PubMed Health⌕ Search

Biomedical subjects

William C Dooley

Publications and source records attributed to William C Dooley.

16 recordsLinked to original sources
PubMed2005

Understanding the mechanisms creating false positive lumpectomy margins.

OBJECTIVE: All breast surgeons deal with the frustration of initial pathologic close or positive margins that have no residual cancer upon re-excision. To understand the mechanisms that create false positive margins, specimen handling was standardized in a single surgeon's practice and margin issues were tracked. METHODS: Prospectively over a 3.5-year period, needle-localized lumpectomies for the management of early-stage breast cancer were standardized in all aspects of specimen handling, including surgeon inking and specimen compression for specimen radiography for quality assurance. The current study reviews 220 such cases where the original lumpectomy included a small piece of overlying skin from over the target lesion. All specimen radiography was performed with compression at the skin to deep level to bias the "pancaking" effect of pushing tumor to specimen surface to the deep margin. RESULTS: Of the 220 therapeutic lumpectomies performed for clinical stage 0-2 breast cancer in this fashion, 175 (79.5%) had negative margins by a distance of 10 mm or more. Margins less than 10 mm were classified as close and were present in 20 (9.1%) of cases. These were heavily biased toward margins closer than 2 mm. Positive initial margins accounted for 25 (11.4%) of cases. Of the 45 close or positive margin cases, 12 involved the deep margin only, and on re-excision none was found to have residual tumor. When other single margins were involved, re-excision found tumor in 5 of 14 cases (35.7%). When multiple margins were close or positive, 9 of 19 cases (47.3%) were found to have residual tumor at re-excision. CONCLUSIONS: Specimen compression increases the incidence of false margin positivity. The best predictors of true margin positivity are multiple close or positive margins or margin positivity in a direction not associated with specimen ex vivo compression.

Breast Neoplasms↗
PubMed2005

Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancer.

BACKGROUND: In 1989, skin-sparing mastectomy started at a number of breast centers in the United States because of an increasing demand for immediate reconstruction and a desire for better cosmetic outcomes. METHODS: To ensure the safety of this new approach, we have reviewed the personal series of a single surgeon using a standardized skin-sparing technique during 1989 to 2004. RESULTS: Skin-sparing mastectomy with immediate reconstruction was performed on 225 patients, and standard mastectomy was performed on 1,022 patients. The age distribution was 8 years younger on average in the reconstructed group. The average follow-up for each group was 49 months. The local recurrence for each group was 1.7% and 1.5% (P > .80). The regional recurrence was 3.8% and 3.9% (P > .80). The average time to local recurrence was similar in each group (33.1 and 32.6 months, P > .80). CONCLUSIONS: A skin-sparing mastectomy does not change the local, regional, or systemic risk to breast cancer patients.

Adult↗
PubMed2005

Nonsurgical ablation of primary breast cancer.

The potential for these therapies is overwhelming when one considers that as many as 90,000 patients may be candidates annually in the United States. The ideal therapy should be safe, as painless as possible, accessible, and effective in reducing local recurrence. Because of the novelty of these techniques, no therapy has met all of these goals. Even if these ideals are attained, questions remain about how to follow these patients with regard to frequency and imaging modality for local recurrence. As these technologies are refined, and they mature; it is conceivable that the future treatment of breast cancer may be less morbid than the open breast biopsies now being used for just the diagnosis of the disease.

Breast Neoplasms↗
PubMed2004

Office-based breast ductoscopy for diagnosis.

OBJECTIVE: Ductoscopy is an evolving technology that has been used primarily and historically in conjunction with open surgical procedures. New technical improvements allow intraductal biopsy and therefore its application in the clinical setting for diagnostic evaluations of the breast. This study looks at the initial use of intraductal biopsy in a variety of settings from an academic university practice to a private single-surgeon office. METHODS: This is a multicenter retrospective series of 88 patients undergoing ductoscopy of > or =1 duct for the diagnostic workup of common breast problems. The procedures were done with the patient under local anesthesia, and intraductal biopsy specimens were taken and analyzed as breast cytology samples. RESULTS: Of the 88 patients undergoing office ductoscopy, nipple discharge was the most common indication (n = 83 patients; 94% to 66% spontaneous and 34% elicited). Fifty-five percent were high risk for breast cancer by history. The majority of patients had normal previous mammograms: 48 Breast Imaging-Reporting and Data System (BIRADS) 1, 24 BIRADS 2, and 7 BIRADS 3 to 5. The most common finding was papilloma present in 29 (32%) patients by endoscopy. Only 31% of patients had a history of brown or bloody nipple discharge. A wide variety of other endoscopic abnormalities were seen and biopsied. The average number of biopsies per patient was 2 with 18 (20.5%) having severe or malignant atypia. Further follow-up and management of these more concerning abnormalities is currently ongoing. CONCLUSIONS: These results indicate that office ductoscopy with biopsy is both feasible and does identify suspicious or malignant atypia in patients with expressed or spontaneous nipple fluid.

Adult↗
PubMed2004

Focused microwave phased array thermotherapy for ablation of early-stage breast cancer: results of thermal dose escalation.

BACKGROUND: Tumor ablation as a means of treating breast cancer is being investigated. Microwave energy is promising because it can preferentially heat high-water-content breast carcinomas, compared to adipose and glandular tissues. METHODS: This is a prospective, multicenter, nonrandomized dose-escalation study of microwave treatment. Thermal dose was measured as (1) thermal equivalent minutes (cumulative equivalent minutes; CEM) of treatment relative to a temperature of 43 degrees C and (2) peak tumor temperature. Microwaves were guided by an antenna-temperature sensor placed percutaneously into the tumor. Outcomes measured were pathologic response (tumor necrosis) side effects. RESULTS: Twenty-five patients (mean age, 57 years) were enrolled. The mean tumor diameter was 1.8 cm. Tumoricidal temperatures (>43 degrees C) were reached in 23 patients (92%). Tumor size was unchanged after thermotherapy (P = not significant). Pathologic necrosis was achieved in 17 (68%) patients. Complete necrosis of the invasive component was achieved in two patients. One hundred forty CEM is predictive of a 50% tumor response, and 210 CEM is predictive of a 100% tumor response (P =.003). Univariate linear regression predicts that peak tumor temperatures of 47.4 degrees C and 49.7 degrees C cause a 50% tumor response and a 100% tumor response, respectively. CONCLUSIONS: Thermotherapy causes tumor necrosis and can be performed safely with minimal morbidity. The degree of tumor necrosis is a function of the thermal dose. Future studies will evaluate the impact of high doses of thermotherapy on margin status and complete tumor ablation.

Breast Neoplasms↗
PubMed2003

Ductal lavage, nipple aspiration, and ductoscopy for breast cancer diagnosis.

The intraductal approach to breast cancer has been invigorated this year by a series of papers exploring ductal-based screening through nipple aspiration and lavage and ductal exploration through endoscopy. The merging of these efforts to define the earliest biologic changes in the progression toward breast cancer is opening new fields for both bench-translational and clinical research. These techniques have already begun to show value in defining the presence and extent of proliferative disease in high-risk patients, allowing for more informed therapeutic decision making.

Breast Neoplasms↗
PubMed2002

Routine operative breast endoscopy for bloody nipple discharge.

BACKGROUND: Submillimeter endoscopes are now available and have been described to assist surgeons in the evaluation and management of symptomatic nipple discharge. METHODS: To evaluate its potential use, a microendoscope (0.9 mm Acueity) was used on all patients in a single surgeon's practice who were undergoing nipple exploration for spontaneous hemoccult positive nipple discharge. This procedure was performed at the surgical resection of the symptomatic retro-areolar duct, and 27 patients underwent the endoscopy during the period from January 2000 to August 2001. RESULTS: In 96% (26 of 27) of the patients, the endoscope was successfully introduced into the lactiferous sinus, and the proximal breast ducts were successfully visualized. A lesion accounting for the bleeding was seen in all 26 patients, with 70% (n = 19) having multiple intraluminal defects. Cancers were identified in two cases (7.4%), and in both cases, there was a more proximal papilloma in the same ductal system. Similarly, in 33% of the benign cases, both papillomas and usual or atypical ductal hyperplasia were present. Lesions were identified that extended up to 7.5 cm deep to the nipple. The deepest lesion was one of the endoscopically identified cancers in a patient with normal mammogram and breast ultrasound. Surgical resection could be directed by simple transillumination of the skin during endoscopy. CONCLUSIONS: This series demonstrates the clinical feasibility of routine operative breast endoscopy in the management of bloody nipple discharge. The high incidence of multiple lesion identification suggests that the classic blind resection of a limited distance of duct in the retroareolar space may significantly underestimate the true extent of proliferative disease accounting for pathologic nipple discharge.

Adolescent↗
PubMed2002

Ambulatory mastectomy.

BACKGROUND: Ambulatory mastectomy has been a topic of heated political debate with little analysis of clinical data. METHODS: Based on extensive satisfaction surveys, an ideal surgical treatment experience was developed that decreased nausea, increased preoperative education, and reduced perioperative narcotic usage. Using this new algorithm, patients treated by a single surgeon were given the choice of overnight stay versus discharge to home with visiting nurse care. RESULTS: From March 1 to October 31, 2001, 92 mastectomies or lumpectomy/axillary dissections were performed in 87 patients. One patient chose to remain in the center overnight. All others were discharged in less than 2.5 hours postoperatively. Perioperative complications fell to 20% of those of the prior year. Hospital charges fell 79.5%. CONCLUSIONS: Despite lay reservations about ambulatory mastectomy, a detailed approach can result in markedly reduced health care costs without incurring additional morbidity or mortality.

Adult↗
PubMed2002

Breast enhanced scintigraphy testing distinguishes between normal, inflammatory breast changes, and breast cancer: a prospective analysis and comparison with mammography.

The detection of breast cancer has primarily focused on anatomic findings, whereas assessment of physiologic information using nuclear imaging has been used for the detection of heart disease. Using this approach, the authors developed a method (breast enhanced scintigraphy test [BEST]) for differentiation of breast tissue by enhancing the delivery of isotope. To determine if this technique could distinguish between normal (Nl), inflammatory changes of the breast (ICB), and breast cancer (CA), 100 women were prospectively studied using BEST imaging, and results were compared with mammography and pathology findings using either biopsy or ductoscopy approaches. Mammography demonstrated a sensitivity and specificity of 69% and 84%, respectively. Using BEST imaging, maximal count activity (MCA) was able to distinguish between Nl, ICB, and CA. The results of 2-tailed t test analysis demonstrated statistically significant differences between Nl and ICB MCA (P </=.001); ICB and CA MCA(P </=.001); and N1 and CA MCA(P </=.001). Using MCA results obtained via BEST imaging, breast tissue was able to be differentiated, whereas mammography was able to detect breast cancer in only 69% of cases and incorrectly identified cancer in 16% of cases.

Adult↗
PubMedDate not supplied

Routine operative breast endoscopy during lumpectomy.

BACKGROUND: Lumpectomy for the management of breast cancer is commonly directed by mammography or ultrasound. We hypothesized that fluid-producing ducts would likely connect to the site of the known cancerous or precancerous lesion and that endoscopic evaluation might reveal unsuspected additional disease. METHODS: All women undergoing lumpectomy in a single surgeon's practice from January 2000 to August 2001 were evaluated for fluid production from the nipple at the time of lumpectomy. All fluid-producing ducts were cannulated and endoscoped with a 0.9-mm Acueity microendoscope. RESULTS: Of the 201 patients (16 with atypical ductal hyperplasia, 52 with ductal carcinoma-in-situ, and 133 with stage 1 or 2 breast cancers), 150 (74.6%) could be successfully dilated and scoped. Additional lesions outside the anticipated lumpectomy were identified in 41% (n = 83) of cases. If successful, the chances for a positive margin for cancer decreased from 23.5% to only 5.0%. Endoscopy proved to be a useful adjunct in this series of patients because it identified all cases of extensive intraductal component in early-stage breast cancer. CONCLUSIONS: Routine operative breast endoscopy can reduce the need for re-excision lumpectomy. It also finds substantially more cancerous and precancerous disease than anticipated by routine preoperative mammography and ultrasound.

Adult↗