Patient Stories

annable-275Clinical Trial Detects Hidden Breast Cancer

In 2000, 40-year-old Stephanie Annable had what she thought would be another routine mammogram. But in her film, the radiologist saw a small cluster of calcifications. Those turned out to be Stage 0 breast cancer.

Annable knew how fortunate she was the calcifications were even picked up. As with an estimated 60 percent of American women, Annable had dense breast tissue, which is made up of more connective tissue and appears white on a mammogram. Because cancer also appears white on a mammogram, tumors can be difficult to detect.

“As the breast density goes up, the mammogram’s accuracy drops,” said Marc Inciardi, MD, a breast imaging radiologist at The University of Kansas Cancer Center. “In non-dense breasts, a tumor is easy to see [in a mammogram] as a little white ball. But in a dense breast it’s like trying to find a snowball in a snowstorm.”

After receiving treatment, Annable sought out Breast Cancer Prevention experts at The University of Kansas Cancer Center. Her prevention team educated Annable about lifestyle changes, preventive drug options, additional screening opportunities and future risk assessments. She started taking the breast cancer drug Tamoxifen, and had a mammogram or a sonogram every six months.

“I had a gut feeling this could come back, and I wanted to be fully armed and ready should that occur,” Annable said. “I wanted to do everything in my power to keep this from coming back, and I knew I would be in the best hands here.”

In September 2009, Annable had her six-month mammogram at The University of Kansas Cancer Center. Elated that her mammogram showed nothing abnormal, Annable decided to participate in the new SOMO·INSIGHT clinical trial. The trial studies whether Automated Breast Ultrasound (ABUS) technology is more accurate than a routine screening mammogram alone in detecting breast cancer in women with dense breast tissue.

Through a gentle scanning process, the ABUS scans each breast from the front, outer and inner sides, providing radiologists with a clear 3D ultrasound. “It’s another tool in the fight, so I absolutely wanted to participate,” Annable said. “But I thought, ‘They won’t find anything.’ ”

Annable was shocked to learn the ABUS revealed a spot her mammogram hadn’t showed. Further tests confirmed it was Stage 1 breast cancer.

Though this trial will take at least two more years to complete, Dr. Inciardi, the trial’s principal investigator at the cancer center, has already seen the value in ABUS: In February, breast radiologists detected an early-stage cancer in a second trial participant.

“We will need more results to confirm, of course,” Dr. Inciardi said. “But if the trial results show this is applicable to the general population with dense breasts, this may result in another tool for early detection.”

For her part, Annable said that until a cure is found, services like Breast Cancer Prevention and access to clinical trials at The University of Kansas Cancer Center provide more hope to women.

“I’m so fortunate that because of the clinical trial, they found this cancer so early,” Annable said. “I’m so blessed to have the team at The University of Kansas Cancer Center, and to have had access to this tool.”

tiny-survivor-275Tiny Survivor
Newborn’s rare brain aneurysm successfully shut with superglue

For her first two weeks, little Ashlyn Julian was, according to The University of Kansas neurosurgeon who saved her life by repairing an extremely rare ruptured brain aneurysm, “very rambunctious and attentive and full of energy.” When she suddenly began sleeping and feeding poorly, her parents took her to their local Kansas City-area hospital, where doctors suspected the child was suffering from typical maladies, most likely an upset stomach. But symptoms persisted, and Ashlyn even had a seizure, with her body contracting and stiffening.

She promptly returned to normal, but her parents, Jared and Gina Julian, were concerned enough to take her to Children’s Mercy Hospital, where doctors found that the soft spots on Ashlyn’s skull had become tense. An ultrasound detected what was first thought to be a tumor, until pediatric neurosurgeon John Clough, m’94, concluded that a tumor would probably not have caused her symptoms.

Clough ordered an MRI, which revealed bleeding in the child’s brain, an event so rare in infants less than 28 days old that medical literature had recorded a mere 17 such cases since 1949; Ashlyn was No. 18.

He brought the case to the daily neurosurgery conference at The University of Kansas Medical Center, where it was agreed the best course of treatment would be to access the aneurysm through the baby’s vascular system. Ashlyn’s body had stopped the bleeding by forming a clot, but the clots are delicate and can rupture when the brain is jostled during a typical open-skull surgery; and, because her body was so tiny, any loss of blood might well have been more than Ashlyn could endure.

As our team—including assistant professor and endovascular neurosurgeon Koji Ebersole and assistant professor and interventional neuroradiologist Alan Reeves, c’93, m’97—went through a final discussion of surgical options, the child seized again. They knew her life was in imminent peril and rushed into action.

Working in a specialized operating room equipped with the latest in 3D imaging, the surgeons snaked the tiniest microcatheter they could find into Ashlyn’s blood vessels. Once they progressed from the child’s thigh to the aneurysm in her brain, they inserted into the catheter a micro-wire, about the thickness of a human hair, with which Ebersole delivered a drop of surgical superglue to seal the rupture.

Both Reeves and Ebersole say that although the procedure was exceedingly unusual because of the patient’s tender age, they approached it as they would any other surgery and felt no added pressure with an infant’s life in their hands.

“For me, personally, my anxiety about any procedure has to do with whether or not it’s the right thing to do,” Ebersole says. “Once I’ve decided that I’m doing the right thing, then there’s no nerves at all. ... [And] once she experienced the second bleeding, I was strongly compelled that there was not a better solution, so I was not nervous thereafter.”

Although the use of superglue captured the public’s attention when news about the surgery went out around the world, superglue is actually now a standard tool for sealing aneurysms. For the surgeons and their colleagues, the intriguing aspect of the case was the fact that Ashlyn was just 3 weeks old at the time of the procedure. Our doctors will detail their experience in medical literature so professionals worldwide can learn from the case, but they don’t anticipate that it will be needed anytime soon.

“That’s not just a once-in-a-career case,” Reeves says, “it’s a once-in-a-career case for 100 different surgeons. I don’t ever expect to see a case like this ever again.”

The KU surgeons emphasize that the parents did everything right, as did physicians who initially failed to suspect a brain aneurysm; it is simply too rare of an event to expect it to be immediately diagnosed. For that reason, too, they caution parents who have heard about Ashlyn’s case not to immediately fear a brain bleed if their infant has a turn in health that proves difficult to diagnose.

“That is not the point of broadcasting this situation with this baby,” Reeves says. “It’s just very unique and interesting, and thankfully with a good outcome.”

The relieved Julians brought 3-month-old Ashlyn back for a visit in late August, and her doctors say the bright, happy baby can be expected to enjoy normal childhood development.

“I wasn’t even thinking about anything we went through,” Ebersole said while cradling Ashlyn, who sported a lacy headband and a “My Daddy Rocks” bib. “I was just thinking that she just seems fantastic. I forgot about all those things that we went through.”

hunter-275Destroying Tumors Without Surgery
Interventional radiologists use microwave energy to end teen’s intense leg pain

For nearly a year, Hunter Cashatt, 14, suffered from increasing leg pain that left him unable to run or sleep through the night. The pain kept him out of sports—the center of his world in Beloit, Kansas, population 3,800.

Tumor inside the bone
Hunter was eventually diagnosed with osteoid osteoma, a benign, pea-sized tumor inside his left shinbone. Parents Luke and Heather feared he might be facing complex surgery. Or worse, what if the boy who loved baseball, fishing and hunting could never again be active?

Seeking specialists, the Cashatts drove four hours to The University of Kansas Hospital – Indian Creek Campus in southern Johnson County.

No surgery necessary
They braced themselves after further images confirmed Hunter’s diagnosis. But what they learned next was like winning the lottery. Interventional radiology medical director Zachary Collins, MD, and his team planned to eliminate Hunter’s tumor through microwave ablation, a minimally invasive procedure. That meant no surgery. No overnight hospital stay. No long recovery at home.

“Dr. Collins was very thorough in his explanation and really helped us understand what was going to be involved,” Heather said. “He even took pictures during the procedure to show Hunter exactly how it took place after the procedure.”

Most advanced technology
Microwave ablation harnesses the same type of energy that reheats your leftovers. While the technology is not new, Collins’ team used the NeuWave Medical(R) microwave ablation system—an improved, more powerful version not available elsewhere in the Kansas City area.

With Hunter under anesthesia, the team used high-tech imaging to precisely locate the tumor. Guided by the onscreen image, Collins inserted a needle probe through the shinbone, into the tumor’s core. Powerful microwave energy heated the probe tip to more than 200 degrees, destroying the tumor in 2 1/2 minutes.

Pain-free within two days
The incision in Hunter’s leg was about the size of a freckle. He went home the same day and was pain-free within two days.

“As interventional radiologists, we’re leading experts at image-guided procedures like this,” Dr. Collins said. “We’re specialists in treating cancerous and benign tumors throughout the body.”

This summer finds Hunter playing second base in a new uniform and ear-to-ear grin, grateful to be back in the game.