“The FDA has fully approved the Ablatherm high-intensity focused ultrasound device for the nonsurgical and noninvasive treatment of localized prostate cancer, according to a press release from the device’s manufacturer.
“Ablatherm high-intensity focused ultrasound (EDAP TMS), or Ablatherm HIFU, is recommended for men with localized prostate cancer (stages T1-T2) who are not candidates for surgery, who prefer an alternative option or who failed radiotherapy treatment.
“The device targets the tumor via a computer-controlled rectal probe. Ultrasound waves are intended to destroy the prostate tissue while sparing surrounding organs. Data have indicated the device is effective for prostatic tissue ablation with a low occurrence of side effects, according to the press release.”
“A new study offers help to patients and doctors who are trying to deal with mammogram results that many women consider troubling and confusing: the finding of ‘dense’ breast tissue.
“Not only is breast density linked to an increased risk of cancer, it also makes cancer harder to detect because dense tissue can hide tumors from X-rays. But the new research indicates that not all women with dense breasts are at very high risk.
“Patient advocates urge women with dense breasts to ask doctors about extra tests like ultrasound or an M.R.I. to check for tumors that mammography might have missed. Studies have found that those exams can improve detection of tumors over mammography alone in dense breasts.
“Pressed by advocacy groups, 22 states have passed laws requiring that breast density be reported to mammography patients, and similar federal legislation has been introduced in the House and the Senate.”
“Biopsy guided by a fusion of magnetic resonance imaging (MRI) and ultrasound (US) improves detection of aggressive prostate cancer compared with mapping or targeting alone and systematic 12-core biopsy.
“Among the first 1,000 men to undergo MRI-fusion biopsy of the prostate at the University of California Los Angeles (UCLA), the presence of a grade 5 region of interest on fusion biopsy was the strongest predictor of high-grade prostate cancer. ‘Patients who had a grade 5 lesion compared to those who had no suspicious lesions had 23 times the odds of having Gleason ≥7 cancer,’ said Christopher Filson, MD, at UCLA.
“In a separate series of men presenting for prostate biopsy at New York University (NYU), MRI-targeted biopsy increased the detection of Gleason ≥7 prostate cancer by 23% compared with systematic biopsy while decreasing the detection of Gleason 6 disease by 26%.
“Around 90 per cent of all breast cancers can be definitively diagnosed using magnetic resonance imaging (MRI). This compares to the combined methods of mammography and ultrasound which yielded a detection rate of just 37.5 per cent. This is the key finding of a study published in the highly respected Journal of Clinical Oncology. The study was carried out at the University Department of Radiology and Nuclear Medicine at the MedUni Vienna in cooperation with the University Department of Gynaecology and Obstetrics and the Clinical Institute of Pathology.
” ‘In cases where there is even the slightest doubt, and especially in women at increased risk, the obvious choice is MRI. Our study clearly shows the superiority of magnetic resonance imaging over mammography and breast ultrasound examinations,’ says Thomas Helbich, who led the study with Christopher Riedl. “The superiority of MRI is also completely independent of the patient’s age, gene mutation status and breast density.”
“In 559 women at increased risk, a total of 1,365 screening examinations were carried out. There was one clear ‘winner’: 90 per cent of all breast cancers can be clearly detected by MRI. The combination of MRI and mammography increased the detection rate by just five per cent. None of the cancers were detected by ultrasound alone. The results were similar for non-invasive cancers and for benign breast lesions.”
“Women with lymph node-positive breast cancer who demonstrate complete nodal response by axillary ultrasound after neoadjuvant chemotherapy may be able to avoid axillary dissection, according to study results.
“ ‘Our goal here is really to try to get away from, “Every patient with breast cancer needs these drugs and this amount of chemotherapy and surgery,” and instead to personalize surgical treatment based on how the patient responds to chemotherapy,’ Judy Boughey, MD, chair of the division of surgery research at Mayo Clinic in Rochester, Minnesota, said in a press release.
“The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial included 687 patients with T0-4, N1-2, M0 primary invasive breast cancer. All patients completed neoadjuvant chemotherapy, underwent sentinel lymph node surgery and axillary dissection, and had axillary ultrasound images available for review.
“Previously published results indicated a 12.6% false-negative rate for sentinel lymph node surgery after neoadjuvant chemotherapy for patients who presented with node-positive disease and had two or more sentinel lymph nodes identified and removed. This false-negative rate exceeded the predetermined acceptable rate of 10%. The result suggested patient selection or technique must be improved prior to widespread adoption of sentinel lymph node surgery in this setting, according to study background…
“ ‘That’s one of the really nice things about giving chemotherapy up front,’ Boughey said. ‘It allows us to be less invasive with surgery, both in terms of breast surgery and lymph node surgery, and to tailor treatment based on response to chemotherapy.’ “
“In a single-center study reported in the Journal of Clinical Oncology, Riedl et al found that screening with magnetic resonance imaging (MRI) had greater sensitivity for detection of breast cancer in high-risk women vs mammography or ultrasound irrespective of age, mutation status, or breast density. The addition of mammography or ultrasound added little to the sensitivity of MRI.
“In the study, BRCA mutation carriers and women with a high familial risk (> 20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months at the Medical University of Vienna. Overall, 559 women with 1,365 complete imaging rounds were included in the analyses. There were 204 suspicious findings (15%). Of these, 38 (19%) were malignant; two additional cancers were found during the study period, including one identified by patient-requested biopsy and one interval cancer…
“The investigators concluded: ‘MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.’ ”
“Cancer screening of women with dense breast tissue is a subject of great interest to both the medical community and the press. Dense parenchyma reduces the sensitivity of mammography to half that of fatty breasts. Approximately 40% of women 40 years of age or older have dense breast tissue, making supplemental breast cancer screening essential.
“Although supplemental screening via ultrasound is unaffected by breast density, is not associated with ionizing radiation, and does not require IV contrast material, acceptance of this modality has lagged.
“According to Ellen B. Mendelson, professor of radiology at Northwestern University Feinberg School of Medicine, and Wendie A. Berg, professor of radiology at Magee-Womens Hospital of UPMC, a significant factor is lack of available intensive training opportunities.
” ‘The most common alternative screening modality, MRI, cannot be used with women who have pacemakers or other devices, severe claustrophobia, or renal insufficiency,’ say Drs. Mendelson and Berg. To realize ultrasound’s potential to increase the number of cancers detected, intensive training programs need to be put in place for physician performers and interpreters for both handheld and automated breast ultrasound systems.’ “
“Which breast cancer patients need to have underarm lymph nodes removed? Mayo Clinic-led research is narrowing it down. A new study finds that not all women with lymph node-positive breast cancer treated with chemotherapy before surgery need to have all of their underarm nodes taken out. Ultrasound is a useful tool for judging before breast cancer surgery whether chemotherapy eliminated cancer from the underarm lymph nodes, the researchers found. The findings are published in the Journal of Clinical Oncology.
“In the past, when breast cancer was discovered to have spread to the lymph nodes under the arm, surgeons routinely removed all of them. Taking out all of those lymph nodes may cause arm swelling called lymphedema and limit the arm’s range of motion.
“Now, many breast cancer patients receive chemotherapy before surgery. Thanks to improvements in chemotherapy drugs and use of targeted therapy, surgeons are seeing more women whose cancer is eradicated from the lymph nodes by the time they reach the operating room, says lead author Judy C. Boughey, M.D. a breast surgeon at Mayo Clinic in Rochester.”
“If results of a prostate-specific antigen test or digital rectal exam are positive, the next port of call is normally a prostate biopsy to confirm whether cancer is present. In a new study published in JAMA, researchers claim a targeted biopsy method is much more accurate in detecting high-risk prostate cancers than the standard biopsy technique.
“The standard method of prostate biopsy, also referred to as a core needle biopsy, involves a doctor removing samples of tissue from the prostate using a thin, hollow needle. The samples are then sent to a pathologist who views them under a microscope and assesses them for cell abnormalities that indicate cancer.
“But the research team, led by Dr. Mohammad Minhaj Siddiqui of the University of Maryland School of Medicine – who was a fellow at the National Institutes of Health at the time of study – says the technique used in their study involves a combination of ultrasound and magnetic resonance imaging (MRI), which they say can effectively differentiate high-risk prostate cancers from those that are low risk.
” ‘There is a concern that we overdiagnose and overtreat low-risk cancers that are unlikely to be terminal, and this technology enables us to make a more reliable diagnosis than the current standard practice,’ says Dr. Siddiqui.”