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Biomedical subjects

Ronda Henry-Tillman

Publications and source records attributed to Ronda Henry-Tillman.

9 recordsLinked to original sources
PubMed2006

Hematoma-directed ultrasound-guided (HUG) breast lumpectomy.

BACKGROUND: Needle localization breast biopsy (NLBB) is presently the primary means of localizing non-palpable lesions. Disadvantages of NLBB include vasovagal episodes, patient discomfort, and miss rates. Because hematomas naturally fill the cavity after vacuum-assisted breast biopsies (VABB), we hypothesized that ultrasound (US) could be used to find and accurately excise the actual biopsy site of non-palpable breast lesions without a needle. METHODS: This is a retrospective study from January 2000 to July 2005. Electronic chart review identified patients with non-palpable breast lesions detected by means of mammogram who then underwent lumpectomy via NLBB or the hematoma-directed ultrasound-guided technique (HUG). HUG involved localizing the hematoma with a 7.5-MHz US probe and using the "line of sight" technique straight down toward the chest wall. A block of tissue encompassing the hematoma was then excised. RESULTS: Localization procedures were performed in 186 patients-63 (34%) via needle localization and 123 (66%) via HUG. The previous VABB site in 100% of patients was successfully excised using HUG, 65 of 123 (53%) were benign and 58 of 123 (47%) were malignant; margins were positive in 13 of these 58 (22%). NLBB was successful in 100% of patients, 44 of 63 (70%) were benign and 19 of 63 (30%) were malignant; margins were positive in 14 of these 19 (73%). Margin positivity was significantly higher for NLBB than HUG (P = 0.0001, Fisher Exact). CONCLUSIONS: This study suggests that HUG is more accurate in localizing non-palpable lesions than NLBB. By eliminating the additional procedure needed for NLBB, HUG may also be more time- and cost efficient. HUG makes VABB not only a less invasive diagnostic procedure, but also a localization procedure.

Adult↗
PubMed2006

Arkansas Special Populations Access Network perception versus reality--cancer screening in primary care clinics.

The origin of cancer health disparities and mortality in Arkansas is multifactorial. In response to a cooperative agreement with the National Cancer Institute's Center to Reduce Cancer Health Disparities, the Arkansas Special Populations Access Network (ASPAN) was developed to reduce these disparities. ASPAN's partnership with local primary care physicians of the Arkansas Medical, Dental, and Pharmaceutical Association through the Cancer Education Awareness Program is the focus of this article. A quasi-experimental intervention, the Community Cancer Education Awareness Program, was employed that included 1) physician education to increase awareness of risk factors and cancer screening; and 2) patient education to increase screening, and 3) patient-generated screening questionnaires to prompt discussion of cancer risk and screening recommendations between patients and physicians. Two urban and 2 rural clinics were targeted during a 12-month period with interval intervention assessments. Baseline review of records (n = 200) from patients >/=40 were utilized to assess the rate of breast, prostate, and colorectal screenings among clinics. For the patient education intervention, patients (n = 120) were interviewed via a 34-item assessment. Physician awareness of cancer risk factors and screening recommendations significantly increased. Statistically significant increases were seen for prostate (P = .028), breast (P = .036), and colorectal (P < .001) cancer screening across all 4 clinics. Patients' increased likelihood of cancer screenings was associated with knowledge about consumption of animal fat (P < .001), dietary fiber (P < .013), and mammograms (P < .001). Utilizing the physician as the central change agent, the ASPAN provider network successfully enhanced cancer screening awareness of minority physicians and their patients. Cancer 2006. (c) 2006 American Cancer Society.

Adult↗
PubMed2006

eRFA: excision followed by RFA-a new technique to improve local control in breast cancer.

INTRODUCTION: Excision followed by RFA (eRFA) may allow improved cosmesis while ensuring negative margins in patients with breast cancer. This technique utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA will decrease the need for re-excision of inadequate margins. METHODS: Between July 2002 and January 2005, we conducted a multiphase trial of RFA of prophylactic mastectomy specimens and of women desiring lumpectomy. In both models, a lumpectomy was performed, the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100 degrees C for 15 min. Whole mount slides were used to measure the zone of ablation for ex vivo specimens. Hematoxylin and eosin staining of in vivo lumpectomy margins < 3 mm was considered inadequate. RESULTS: Nineteen prophylactic mastectomy ablations revealed a consistent perimeter of ablation. Forty-one patients (mean age 63 +/- 14 years) had an average tumor size of 1.6 +/- 1.5 cm underwent in vivo eRFA, and 25% had inadequate margins: one focally positive, one < 2 mm, eight < 1 mm and one grossly positive. Only the grossly positive margin was re-excised. Overall complication rate of in vivo ablations was 7.5%. Twenty-four of 41 patients did not have post-eRFA XRT. No in-site local recurrences have occurred during a median follow-up of 24 months (12-45 months). Two patients have occurred elsewhere. CONCLUSIONS: The ex vivo ablation model reliably created a 5-10 mm perimeter of ablation. In vivo, this zone reduced the need for re-excision for inadequate margins by 91% (10/11). Short-term follow-up suggests that eRFA could reduce re-excision surgery and local recurrence.

Adult↗
PubMed2006

The POD: a new model for mentoring underrepresented minority faculty.

Mentoring, long recognized as a catalyst for successful careers, is particularly important to the career development of underrepresented minority (URM) faculty. In academic medicine, mentor-protégé relationships are seriously threatened by increased clinical, research, and administrative demands and an emphasis on scholarship over citizenship. New mentoring models are needed, and they should be adaptable to a medical school's unique structure and mission. The Peer-Onsite-Distance (POD) model, developed in 2002 by the authors and introduced at the College of Medicine at the University of Arkansas for Medical Sciences, is a targeted, multilevel mentoring prototype that is built on a solid research foundation and tailored to the unique needs of URM medical school faculty. The mentee's individual needs for guidance related to career goals, resources, and the content and interaction skills that are known to be critical to successful academic careers are targeted for development. The multilevel approach provides a unique network of peer and faculty mentors who provide site-specific career guidance. Also in the network are leaders in their fields who can provide access to accurate information, cautions, predictions, and announcements of future resources or potential restrictions in academic medicine. Mentor commitments are clearly defined and time contributions are maximized. The POD model aims to promote retention and advance the careers of URM faculty by wrapping them in a protective cushion of interpersonal and intrapersonal support. The flexibility of the design allows for adaptation to any institution's unique structure and mission.

Career Mobility↗
PubMed2003

Subareolar sentinel node biopsy for multiple breast cancers.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is deemed suitable only for unifocal breast cancers since multiple foci of cancers may drain to different nodes. We hypothesized that subareolar injection (SI) could identify the sentinel lymph nodes (SLN) accurately in patients with multiple cancers (MC) in the breast. METHODS: We prospectively employed SI of lymphazurin or technetium sulfur colloid, or both, for the identification of SLN in patients with MC in the breast. All patients underwent axillary dissection to compute the accuracy of SLNB. RESULTS: Forty patients presented with MC in the same breast between January 1996 and July 2002. Fifty-two percent (21 of 40) of patients had involvement of more than 1 quadrant; 18% (7 of 40) had more than 1 histologic type of cancers. SLNs were successfully identified in 100% of patients. Axillary disease was present in 63% (25 of 40) of patients. Sensitivity of SLNB was 100% and false negative rate was 0%. The SLN was the only node involved in 45% (18 of 40) of patients. CONCLUSIONS: SLNB using the SI technique may be an alternative to complete axillary dissection in patients with multiple breast cancers.

Adult↗
PubMed2003

Surgical use of breast ultrasound.

As surgeons become increasingly more comfortable in interpreting and using US to determine benignancy and malignancy of breast lesions, use of US-guided needle biopsy. US-guided lumpectomy, percutaneous excision of benign masses, and ablation of cancers will become routine.

Breast Neoplasms↗
PubMed2002

The medical student as patient navigator as an approach to teaching empathy.

BACKGROUND: When empathy was presented in a lecture, medical students did not appreciate the topic or have opportunities to practice empathic techniques. The Patient Navigator Project was designed to foster understanding of a patient's experiences and encourage empathic communication. METHODS: The project uses experiential learning in an outpatient setting in the first year of training. Each student was to "shadow" a patient during a visit to a surgical oncologist and could observe the patient throughout treatment. Patient consent was obtained. Assignments were made before the appointments. Afterward, students met in small groups to reflect on their experiences. RESULTS: Patients were willing to let medical students observe their care. Most students reported a positive learning experience and that they learned to see patients as people, not as numbers or diseases. CONCLUSIONS: Requiring individualized patient-centered activities in the preclinical curriculum is challenging owing to the large number of students and the unpredictable nature of patients.

Adult↗
PubMed2002

Clip migration in stereotactic biopsy.

BACKGROUND: Needle localization breast biopsy (NLBB) is the standard for removal of breast lesions after vacuum assisted core biopsy (VACB). Disadvantages include a miss rate of 0% to 22%, a positive margin rate of approximately 50%, and vasovagal reactions (approximately 20%). We hypothesized that clip migration after VACB is clinically significant and may contribute to the positive margin rates seen after NLBB. METHODS: We performed a retrospective review of postbiopsy films in patients who had undergone VACB with stereotactic clip placement for abnormal mammograms. We measured the distance between the clip and the biopsy site in standard two view mammograms. The location of the biopsy air pocket was confirmed using the prebiopsy calcification site. The Pythagorean Theorem was used to calculate the distance the clip moved within the breast. Pathology reports on NLBB or intraoperative hematoma-directed ultrasound-guided breast biopsy (HUG, which localizes by US the VACB site) were reviewed to assess margin status. RESULTS: In all, 165 postbiopsy mammograms on patients who had VACB with clip placement were reviewed. In 93 evaluable cases, the mean distance the clip moved was 13.5 mm +/- 1.6 mm, SEM (95% CI = 10.3 mm to 16.7 mm). Range of migration was 0 to 78.3 mm. The median was 9.5 mm. In 21.5% of patients the clip was more than 20 mm from the targeted site. Migration of the clip did not change with the age of the patient, the size of the breast or location within the breast. In the subgroup of patients with cancer, margin positivity (including those with close margins) after NLBB was 60% versus 0% in the HUG group. CONCLUSIONS: Significant clip migration after VACB may contribute to the high positive margin status of standard NLBBs. Surgeons cannot rely on needle localization of the clip alone and must be cognizant of potential clip migration. HUG as an alternative biopsy technique after VACB eliminates operator dependency on clip location and may have superior results in margin status.

Adult↗