Stereotactic needle biopsy is a method by which small pieces of tissue may be removed from the breast, under x-ray guidance, through a skin puncture or a small incision and without surgery. Of the many suspicious-looking shadows found on routine mammograms, less than one third are actually cancerous. Stereotactic needle biopsy allows accurate diagnosis of the majority of these lesions without open biopsy.
At Rush Presbyterian St. Luke's Medical Center, pathologists use 2mm sections to detect the spread of cancer cells to the sentinel nodes. This implies 5 cuts of each of the 2 sentinel nodes as illustrated below. This has improved the detection rate of metastases.
Our research involves additional cutting of the sentinel nodes as shown in the diagram.
Our recent data analysis (July, 1999) indicates that the sentinel nodes of 35 of 113 patients with breast cancer, thin-sectioned as shown above, harbored metastases. Half of these were occasional cells and the other half were larger metastases as shown below. Although the significance of these findings need to be checked in future trials, we believe that patients with larger metastases need treatment.
Microscopic appearance of two sentinel nodes showing small (on the left) and large (on the right) metastases; both detected by thin cutting technique.
Laser therapy for breast cancer uses a heat-generating laser to create a thermal sphere that is directed centrally in the tumor. It has been discovered the temperatures greater than 60oC (140oF) effectively destroys viable tissue. With the aid of a temperature probe, the extent of tissue destruction can be assessed and focused to consume the tumor with limited damage to surrounding tissue.
It is suspected that once the tumor is "devitalized," the body's internal scavengers (macrophages) will digest the dead tissue and replace it with a scar.
The technique was developed by Dr. Kambiz Dowlat at Rush-Presbyterian St. Luke's Medical Center and tested in animal experiments. This procedure was also shown to be effective in patients with inoperable liver tumors.
In 35 patients with early breast cancer, all laser treated tumors were removed and examined by a pathologist. 100% cancer destruction was achieved whenever the tumor temperature reached 60oC or higher. We are testing imaging techniques: color doppler ultrasound and PET scan for follow up of laser treated breast cancers before comparing laser therapy with lumpectomy in a clinical trial.
*Pre-Laser Doppler Ultrasound *Post-Laser 1 hour Doppler
Post-Laser 19 days Doppler Ultrasound
*PET Scan (Pre-Laser Therapy vs. Post-Laser Therapy)