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Diagnostic Evaluations

Ultrasound

Ultrasounds send out sound waves that bounce against organs and reverberate back to a device called a transducer. The transducer processes the reflected waves and converts them into an image of targeted organs or tissues, projected onto a computer screen.

The sound waves travel at varying speeds, depending on the type of tissue under examination. The tissue types are identified by the speed and volume of the sound waves as they return to the transducer. The sound waves echo off abnormal tissue differently than they do healthy tissue, allowing doctors to distinguish tumors from normal cells.

Because ultrasounds identify locations of abnormal tissue, they may also be used to pinpoint the position of a tumor in order to guide a biopsy or aspiration procedure. For example, an ultrasound may be used to mark out the boundaries of a tumor prior to its removal. It also may be used to administer cancer treatments.

Ultrasound tests are often named for the body part they are being used to examine—a breast ultrasound or an abdominal ultrasound, for example. Ultrasounds are commonly used to explore tissue in the abdomen, breasts, heart (cardiac ultrasound), pelvis, prostate, kidneys, testicles and thyroid.

Ultrasounds are typically painless, generally take less than 20 minutes, and are usually performed by an ultrasound technologist, also called a sonographer. The technologist applies gel to a patient’s skin to help eliminate air pockets that would compromise the quality of the images. While the transducer is pressed firmly against the gel, the screen displays images of the targeted tissue or organs. A radiologist interprets ultrasound results.

Some types of ultrasound we perform include:

Endoscopic ultrasound (EUS)

Doctors use EUS to diagnose and stage esophageal, pancreatic, gastric, rectal and bile duct cancers. In some cases, they may also use EUS for therapeutic purposes.

EUS often produces more accurate and detailed images than those obtained by traditional ultrasound. This is because a small ultrasound transducer is located on the tip of the endoscope, which allows the instrument to get closer to the tumor and surrounding areas.

In this minimally invasive imaging procedure, an endoscope (a long, flexible, lighted tube with an attached camera) is inserted into the mouth or rectum. Then, ultrasound waves produce images of internal parts of the body, such as the digestive tract, as well as surrounding tissues and organs.

Endoscopic ultrasound may be used for diagnostic purposes to perform a biopsy and plan treatment, and to check for recurrence after treatment ends. In these cases, the ultrasound may be performed using fine needle aspiration. During this process, a thin needle is placed through the endoscope and directed into the mass or surrounding lymph nodes to obtain a biopsy specimen.

In cases where more tissue is required to make a definitive diagnosis, a core needle biopsy, which uses a larger needle, may be performed during endoscopic ultrasound.

For pancreatic tumors, EUS may also be a therapeutic tool. For example, medication may be injected into the celiac ganglion (the mass of nerve tissue in the upper abdomen) to alleviate pain associated with pancreatic cancer.

The EUS procedure typically takes 10 to 60 minutes, depending on whether it is for diagnostic or therapeutic reasons. An anesthesiologist may administer moderate sedation so the patient is asleep during the procedure. Usually, little or no sedation is required.

Endobronchial ultrasound (EBUS)

EBUS may be used to diagnose and stage lung cancer, and to determine whether the disease has spread to other parts of the body, such as the lymph nodes.

During an EBUS procedure, a thin, flexible instrument called a bronchoscope is fitted with an ultrasound device and guided through the patient’s mouth and trachea.

This technique allows doctors to obtain real-time images in and around the lungs and to identify difficult-to-reach tumors. The EBUS may also be used to biopsy a tissue or fluid sample from the lungs and surrounding lymph nodes of the chest.

EBUS is a less invasive alternative to conventional mediastinoscopy, a surgical procedure requiring a series of incisions in the chest under general anesthesia. With EBUS, the same procedure may be performed using a very thin needle aspiration under local anesthesia in an outpatient setting.