Advanced Ultrasonic Evaluation of Sentinel Lymph Nodes

前哨淋巴结的高级超声评估

• 批准号: 8337319
• 负责人: Ernest Joseph Feleppa
• 金额: $ 24.17万
• 依托单位: RIVERSIDE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8337319
• 关键词: 3-Dimensional; Abdomen; Adverse effects; Algorithms; Axillary lymph node group; Biopsy; Breast; Cancer Patient; Classification; Clinical; Colorectal; Colorectal Cancer; Data; Databases; Detection; Devices; Diagnostic Neoplasm Staging; Disease; Dissection; Disseminated Malignant Neoplasm; Engineering; Equilibrium; Evaluation; Failure; Frequencies; Funding; Grant; Hawaii; Hematoxylin and Eosin Staining Method; Histologic; Histology; Histopathology; Image; In Situ; In Vitro; Laboratories; Lung; Lymphoma; Malignant Lymph Node Neoplasm; Malignant Neoplasms; Malignant neoplasm of abdomen; Malignant neoplasm of lung; Malignant neoplasm of thyroid; Maps; Medical; Medical center; Methods; Micrometastasis; Microscope; Microscopy; Microtomy; Modeling; Needle biopsy procedure; Neoplasm Metastasis; Operating Rooms; Operative Surgical Procedures; Optics; Pancreas; Paris, France; Pathologist; Pathology; Performance; Postoperative Period; Procedures; Process; Prostate; Research; Research Institute; Research Project Grants; Resolution; Scanning; Sensitivity and Specificity; Sentinel Lymph Node; Signal Transduction; Spectrum Analysis; Staging; Staining method; Stains; Stomach; Techniques; Thyroid Gland; Time; Tissues; Ultrasonics; Ultrasonography; United States National Institutes of Health; Universities; base; cancer therapy; cancer type; clinically significant; computerized data processing; cost; data acquisition; electric impedance; imaging modality; improved; instrument; lymph nodes; malignant breast neoplasm; malignant stomach neoplasm; novel; outcome forecast; programs; quantitative ultrasound; statistics; treatment planning

DESCRIPTION (provided by applicant): Riverside Research Institute, the University of Hawaii and Kuakini Medical Center, and the National Center for Scientific Research (Paris, France) propose to continue to investigate, refine, and expand the use of novel quantitative ultrasound methods for discriminating between cancer-containing and cancer-free lymph nodes of cancer patients. Detection of metastatic cancer in lymph nodes is absolutely crucial for accurate staging, prognosis, and treatment planning. Our overall objective is to reduce markedly the unacceptable failure of existing histopathological methods to detect metastases in 25% to 30% of dissected nodes and 50% in nodes with micrometastases. To achieve this objective, we proposed to develop quantitative imaging methods using high-frequency ultrasound in the pathology laboratory to identify regions of dissected nodes that warrant careful histologic examination. We have made exciting progress toward this objective by developing a sensitive and specific ultrasonic method of imaging metastatic disease present in lymph nodes with fine spatial resolution. Our results have shown a remarkable ability to detect cancer in dissected lymph nodes for a broad range of cancer types, and they promise a revolutionary means of guiding pathologists to cancer-containing regions of dissected lymph nodes. The demonstrated ability of our proposed methods to pinpoint metastatic cancer potentially can reduce the occurrence of false-negative determinations drastically when nodes contain micrometastatic disease, which easily can be overlooked using current histopathology methods. Our current results substantially have validated our original hypothesis that the proposed methods can identify cancer- containing regions of dissected nodes with a simultaneous sensitivity and specificity of approximately 90%. These findings provide encouragement that our proposed studies fully achieve our general objective, and they suggest that a simultaneous sensitivity and specificity exceeding 95% in fact may be possible. Therefore, we propose to acquire additional data to expand our existing database and thoroughly validate our findings. We also propose to investigate the feasibility of applying the same techniques at lower frequencies for clinical use in the examination or operating room to identify nodes that warrant biopsy or dissection. In addition, we propose to improve models for ultrasound scattering in lymph nodes using very-high-frequency ultrasonic microscopy and to formulate engineering specifications for a low-cost ultrasound instrument capable of performing node evaluations routinely in the pathology laboratory. In conclusion, this project can benefit lymph-node evaluations for staging, prognosis, and treatment planning of all types of cancers, e.g., breast, colorectal, gastric, pancreatic, lung, thyroid, prostate, etc., as well as sentinel-node dissection procedures, e.g., for breast cancer. The methods we are developing clearly can have a significant beneficial impact on in situ evaluations of lymph nodes examined prior to or during surgery, intra-operative evaluations of regional nodes including sentinel-nodes, and post-operative evaluations of dissected nodes.

描述（由申请人提供）：河滨研究所、夏威夷大学和夸基尼医学中心以及国家科学研究中心（法国巴黎）提议继续研究、完善和扩大新型定量超声方法的使用，以区分癌症患者的含癌淋巴结和无癌淋巴结。淋巴结转移癌的检测对于准确的分期、预后和治疗计划绝对至关重要。我们的总体目标是显着减少现有组织病理学方法在 25% 至 30% 的解剖淋巴结和 50% 的微转移淋巴结中检测转移的不可接受的失败。为了实现这一目标，我们建议在病理实验室使用高频超声开发定量成像方法，以识别需要仔细组织学检查的解剖淋巴结区域。通过开发一种敏感且特异的超声方法，以精细的空间分辨率对淋巴结中存在的转移性疾病进行成像，我们在实现这一目标方面取得了令人兴奋的进展。我们的研究结果显示出在多种癌症类型的解剖淋巴结中检测癌症的卓越能力，并且它们有望提供一种革命性的方法来引导病理学家找到解剖淋巴结中含有癌症的区域。当节点含有微转移性疾病时，我们提出的方法所证明的查明转移性癌症的能力可能会大大减少假阴性测定的发生，而使用当前的组织病理学方法很容易忽视这种疾病。我们目前的结果基本上验证了我们最初的假设，即所提出的方法可以识别解剖淋巴结的含癌区域，同时敏感性和特异性约为 90%。这些发现鼓励我们提出的研究完全实现了我们的总体目标，并且它们表明事实上同时超过 95% 的敏感性和特异性是可能的。因此，我们建议获取更多数据来扩展我们现有的数据库并彻底验证我们的发现。我们还建议研究在检查或手术室中以较低频率应用相同技术进行临床使用的可行性，以确定需要活检或解剖的淋巴结。此外，我们建议使用甚高频超声显微镜改进淋巴结中的超声散射模型，并制定能够在病理实验室常规进行淋巴结评估的低成本超声仪器的工程规范。总之，该项目可以有益于所有类型癌症（例如乳腺癌、结直肠癌、胃癌、胰腺癌、肺癌、甲状腺、前列腺癌等）的分期、预后和治疗计划的淋巴结评估，以及乳腺癌等前哨淋巴结切除手术。我们正在开发的方法显然可以对术前或术中检查的淋巴结的原位评估、包括前哨淋巴结在内的区域淋巴结的术中评估以及解剖淋巴结的术后评估产生显着的有益影响。