.

Calculi↗
PubMed1985

[Prostatic cancer: role of echography in the diagnosis, evaluation and surveillance].

The author reviews the latest technical improvements, the benefits and limitations of prostatic sonography in the evaluation and follow-up of prostatic cancer. Emphasis is put on the optimal cost/risks/information ratio of transrectal scanning, the accuracy of real-time ultrasound guided transperineal prostatic biopsies and the basic role of transrectal sonography in monitoring the response to treatment.

Adenocarcinoma↗
PubMed1984

[Echographic aspects of superficial lipoma].

The author analyzes the sonographic patterns of 14 superficial benign lipomas. Echogenicity ranges from hypoechogenicity with distal sound enhancement to isoechogenicity with the possibility of hyperechoic areas. 50% of the lipomas of this series were ill-defined from the surrounding fatty soft-tissues.

Humans↗
PubMed1984

[Diagnosis of calcification of the patellar tendon. Echo-radiographic comparison].

Real-time sonography was compared to low-kilovoltage radiographs in the diagnosis of intra-tendinous calcifications in 10 patients with chronic patellar tendonitis. In these patients sonography demonstrated thickening (100% of cases) and hypoechogenicity (90% of cases) of the patellar tendon. Ultrasound disclosed all calcifications displayed on radiographs showing hyperechoic foci. The associated acoustic shadow was absent in one case of a calcification less than one millimeter in diameter. Real-time ultrasound appears highly reliable in the diagnosis of even minute intra-tendinous calcifications. It also provides an accurate three-dimensional localization of the calcific deposits in the tendons.

Calcinosis↗
PubMed1984

[Endorectal echography of the prostate. Comparison of radial and linear type probes].

Prostatic sonography is now routinely performed. Transrectal scanning provides the best imaging quality. Two different types of probes are available: radial probes for transverse scans and linear array probes for longitudinal scans. A comparative study of both types of probes has been performed in 98 patients. Complementary roles of radial and linear probes are demonstrated and the consecutive use of both probes is recommended for a complete sonographic study of prostate and surrounding structures.

Humans↗
PubMed1983

[Contribution of ultrasonics in the evaluation of abdominal tumors in children].

Twenty-eight children with abdominal tumors were examined ultrasonically. Real-time ultrasonography proved particularly useful in infants. In most cases ultrasonography shortened the diagnostic procedure by giving accurate images of the tumor's limits, size, contents, and origin. The method yielded an overall diagnostic accuracy rate of 89%. Moreover, ultrasonography is a reliable and safe means of monitoring abdominal tumors during and after therapy. In 1981, plain roentgenograms, intravenous urography with cavography and ultrasonography should be sufficient in the standard radiologic approach of most children with abdominal tumors.

Abdominal Neoplasms↗
PubMed1983

[A new technic of transperineal puncture of the prostate guided by real-time endorectal echography].

The author reports a technique of ultrasonically-guided prostatic biopsy using a new transrectal linear array real-time transducer. The needle is inserted transperineally parallel to the probe towards the prostatic suspicious abnormalities disclosed by transrectal sonography. The needle is entirely visualized and its progression is accurately and safely monitored by a permanent real-time control.

Biopsy, Needle↗