The Stanford Way

Misschien is het hier normaal, maar in Nederland heb ik het nog nooit meegemaakt. Maar maandag is het me dan toch overkomen. Rond 17 uur een mailtje van mijn Stanford begeleider in de mail:

I am hoping to restart our weekly breast MRI ressearch meetings on Tuesdays at 3:30. I was wondering, if you would mind give a presentation on your project. The audience will be interested students, post-docs and faculty at Lucas and in our department?

Dus ik kon lekker aan de slag. Gelukkig had ik nog ergens een halve presentatie liggen, dus uiteindelijk viel het allemaal wel mee.... maar toch, je wilt dit soort dingen toch wel goed voobereiden...

Iig er is door mijn begeleider een korte samenvatting geschreven over mijn presentatie en onderzoek. En op aanraden van Roen, plaats ik hem voor jullie allemaal op de site, zodat jullie kunnen lezen waar mijn project nou werkelijk over gaat!

Veel liefs en dank voor al jullie lieve reacties tot nu toe!
XXX Anne



Speaker number 2: Annemarie Schmitz.
MRI Guided preoperative localization of non-palpable breast lesions using MRI-guided Focused ultrasound.

Please give a warm welcome to Annemarie Schmitz – a visiting Radiology Resident from University of Utrecht, Netherlands. Annemarie will be here for 4 months.

MRI-guided focused ultrasound therapy utilizes a focused ultrasound transducer outside the body to focus a 0.5 - 4 MHz high power acoustic beam to sonicate a small target inside the body, through the skin. This causes local heating of the tissue of 60-90°C, creating instant cell death and tissue edema. The technique is non-invasive, and can be performed inside a specially modified MRI scanner, available on the 3T research system at the Lucas center.

There are about 8 articles that report between 1 and 30 patients with breast cancer being treated with MRI-guided focused ultrasound. Despite attempted complete ablation, preliminary studies leave significant untreated tumor.

Perhaps it is too hard to make MRI-guided ablation now. How about using MRI-guided FUS to make non-palpable tumors palpable, so that the surgeon can remove them?

Current standard for removal of non-palpable breast tumors (25% or more of all breast tumors) is using a localizing wire.

Problem is that wire localization only achieves tumor free resection margins in 20-40% of patients, if a small excision is done. If a large excision is done, then cosmetic outcome is poor.

Why MRI-guided FUS for this problem?
Because we estimate that with FUS you can make the non-palpable lesion palpable.
This might (hopefully) result as a clear guideline for the surgeons to create tumorfree margins and a good cosmetic result in patients with non-palpable breast cancer.

Stanford study:

Plan is to use cadaveric breast tissue from autopsy service to try this out for the first time.

Planned methods:
1. Create two lesions in the breast tissue. Lesions are made out of interstitially injected solution of dilute Gd and Gelatin (thickening agent).
2. Mark one lesion with a hookwire
3. Mark the other lesions with MRI-guided FUS
4. Ask surgeon to resect each lesion
5. Scan each lesion, and residual tissue to determine if resection is complete.
6. Repeat with up to 20 breast specimens.

Issues:

What type of FUS lesion is best - ring / rim / individual spots ?