Robert A. Kane

Image-guided tumor ablation: standardization of terminology and reporting criteria.

The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency (RF), laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the groups intention that adherence to the recommendations will facilitate achievement of the groups main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes. The intent of this standardization of terminology is to provide an appropriate vehicle for reporting the various aspects of image-guided ablation therapy.

Characteristics of prostate cancers detected in a multimodality early detection program

Background. Few data are available to describe the clinical and pathologic characteristics of prostate cancers detected through early detection programs. The American Cancer Society National Prostate Cancer Detection Project (ACS‐NPCDP) is a multimodality, multicenter study of the feasibility of early prostate cancer detection using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). One hundred fifty‐six prostate cancers are available from this project for analysis.

Characteristics of Prostate Cancer Detected in the American Cancer Society-National Prostate Cancer Detection Project

The American Cancer Society-National Prostate Cancer Detection Project is a prospective, comparative study of a cohort of 2,999 men 55 to 70 years old not suspected on entry of having prostate cancer. A total of 164 prostate cancers is available from this project for analysis. A small proportion of tumors detected were advanced in terms of the clinical stage at diagnosis. Cancer detected by digital rectal examination tended to be more advanced than that found on the basis of only transrectal ultrasound or prostate specific antigen (PSA). A large proportion of patients received curative therapy involving radical prostatectomy in 67.1% and radiotherapy in 18.3%. Of 103 men presumed to have organ confined disease and treated by prostatectomy 64 (37.9%) actually had locally extensive cancer pathologically. PSA level and PSA density were associated with the detection of organ confined cancer but several advanced tumors had PSA levels in the normal range. Age referenced PSA, compared to conventional standards, demonstrated lower sensitivity to cancer with little improvement in specificity. The disease resulting from this multimodality detection effort represented a spectrum of pathological conditions. Further followup and evaluation are needed to determine whether these benefits are reflected in long-term mortality and survival experience.

The impact of intraoperative ultrasonography on surgery for liver neoplasms

To analyze the effect of IOUS on surgical decision making, we performed a retrospective study of 45 patients who had exploratory laparotomy and IOUS for liver neoplasms. Preoperative lesion detection was compared with intraoperative findings. The effect of IOUS on the choice of surgical procedure was analyzed. Preoperative imaging detected 67% of lesions, 78% when combined with surgical inspection and palpation, and 97% were recognized by IOUS. Surgery was modified in 23 of 45 cases (51%); 19 of those 23 cases (83%) were based on IOUS findings alone. IOUS demonstrated superior lesion detection over noninvasive preoperative liver imaging, and IOUS significantly affected surgical decision making.

A Navigation System for Augmenting Laparoscopic Ultrasound

Establishing image context is the major difficulty of performing laparoscopic ultrasound. The standard techniques used by transabdominal ultrasonographers to understand image orientation are difficult to apply with laparoscopic instruments. In this paper, we describe a navigation system that displays the position and orientation of laparoscopic ultrasound images to the operating surgeon in real time. The display technique we developed for showing the orientation information uses a 3D model of the aorta as the main visual reference. This technique is helpful because it provides surgeons with important spatial cues, which we show improves their ability to interpret the laparoscopic ultrasound.

Intraoperative ultrasonography: history, current state of the art, and future directions.

Abbreviations CT, computed tomography; IOUS, intraoperative ultrasonography; LUS, laparoscopic ultrasonography; MRI, magnetic resonance imaging t is a privilege to contribute an article on intraoperative ultrasonography (IOUS) to the series of articles on the history of ultrasound in commemoration of the 50-year anniversary of the American Institute of Ultrasound in Medicine in 2005. On approaching my own 30th anniversary in the practice of diagnostic radiology, it is amazing to reflect back on the uses of A-mode, B-scanning on nonpersistent green fluorescent oscilloscopes, and bistable B-mode scanning as the first primitive diagnostic ultrasonographic tools. Although IOUS began developing in earnest in the late 1970s and early 1980s, after the development of gray scale B-mode ultrasonography and especially after the development of real-time imaging, early investigators were using the more primitive tools as early as the 1960s. One of the very first reports of IOUS was by Schlegel et al1 in 1961, who used A-mode ultrasonography for the localization of renal calculi (Figure 1). A-mode was also reported as useful in detection of stones in the gallbladder and common duct in an article by Knight and Newell2 in 1963 and in another article by Eiseman et al3 in 1965. A-mode echoencephalography was also reported as useful in delineation of intracerebral mass lesions in a study by Dyck et al4 in 1966. The inability to display tissue texture in A-mode or bi-stable B-scanning as well as the rather large, bulky size of the equipment limited the more widespread use of IOUS. A small direct-contact ophthalmic B-scanner was developed and proved useful for B-scan ultrasonography during orbital surgery for tumors, as reported by Purnell et al5 in 1973 (Figure 2), but very little further development was reported until the advent of real-time scanners and smaller, more portable equipment. One of the first reports of real-time B-mode ultrasonographic scanning was by Sigel et al6 in 1982, which described the use of ultrasonography for precise localization of renal calculi, thereby allowing for the use of smaller nephrotomy incisions, reduced operating room time, and determination that all stone fragments were removed before completion of the procedure. My own experience with IOUS began rather inadvertently in 1983, when I received a call from a distraught surgeon in the operating room, who could not find the intrahepatic abscess that we had shown on preoperative ultrasonography and computed tomography (CT) in a patient

A prospective evaluation of fatty pancreas by using EUS

BACKGROUND Fatty liver is associated with obesity, diabetes, hyperlipidemia, and the metabolic syndrome. The pathophysiology of fatty pancreas is poorly understood, but it may be closely related to fatty liver. OBJECTIVE The aim of our study was to determine the prevalence of fatty pancreas and risk factors associated with its development. DESIGN Prospective, single center study. SETTING Tertiary-care academic medical center. PATIENTS This study involved 250 consecutive patients referred for EUS examination. INTERVENTION All patients undergoing EUS at our institution were prospectively identified. Information regarding demographics, tobacco use, alcohol use, blood test results, and comorbidities were collected before EUS. Pancreatic echogenicity was graded in comparison to the spleen at the time of EUS by using an a priori specified grading scheme. MAIN OUTCOME MEASUREMENTS Prevalence of fatty pancreas and factors associated with its development. RESULTS During the study period, 250 consecutive patients were prospectively enrolled. The prevalence of fatty pancreas was 27.8% (95% CI, 22.1-34.1). Fatty liver was seen in 22.6% of patients. Factors associated with fatty pancreas on univariate analysis were increasing body mass index (BMI) (P=.004), fatty liver (P<.0001), hyperlipidemia (P=.04), and the metabolic syndrome (odds ratio [OR] 3.13, P=.004). The presence of any metabolic syndrome components, that is, BMI≥30, hyperlipidemia, diabetes, or hypertension, increased the prevalence of fatty pancreas by 37% (OR 1.37, P=.01). Factors independently associated with fatty pancreas on multivariate analysis were increasing BMI (OR 1.05, P=.03) and fatty liver (OR 3.61, P<.001). We found no association between fatty pancreas and chronic pancreatitis or adenocarcinoma of the pancreas. LIMITATIONS Single institution study. All patients were referred for EUS, which limits generalizability. Lack of histological confirmation of pancreatic fat. CONCLUSION We found a strong association between fatty pancreas and the metabolic syndrome.

Benign Hepatic Tumors and Iatrogenic Pseudotumors

Myriad benign tumors may be found in the liver; they can be classified according to their cell of origin into tumors of hepatocellular, cholangiocellular, or mesenchymal origin. Common benign hepatic tumors may pose a diagnostic dilemma when they manifest with atypical imaging features. Less frequently encountered benign hepatic tumors such as inflammatory pseudotumor or biliary cystadenoma demonstrate less specific imaging features; however, awareness of their findings is useful in narrowing differential diagnostic considerations. In addition, certain iatrogenically induced abnormalities of the liver may be confused with more ominous findings such as infection or neoplasia. However, knowledge of their common imaging appearances, in addition to the clinical history, is critical in correctly diagnosing and characterizing iatrogenic abnormalities of the liver. Familiarity with both expected and unexpected imaging appearances of common benign hepatic tumors, less commonly encountered benign hepatic tumors, and iatrogenic abnormalities potentially masquerading as hepatic tumors allows the radiologist to achieve an informed differential diagnosis.

Intraoperative Sonography for Neurosurgery

The purpose of this study was to review the technical aspects and the clinical applications of intraoperative sonography of the central nervous system (CNS) as well as the characteristic appearances of brain and spine diseases.

American cancer society–national prostate cancer detection project. Results from multiple examinations using transrectal ultrasound, digital rectal examination, and prostate specific antigen

Background. The American Cancer Society–National Prostate Cancer Detection Project is a prospective study of the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). Two thousand nine hundred ninety‐nine men not previously suspected of having prostate cancer have been entered on study in ten participating clinical centers.