Biomedical subjects

Bruno D Fornage

Publications and source records attributed to Bruno D Fornage.

15 recordsLinked to original sources

PubMed2006

Sonographic and mammographic appearances of granular cell tumors of the breast with pathological correlation.

PURPOSE: To describe the sonographic and mammographic appearance of granular cell tumors (GCTs) of the breast in 6 patients with pathological correlation. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Adolescent↗

PubMed2006

Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Humans↗

PubMed2005

Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Adult↗

PubMed2005

Thermoacoustic and photoacoustic tomography of thick biological tissues toward breast imaging.

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.

Algorithms↗

PubMed2004

Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study.

PURPOSE: To determine the feasibility and safety of ultrasonographically (US) guided percutaneous radiofrequency (RF) ablation in the local treatment of invasive breast carcinomas 2 cm or less in greatest diameter. MATERIALS AND METHODS: RF ablation of 21 malignant lesions was performed in 20 patients immediately before their scheduled lumpectomy or mastectomy. A 15-gauge needle electrode was placed in the lesions, and the prongs of the needle electrode were deployed with real-time US guidance. A temperature of approximately 95 degrees C was maintained for 15 minutes at the tips of the prongs. Histopathologic examination of the resected specimens included use of nicotinamide adenine dinucleotide in its reduced form-diaphorase stain, which is specifically used to confirm thermal cell injury and lack of viability. The desired outcome of the procedure was ablation of the tumor and of an adequate margin around it, as confirmed by the absence of viable tissue in the surgical specimen. RESULTS: In all 21 cases, complete ablation of the target lesion was visualized at US. In one patient, who had undergone preoperative chemotherapy for a mass that was initially judged to be a T2 tumor but who was found to have a small residual tumor at mammography and US performed at the time of ablation, the target lesion was ablated but residual in situ mammographically and US occult invasive carcinoma was found at histopathologic examination. There were no adverse effects. CONCLUSION: US-guided percutaneous ablation of small invasive breast carcinomas is feasible and safe.

Adenocarcinoma, Mucinous↗

PubMed2003

Imaging in cervical cancer.

Cervical cancer traditionally has been staged clinically. Advances in imaging could improve the staging of cervical cancer by facilitating the detection of lymph node metastases and micrometastases in distant organs. Such progress could lead to improvements in treatment selection and therefore increase overall survival rates. At the Second International Conference on Clinical Cancer (Houston, TX, April 11-14, 2002), a panel composed of gynecologic oncologists, radiation oncologists, and diagnostic radiologists reviewed relevant technologies. Advances in lymphangiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and lymphatic mapping were reviewed, along with the impact of these advances on the diagnosis, treatment, and survival of patients with cervical cancer. Few cancer centers still use lymphangiography, but the sensitivity of this method ranges from 28% to 83%, with specificity ranging from 47% to 100%. The roles of transabdominal and transvaginal ultrasonography in evaluating cervical cancer are expected to expand when new contrast agents increase the sensitivity of these techniques to parametrial invasion and lymph node metastases; meanwhile, ultrasonography's most significant contributions may involve the identification of uterine and cervical leiomyomas and the evaluation of urinary tract obstruction. Advances in CT have made it a rival technique to MRI, but limitations prevent CT from providing definitive information on certain parameters. MRI, which is valuable because of its superior soft tissue contrast resolution, multiplanar capabilities, and cost-effectiveness, is used to determine the size of the cervix and to detect certain types of invasion, characteristics of lymph nodes, and the presence of disease in the ureter, lung, and liver. PET with 2-[fluorine-18]fluoro-2-deoxy-D-glucose has been found to detect abnormal lymph node regions better than CT does but PET can also be used in conjunction with CT to measure tumor dimensions. PET also has become a method for identifying tumors that are unresponsive to chemoradiation. When used together with immunohistochemical and molecular techniques as well as conventional stains, sentinel lymph node mapping, an important development in the surgical management of solid tumors, is expected to improve gynecologic cancer management. Advances in imaging methods and in contrast agents, along with advances in the combined use of the two, are expected to make imaging technologies more valuable in cervical cancer assessment.

Diagnostic Imaging↗

PubMed2003

Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients.

BACKGROUND: False-positive, false-negative, and indeterminate fine-needle aspiration (FNA) biopsy results complicate the management of patients with thyroid nodules. METHODS: Thyroid FNA results from 240 consecutive patients (seen 1991 to 2002) were categorized into four groups: positive for malignancy, negative for malignancy, indeterminate for malignancy, and nondiagnostic. Indeterminate results included follicular neoplasm, Hürthle cell neoplasm, and suspicious for papillary carcinoma. The FNA results were compared with histopathologic analysis after thyroidectomy. RESULTS: The FNA results were 76 (32%) positive for malignancy, 53 (22%) negative for malignancy, 100 (42%) indeterminate for malignancy, and 11 (5%) nondiagnostic. There were 3 (4%) false-positive and 2 (4%) false-negative FNA results. Among the 100 indeterminate FNA results, carcinoma was found in 11 (15%) of 73 follicular neoplasms, 2 (20%) of 10 Hürthle cell neoplasms, and 14 (82%) of 17 suspicious for papillary carcinoma. For the 73 patients with follicular neoplasms, nodule diameter >2 cm was associated with an increased risk of malignancy (P <0.03). CONCLUSIONS: False-negative FNA results are uncommon, supporting the practice of observation in most of these patients. Among those with indeterminate biopsy results, high-risk subgroups include patients with FNA results suspicious for papillary carcinoma and follicular neoplasms >2 cm.

Adenoma, Oxyphilic↗

PubMed2003

Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer.

BACKGROUND: Cervical recurrence occurs in up to 30% of patients with differentiated thyroid carcinoma. We retrospectively compared preoperative transcutaneous ultrasonography and physical examination (PE) results in the detection of local-regional metastases (lymph node and soft tissue) in patients with thyroid cancer. METHODS: Data were collected retrospectively from the medical records of patients with thyroid carcinoma who underwent preoperative ultrasonography. Patients were divided into 3 groups: group 1, those undergoing primary thyroid/neck surgery; group 2, those undergoing reoperation for persistent disease; and group 3, those undergoing reoperation for recurrent thyroid carcinoma. For each group, we recorded the frequencies with which ultrasonography detected disease in a neck compartment (central or lateral) that was normal on PE. RESULTS: Two hundred twelve patients underwent operation for primary, persistent, or recurrent papillary (n=130), medullary (n=61), or follicular/Hürthle cell (n=21) carcinoma. Ultrasonography detected additional sites of metastatic disease not appreciated on PE in 21 (20%) of 107 group 1 patients, 9 (32%) of 28 group 2 patients, and 52 (68%) of 77 group 3 patients. The surgical procedure performed was altered by the information obtained from preoperative ultrasonography in 82 (39%) of the 212 patients. Of the 107 group 1 patients, cervical recurrence has been detected in only 6 (6%) at a median follow-up of 36 months, in spite of 67 (63%) having tumors larger than 2 cm or lymph node metastases. CONCLUSIONS: Preoperative high-quality ultrasonography detected lymph node or soft-tissue metastases in neck compartments believed to be uninvolved by PE in 39% of patients. Ultrasound findings altered the operative procedure in these patients, facilitating complete resection of disease and potentially minimizing local-regional recurrence.

Adenocarcinoma↗

PubMed2003

Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis.

PURPOSE: To assess the value of ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in the detection and diagnosis of recurrent cancer in breasts reconstructed with autogenous myocutaneous flaps after mastectomy for primary breast cancer and to describe the US appearances of recurrence in the reconstructed breast. MATERIALS AND METHODS: Between July 1994 and March 2001, US of the reconstructed breast was performed in 20 women with autogenous myocutaneous flap reconstruction. US findings were correlated with clinical and mammographic findings. US-guided FNAB of 25 (64%) of the 39 recurrent cancers depicted at US was performed. RESULTS: Twenty-one (54%) of the 39 recurrent cancers depicted at US were clinically occult. Mammography performed in 12 of the 20 patients with reconstructed breasts depicted 14 (56%) of the 25 recurrent cancers that were detected at US in these patients. US-guided FNAB helped to establish a definitive diagnosis of recurrent breast carcinoma in 24 (96%) of the 25 tumor specimens sampled. CONCLUSION: US and US-guided FNAB are valuable for the assessment of both palpable and clinically occult recurrent breast cancers in autogenous myocutaneous flap breast reconstructions.

Adult↗

PubMed2003

Feasibility of adjuvant hepatic arterial infusion of chemotherapy after radiofrequency ablation with or without resection in patients with hepatic metastases from colorectal cancer.

BACKGROUND: The safety of combined hepatic artery infusion chemotherapy (HAI) and radiofrequency ablation (RFA) for liver metastases has not been assessed. We conducted a study to determine the feasibility of using HAI after RFA for colorectal cancer (CRC) liver metastases. METHODS: Between 1996 and 2001, patients with hepatic metastases from CRC were enrolled onto a prospective study of RFA plus HAI consisting of continuous-infusion floxuridine and bolus fluorouracil. Surgical complications, treatment-related toxicities, and patient outcomes were recorded. RESULTS: Fifty patients were treated with RFA and HAI with or without resection. A median of two lesions per patient, with a median greatest diameter of 2.0 cm, were treated with RFA. Postoperative complications, including 1 death, occurred in 11 of 50 patients. Toxicity from HAI was relatively mild. At 20 months' median follow-up, 32% of patients remained disease free. Ten percent of patients had recurrences at the site of RFA, 30% developed new liver metastases, and 48% developed extrahepatic disease. CONCLUSIONS: RFA of CRC liver metastases followed by HAI is feasible and is associated with acceptable complication and toxicity rates. The high rate of disease recurrence in our patients indicates that novel combinations of regional and systemic therapies are needed to improve patient outcomes.

Adult↗

PubMed2003

Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer.

BACKGROUND: Ultrasonography and fine-needle aspiration (FNA) are used to evaluate the breast and regional nodes in breast cancer patients. We sought to identify factors influencing the sensitivity of ultrasonography for detection of nodal metastasis. METHODS: Patients with a clinically negative axilla who underwent axillary ultrasonography and sentinel lymph node biopsy were included. RESULTS: Of 208 patients, axillary ultrasonography was negative in 180 (86%) and suspicious or indeterminate in 28 (14%). FNA was performed in 22 patients whose findings were indeterminate or suspicious, and 3 were positive for malignancy. Final pathological examinations revealed positive nodes in 53 patients: 39 (22%) of 180 with negative ultrasonographic findings and 14 (50%) of 28 with indeterminate or suspicious ultrasonographic findings (P =.001). Excisional biopsy was more common for patients with indeterminate or suspicious findings on preoperative ultrasonography (P =.038). There were no significant differences in tumor size, histological features, size of nodal metastasis, or number of positive nodes between patients whose ultrasonography findings were negative and those whose findings were indeterminate or suspicious. CONCLUSIONS: Ultrasonographically suggested nodal metastasis is associated with the finding of nodal disease on final pathological examination. No significant clinicopathologic criteria were found to impact sensitivity of ultrasonography; however, excisional biopsy for diagnosis may be a confounding variable in subsequent axillary ultrasonography.

Adult↗

PubMed2002

Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma.

BACKGROUND: Ultrasound (US) is more sensitive than physical examination alone in determining axillary lymph node involvement during preliminary staging of breast carcinoma. Due to occasional overlap of sonographic features of benign and indeterminate lymph nodes, fine-needle aspiration (FNA) of sonographically indeterminate/suspicious lymph nodes can provide a more definitive diagnosis than US alone. This study was undertaken to determine the diagnostic accuracy of US-guided FNA of indeterminate/suspicious/metastatic-appearing axillary lymph nodes during the initial staging of breast carcinoma. METHODS: The cytology of 103 cases of US-guided FNA of nonpalpable indeterminate/suspicious/metastatic-appearing lymph nodes was compared with the final histopathologic status of the entire axilla after axillary dissection. The final axillary lymph node status was categorized as either negative when all lymph nodes were negative for metastasis or positive when there was evidence of metastasis in one or more lymph nodes. The sensitivity, specificity, diagnostic accuracy, and false-negative rate of US-guided FNA of nonpalpable axillary lymph nodes in the preliminary staging process were calculated. RESULTS: In 51 of 103 cases (49.5%), the US-guided FNA and histopathology were both positive for metastasis. In 24 of 103 cases (23.3%), both were negative. The apparent false-positive FNA in 16 (15.5%) cases was explained by the complete response of the metastatic lymph nodes to neoadjuvant chemotherapy in the interval between FNA and axillary dissection. In 12 cases (11.6%), US-guided FNA was negative, but metastasis was seen in histologic sections. All cases with three or more lymph nodes with metastatic disease and 93% of those with metastatic deposit measuring more than 0.5 mm were detected by US-guided FNA. The probability of detecting lymph nodes with smaller metastatic deposit measuring less than 0.5 cm was 44%. The overall sensitivity of US-guided FNA was 86.4%, the specificity was 100%, the diagnostic accuracy was 79.0%, the positive predictive value was 100%, and the negative predictive value was 67%. CONCLUSIONS: US-guided FNA of nonpalpable indeterminate and suspicious axillary lymph nodes is a simple, minimally invasive, and reliable technique for the initial determination of axillary lymph node status in breast carcinoma. The common causes of discrepancy between the initial and final axillary lymph node status include failure to visualize all lymph nodes during US examination, small-sized metastases, and preoperative neoadjuvant chemotherapy.

Axilla↗

PubMed2002

Interventional breast sonography.

This review article covers the basic applications of and latest developments in interventional breast sonography (US). For breast masses, US has become the standard for guiding needle biopsy, whether a fine needle or a core biopsy needle is used. US has also become the preferred method for guiding insertion of various localization devices for nonpalpable masses, and US's intraoperative use for this purpose is expanding. Recently, US has been used to monitor the placement of percutaneous ablation devices, such as radiofrequency ablation needle-electrodes, into breast masses, including carcinomas. US is not indicated for the routine evaluation of microcalcifications. However, on occasion, clusters of microcalcifications without a mass can be visualized on sonograms with sufficient clarity to undertake a US-guided core biopsy if stereotactically guided biopsy cannot be performed for technical reasons.

Biopsy, Needle↗

PubMed2002

Radiofrequency ablation of hepatic metastases.

The liver is one of the most common sites for cancer metastases that result in significant morbidity and mortality. Although surgical resection is associated with improvements in local control and survival, only a minority of patients are candidates for this approach. Radiofrequency ablation (RFA) is an important alternative/complementary tool in the treatment of metastatic disease to the liver and can lead to palliation as well as increased survival in selected patients. RFA has been shown to be safer and better tolerated than other ablative techniques and has been associated with a low rate of local recurrence when performed properly. RFA also has shown some promise in combination with surgical resection and other therapies. Patients who undergo RFA still suffer from progressive metastatic disease, reinforcing the premise that local therapies have little impact on the natural history of aggressive cancers. Trials combining RFA with surgical resection and regional and systemic chemotherapy are ongoing and it is the hope that RFA combined with multimodality adjuvant therapy will reduce the development of both local disease and progressive metastatic disease, leading to improved overall survival.

Catheter Ablation↗

PubMedDate not supplied

Radiofrequency ablation of early-stage invasive breast tumors: an overview.

As the management of breast cancer evolves toward less invasive treatments, the next step is the possibility of removing the primary tumor without surgery. The most promising of the noninvasive ablation techniques is radiofrequency ablation, which uses frictional heating that is caused when ions in the tissue attempt to follow the changing directions of a high-frequency alternating current. Three pilot studies, including an ongoing study at M.D. Anderson Cancer Center, have demonstrated that radiofrequency ablation is effective for the destruction of small primary breast cancers. The most important factorfor successful radiofrequency ablation is accuracy of the ultrasound evaluation, which is used to estimate tumor size, localize the tumor for treatment, and monitor the progress of the ablation. A study in preparation at M.D. Anderson will determine whether the use of radiofrequency ablation alone for the local treatment of primary breast cancer will result in outcomes equivalent to those obtained with breast conservation therapy.

Breast Neoplasms↗