Advanced Ultrasonic Evaluation of Sentinel Lymph Nodes

描述(由申请人提供)：Riverside Research Institute和夏威夷大学及其附属的Kuakini医学中心提议调查使用“新的超声波方法来区分乳腺癌患者的腋窝淋巴结是否有癌”。我们的重点将是改进乳腺癌患者的前哨淋巴结清扫活组织检查程序；然而，该项目的成功将有利于所有类型的淋巴结评估，不仅适用于乳腺癌，还适用于一系列其他癌症，包括结直肠癌、表皮(例如恶性黑色素瘤)、淋巴癌等。我们的前提是，使用所建议的方法，有癌和无癌结节的后向散射特征有足够的差异来区分它们。基于我们非常鼓舞人心的初步研究，我们的总体假设是，这些方法可以使用非常高的超声频率识别解剖结节的含癌区域，同时灵敏度和特异度至少达到90%。我们的初步研究提供了强有力的鼓舞，我们的方法很容易验证这一假设。我们的主要目标是开发我们的方法，当我们在病理实验室使用非常高的频率来识别需要仔细组织学检查的结节区域时。我们提出的方法将应用于术中，以更好地检测前哨淋巴结清扫中的隐匿性微转移，以及术后，以更好地检测正规或根治性切除的淋巴结中的转移以及前哨淋巴结中的转移。我们的目的是显著减少现有的组织病理学方法在25%到30%的切除结节中检测转移的失败。我们的目标也是深入了解淋巴结中潜在的超声散射机制。如果我们成功地实现了我们的目标，近期的重大益处将导致对乳腺癌病例的腋窝淋巴结进行评估，而从长远来看，类似的好处将导致对其他癌症的淋巴结评估。

DESCRIPTION (provided by applicant): Riverside Research Institute and the University of Hawaii and its affiliated Kuakini Medical Center propose to investigate the use "of novel ultrasonic methods for discriminating between cancer-containing and cancer-free axillary lymph nodes of breast-cancer patients. Our emphasis will be on improving sentinel-node dissection biopsy procedures for breast-cancer patients; however, success in this project will benefit lymph- node evaluations of all types, not only for breast cancer, but also for a range of other cancers, including colorectal, epidermal (e.g., malignant melanoma), lymphatic, etc. Our premise is that the backscattering features of cancer-containing and cancer-free nodes differ sufficiently to differentiate between them using the proposed methods. Based on our extremely encouraging preliminary studies, our general hypothesis is that these methods can identify cancer-containing regions of dissected nodes using very-high-ultrasound frequencies with a simultaneous sensitivity and specificity of at least 90%. Our preliminary studies provide strong encouragement that our methods easily will validate this hypothesis. Our primary specific aims are to develop our methods when applied using very-high frequencies in the pathology laboratory to identify regions of nodes that warrant careful histologic examination. The methods we propose would be applied intra-operatively to better detect occult micrometastasis in sentinel-node dissections, and post-operatively to better detect metastasis in nodes excised by formal or radical dissections as well as in sentinel nodes. Our intention is to reduce markedly the failure of existing histopathological methods to detect metastases in 25% to 30% of excised nodes. We also aim to gain insight into underlying ultrasound-scattering mechanisms in lymph nodes. If we are successful in achieving our aims, major near-term benefits will result in evaluations of axillary lymph nodes in breast-cancer cases, and in the longer term, similar benefits will result in nodal evaluations for other cancers.