Advanced Ultrasonic Evaluation of Sentinel Lymph Nodes

描述（由申请人提供）：河滨研究所和夏威夷大学及其附属的Kuakini医学中心提议研究使用“新型超声方法来区分乳腺癌患者的含癌和无癌腋下淋巴结。我们的重点将是改进乳腺癌患者的前哨淋巴结清扫活检程序；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，包括结肠直肠癌、表皮癌（如恶性黑色素瘤）、淋巴癌等。我们的前提是，含癌和无癌淋巴结的后向散射特征有足够的差异，可以使用所提出的方法来区分它们。基于我们非常令人鼓舞的初步研究，我们的一般假设是，这些方法可以使用非常高的超声频率识别淋巴结清扫的含癌区域，同时灵敏度和特异性至少为90%。我们的初步研究提供了强有力的鼓励，我们的方法很容易验证这一假设。我们的主要具体目标是开发我们的方法，当应用时使用非常高的频率在病理实验室，以确定需要仔细的组织学检查的节点区域。我们提出的方法将应用于术中更好地检测前哨淋巴结清扫的隐匿性微转移，以及术后更好地检测正式或根治性清扫切除的淋巴结以及前哨淋巴结的转移。我们的目的是显著减少现有组织病理学方法在25%至30%的切除淋巴结中检测转移的失败。我们还旨在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，主要的短期效益将导致对乳腺癌病例腋窝淋巴结的评估，从长远来看，类似的效益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.