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Welcome to NewsWire! This bi-weekly e-newsletter from the American Registry for Diagnostic Medical Sonography® (ARDMS®), offers its Registrants and members of the sonography community current and innovative news and technology related to the field of sonography.
We want to hear from you! NewsWire was designed to serve as an informational forum. As such, we welcome your article suggestions, questions, comments and feedback on ways to make this resource a more valuable tool in your day-to-day professional life. Please write to us at: communications@ardms.org |
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| New Test for Detecting Early-Stage Ovarian Cancer
There is good news for the women who are worried about developing ovarian cancer, in the form of a new test that could catch it in the early stages. The new blood test is able to detect elevated levels of the protein called CA125, and when combined with ultrasound technology it could prove to be an effective screening strategy for finding ovarian cancer in its earliest and most treatable stages.
Researchers have said that the very early findings from the largest randomized ovarian cancer screening study ever conducted are promising. However, it will still be several years until it is clear if this screening method evaluated during the trial will save lives.
Approximately more than 200,000 postmenopausal women who live in the U.K. are participating in this study, which will be complete in 2014. The researcher Usha Menon, M.D. from the University College London said that the early results from the study show that the screening is feasible.
Ovarian cancer is a highly treatable cancer when it is detected early, with a survival rate of approximately 92 percent at least five years after being diagnosed. However, more than two out of three patients that are diagnosed with the cancer are in the advanced stage of the disease, when the five-year survival rate is only 20 to 30 percent.
According to the American Cancer Society, more than 21,000 new cases of ovarian cancer were diagnosed in the U.S. alone in 2008, and more than 15,000 of the women died from the disease. This is why the stakes are so high for developing an effective early screening strategy.
The CA125 blood test, which was first developed in the early 1980s, measures a protein that is elevated in patients that have ovarian cancer. The second generation of this test has been proven useful for evaluating how well a patient is responding to ovarian cancer treatments. Because of this test's usefulness as a screening tool to detect ovarian cancer, it is more controversial because its false-positive rates tend to be higher, which can lead to unnecessary follow-up testing and surgery.
In the study done in the U.K., the researchers evaluated a new way of using the CA125 blood test, which they hope will prove to be more useful for diagnosing ovarian cancer. Traditionally, a CA125 level of 35 or above has been considered to be elevated and a level of CA125 below this has been considered the normal level. However, in the risk-assessment model that was developed by Menon and colleagues, a woman's absolute CA125 level is less important than the changes in CA125 from year to year. Age also has to be considered, since the risk for developing ovarian cancer increases with age.
The ongoing study in the U.K. includes 202,638 postmenopausal women that are between the ages of 50 and 74 at recruitment between the years of 2001 and 2005 who were randomly assigned to undergo no screening, annual screening alone, or annual screening with the CA125 test and ultrasound for 10 years. Early results from this trial have shown that the CA125 plus ultrasound detected 90 percent of the ovarian cancers identified so far in the combined screening group, while the ultrasound alone identified 75 percent of the cancers that were reported in this screening group.
Almost half of the ovarian cancers detected in both of the screening groups were in the early stages. The total number of the ovarian cancers detected in the two screening groups were similar. However, the combined-screening group had fewer repeat tests and almost nine times fewer surgeries were performed to confirm the diagnosis for every ovarian cancer detected. Approximately thirty-five surgeries were performed to detect one cancer in the ultrasound group alone in comparison to the three surgeries for every cancer detected in the combined screening group.
Robert A. Smith, Ph.D., the Director of Cancer Screening at the American Cancer Society, said that the final results from the trial in the U.K., along with the as yet published results from a study that was conducted by the National Cancer Institute, should reveal more about whether the CA125 test and ultrasound will prove useful for routine screening.
Mr. Smith said, "For two decades we have been exploring ways to effectively use CA125 and ultrasound to screen for ovarian cancer. If these studies conclude that these new methods of using these tools have a favorable benefit-to-harm ratio, routine screening for ovarian cancer may become a reality for postmenopausal women."
View the article online.
Article written by staff at healthnews.com and adapted for the purposes of this newsletter.
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Title: Hand-Carried Ultrasound Performed by Hospitalists: Does It Improve the Cardiac Physical Examination?
Study Question: What is the incremental benefit of hand-carried ultrasound (HCU) compared to the standard physical exam (PE) as rendered by hospitalists for the diagnosis of cardiovascular disease?
Methods: Physical examination followed by HCU was performed by 10 hospitalists in 354 general medical inpatients. Each hospitalist underwent relatively limited training in the use of HCU. PEs were specifically targeted to detection of pericardial effusion (PEF), aortic and mitral regurgitation (AR, MR), aortic stenosis (AS), cardiomegaly (CM), and estimated left ventricular function (LVF). Hospitalist PEs and HCUs were then compared to results of formal echocardiography.
Results: AR was present in 84 patients and detected by PE in 7% and by HCU in 35%; AR was absent in 206 patients, 86% of whom were correctly identified by PE versus 59% by HCU (both p = 0.001). AS was present in 50 patients and detected by PE in 20% and by HCU in 34%, and was absent in 286 and correctly identified as such in 84% by PE and 79% by HCU (p = NS). MR was present in 176 patients and identified on PE in 15% and by HCU in 35%. MR was absent in 114 and correctly classified as such in 79% by PE and 54% by HCU (both p = 0.001). PE was present in 67 patients and detected by PE in only 3% and by HCU in 60%, and was absent in 269 and correctly identified as such in 61% on PE
and 84% by HCU (both p = 0.001). LV function was graded as normal, and mildly, moderately, or severely reduced and precisely matched the results of formal echocardiography in 12% and 32% by PE and HCU in those with abnormal function and in 64% and 73% in those with normal function. When matching only within one assessment level for LVF, PE matched in 49%, and HCU in 85% of those with abnormal function and in 77% and 89% of those with normal LV function (both p = 0.005).
Conclusions: Addition to HCU to physical exam increases the accuracy of a hospitalist for assessment of LVF, cardiomegaly, and PEF, but not for assessment of valvular disease.
Perspective: Prior studies have evaluated the impact of HCU on the ability to make cardiovascular diagnoses, as compared to PE in various subsets of patients and by observers, ranging from medical students to board certified cardiologists. Most studies have suggested a dramatic increase in diagnostic accuracy when HCU is added to the physical exam. This study is somewhat surprising in that the incremental diagnostic accuracy appears less than in a number of previous studies. A major limitation of HCU in the population studied here was that it led to an increase in diagnosis of valvular insufficiency in patients documented to be free of such on formal echocardiography. As the
authors point out, this probably relates to the greater technical difficulty of obtaining optimal color Doppler flow signals, as compared to an overall assessment of left ventricular size and function. The degree to which this limitation is related to the population being evaluated versus the specific equipment utilized is conjectural. Whether the trade-off in the modest improvement in assessment of left ventricular function of 36% to 59% for exact matches and 67% to 88% for one level matches, is balanced by the lack of specificity for excluding significant valvular heart disease, remains to be demonstrated. View the article online.
Article written by staff at cardiosource.com and adapted for the purposes of this newsletter.
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SIR: Prostate-Mapping Biopsy Paves Way for 'Male Lumpectomy'
SAN DIEGO, March 10 -- Prostate biopsies that sample tissue mapped in three dimensions may improve treatment planning and safely allow for a "lumpectomy" approach, researchers said.
Stage and grade revisions with 3-D mapping biopsy were substantial enough to change management for more than 70% of patients, compared with standard transrectal ultrasound (TRUS)-guided biopsy, according to Gary Onik, M.D., of Florida Hospital's Center for Safer Prostate Cancer Therapy in Orlando, and colleagues.
For tumors found with this more extensive biopsy method, targeted cryoablation achieved long-term local control without incontinence in all patients, according to a second study reported by the same group here at the Society of Interventional Radiology meeting.
"Almost every patient who is diagnosed with prostate cancer, except for those who, on their transrectal ultrasound biopsy, showed extensive high-grade disease, needs a mapping biopsy to fully evaluate their situation and treat them appropriately," Dr. Onik said.
Brian Stainken, M.D., of Roger Williams Hospital in Providence, R.I., and SIR president, agreed that the promising findings could be "game changing."
However, he sounded a note of caution in response to Dr. Onik's enthusiasm by emphasizing the need for further validation.
Dr. Onik, anticipating this argument, noted that the low morbidity rate -- no incontinence and 15% impotence in his study -- has been replicated in two other published studies.
These results were more impressive given that more than half of his 120 cryoablation patients with one to 13 years of follow-up were moderate- to high-risk or radiation failure cases, he said.
Likewise, morbidity was minimal with the 3-D mapping biopsy. The only complications were self-limiting hematuria (1.2%) and retention (7%).
These biopsies were done under transrectal ultrasound guidance, with tissue sampled every 5 mm throughout the prostate volume, using a brachytherapy grid. Careful labeling of specimen coordinates allowed the radiologist to reconstruct a detailed picture of the extent and location of the tumor.
Dr. Onik's group used this biopsy method for 180 men who were considering conservative management based on prior standard transrectal ultrasound biopsy that showed unilateral prostate cancer.
But the more extensive 3-D mapping biopsy showed bilateral disease in 55% of patients and increased the Gleason score for 22%.
The researchers estimated that at least 70% of the patients would have a change in therapeutic decision based on the more accurate staging.
It wasn't surprising that this technique beat transrectal ultrasound biopsy, Dr. Onik said. Although the gold standard for prostate biopsy, "we have known for decades that this is not an accurate way of staging prostate cancer," he said, "but it was the only thing we had."
In addition to helping patients decide between watchful waiting and more aggressive therapy, pinpointing the tumor can allow for a more nuanced treatment approach similar to the revolution in breast cancer surgery, Dr. Onik said.
"More than 25 years ago women were in exactly the same situation men are in now," he said. "The treatment was radical mastectomy."
With this as an inspiration, Dr. Onik's group started to pursue what he called "male lumpectomy" with focal cryoablation informed by 3-D mapping biopsy.
With this approach, their study showed that among the very high-risk radiation failure patients, 81% maintained stable prostate-specific antigen levels during follow-up after focal treatment.
In the total cohort, stable PSA rates with no evidence of cancer were reported for 93% by ASTRO criteria and 94% by Phoenix criteria.
Overall, eight patients were retreated to yield a 100% local control rate with targeted cryoablation.
Regardless of the risk level of prostate cancer patients, the biochemical recurrence rate did not climb over time and compared favorably to the 55% rate at 10 years in a prior study of high-risk patients who had radical prostatectomy.
Potency was maintained in 85% of patients potent prior to the procedure and of 120 patients without previous prostate surgery, all were continent (no pads).
Although local control has been thought to have little impact on overall survival in prostate cancer, Dr. Onik said that recent evidence has shown that better control of cancer in the prostate reduces risk of distant metastases and mortality.
The next step will be to compare "male lumpectomy" to robotic radical prostatectomy, he said.
Dr. Onik provided no information on conflicts of interest. Dr. Stainken reported no conflicts of interest.
View the article online.
Article written by staff at medpagetoday.com and adapted for the purposes of this newsletter.
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Predicting Early Bone Loss With Ultrasound
Researchers have developed a new form of ultrasound that may be able to predict early bone loss. The new form of ultrasound was developed by Yi-Xian Qin, Ph.D., Director of Orthopedic Bioengineering Research Laboratory at Stony Brook University. Dr. Qin developed the new ultrasound form jointly with colleagues at Stony Brook and at the NSBRI (National Space Biomedical Research Institute).
Bone loss, or osteoporosis, affects millions of Americans. The new ultrasound machine
called SCAN, for Scanning Confocal Acoustic Navigation, looks at more than just the density of bone. It can look for strength, structure, and stiffness as well. "SCAN uses non-invasive and non-destructive ultrasound to image bone, and the technology enables us to identify weak regions, as well as make a diagnosis and to assist in healing fractures," said Dr. Qin. "Because with SCAN we can assess bone qualities, such as stiffness, we can predict the risk of fracture, as quality of bone rather than density is more of a predictor of fracture risk."
The new technology will be more than just diagnostic; it will be therapeutic as well. By stimulating bone regeneration, ultrasound machines can help accelerate the healing of fractures. "We are trying to use ultrasound technology as a way to get an image of the fracture site," said Dr. Qin. "An integrated probe will directly shoot ultrasound into the region of the fracture. We hope this will result in effective acceleration of fracture healing."
The NSBRI is funded by NASA. NASA is interested in this technology because astronauts who spend extended periods of time in space suffer from bone loss, and are also subject to stress fractures.
As the elderly population in American continues to grow, finding affordable, easy to use ways to provide excellent care will be an increasingly important goal. Dr. Qin and his colleagues believe SCAN technology will not only be easier and less expensive to use than current x-ray based measures of bone density, but that it will also be easier and have more robust capabilities. It is possible that patients may be able to use a small, mobile SCAN device themselves. Currently SCAN is in clinical evaluation.
View the article online.
Article written by staff at portableultrasoundmachines.net
and adapted for the purposes of this newsletter.
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