Mary Soo

Overview:

I have had the privilege of working as an academic radiologist at Duke for almost 30 years. My clinical work focuses on the imaging evaluation of breast abnormalities to detect early forms of breast cancer, and I am particularly interested in supporting patients during these sometimes stressful examinations. Initially, my research evaluated the added benefits of breast ultrasound, MRI, and other imaging tests to identify breast abnormalities, including the study of breast implant integrity.  However, in the past decade, I have focused my research on the imaging-guided breast biopsy process, evaluating ways to optimize women’s experiences as they go through these procedures. Related topics include evaluating patients’ perceptions of breast cancer risk and the biopsy process, the importance of radiologist-patient communication, the spiritual needs of women undergoing biopsy, and use of loving-kindness meditation and other methods to reduce anxiety and discomfort during biopsies.

Positions:

Professor of Radiology

Radiology, Breast Imaging
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1987

Wake Forest University

Grants:

Reducing Benign Breast Biopsies with Computer Modeling

Administered By
Radiology, Breast Imaging
Awarded By
National Institutes of Health
Role
Clinical Investigator
Start Date
End Date

FDG-PEM Detection - Characterization of Breast Cancer

Administered By
Radiology, Breast Imaging
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Pain, Distress and Mammography Use in Breast Cancer Patients

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Computer-Aided Diagnosis Of Breast Cancer Invasion

Administered By
Radiology
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Comfort Talk Study

Administered By
Radiology, Musculoskeletal Imaging
Awarded By
Hypnalgesics, LLC
Role
Collaborator
Start Date
End Date

Publications:

Molecular Subtypes of Breast Cancer: A Review for Breast Radiologists

Gene expression profiling has reshaped our understanding of breast cancer by identifying four molecular subtypes: (1) luminal A, (2) luminal B, (3) human epidermal growth factor receptor 2 (HER2)-enriched, and (4) basal-like, which have critical differences in incidence, response to treatment, disease progression, survival, and imaging features. Luminal tumors are most common (60%-70%), characterized by estrogen receptor (ER) expression. Luminal A tumors have the best prognosis of all subtypes, whereas patients with luminal B tumors have significantly shorter overall and disease-free survival. Distinguishing between these tumors is important because luminal B tumors require more aggressive treatment. Both commonly present as irregular masses without associated calcifications at mammography; however, luminal B tumors more commonly demonstrate axillary involvement at diagnosis. HER2-enriched tumors are characterized by overexpression of the HER2 oncogene and low-to-absent ER expression. HER2+ disease carries a poor prognosis, but the development of anti-HER2 therapies has greatly improved outcomes for women with HER2+ breast cancer. HER2+ tumors most commonly present as spiculated masses with pleomorphic calcifications or as calcifications alone. Basal-like cancers (15% of all invasive breast cancers) predominate among "triple negative"cancers, which lack ER, progesterone receptor (PR), and HER2 expression. Basal-like cancers are frequently high-grade, large at diagnosis, with high rates of recurrence. Although imaging commonly reveals irregular masses with ill-defined or spiculated margins, some circumscribed basal-like tumors can be mistaken for benign lesions. Incorporating biomarker data (histologic grade, ER/PR/HER2 status, and multigene assays) into classic anatomic tumor, node, metastasis (TNM) staging can better inform clinical management of this heterogeneous disease.
Authors
Johnson, KS; Conant, EF; Soo, MS
MLA Citation
Johnson, K. S., et al. “Molecular Subtypes of Breast Cancer: A Review for Breast Radiologists.” Journal of Breast Imaging, vol. 3, no. 1, Jan. 2021, pp. 12–24. Scopus, doi:10.1093/jbi/wbaa110.
URI
https://scholars.duke.edu/individual/pub1474963
Source
scopus
Published In
Journal of Breast Imaging
Volume
3
Published Date
Start Page
12
End Page
24
DOI
10.1093/jbi/wbaa110

An in vivo breast tissue backscatter study with 7.5 MHz and 10 MHz probes

Authors
Anderson, ME; Soo, MSC; Trahey, GE
MLA Citation
Anderson, M. E., et al. “An in vivo breast tissue backscatter study with 7.5 MHz and 10 MHz probes.” 1999 Ieee Ultrasonics Symposium Proceedings, Vols 1 and 2, 1999, pp. 1311–14.
URI
https://scholars.duke.edu/individual/pub914976
Source
wos-lite
Published In
Proceedings Ieee Ultrasonics Symposium
Published Date
Start Page
1311
End Page
1314

Mixed-Methods Study to Predict Upstaging of DCIS to Invasive Disease on Mammography.

BACKGROUND. The incidence of ductal carcinoma in situ (DCIS) has steadily increased, as have concerns regarding overtreatment. Active surveillance is a novel treatment strategy that avoids surgical excision, but identifying patients with occult invasive disease who should be excluded from active surveillance is challenging. Radiologists are not typically expected to predict the upstaging of DCIS to invasive disease, though they might be trained to perform this task. OBJECTIVE. The purpose of this study was to determine whether a mixed-methods two-stage observer study can improve radiologists' ability to predict upstaging of DCIS to invasive disease on mammography. METHODS. All cases of DCIS calcifications that underwent stereotactic biopsy between 2010 and 2015 were identified. Two cohorts were randomly generated, each containing 150 cases (120 pure DCIS cases and 30 DCIS cases upstaged to invasive disease at surgery). Nine breast radiologists reviewed the mammograms in the first cohort in a blinded fashion and scored the probability of upstaging to invasive disease. The radiologists then reviewed the cases and results collectively in a focus group to develop consensus criteria that could improve their ability to predict upstaging. The radiologists reviewed the mammograms from the second cohort in a blinded fashion and again scored the probability of upstaging. Statistical analysis compared the performances between rounds 1 and 2. RESULTS. The mean AUC for reader performance in predicting upstaging in round 1 was 0.623 (range, 0.514-0.684). In the focus group, radiologists agreed that upstaging was better predicted when an associated mass, asymmetry, or architectural distortion was present; when densely packed calcifications extended over a larger area; and when the most suspicious features were focused on rather than the most common features. Additionally, radiologists agreed that BI-RADS descriptors do not adequately characterize risk of invasion, and that microinvasive disease and smaller areas of DCIS will have poor prediction estimates. Reader performance significantly improved in round 2 (mean AUC, 0.765; range, 0.617-0.852; p = .045). CONCLUSION. A mixed-methods two-stage observer study identified factors that helped radiologists significantly improve their ability to predict upstaging of DCIS to invasive disease. CLINICAL IMPACT. Breast radiologists can be trained to better predict upstaging of DCIS to invasive disease, which may facilitate discussions with patients and referring providers.
Authors
Grimm, LJ; Neely, B; Hou, R; Selvakumaran, V; Baker, JA; Yoon, SC; Ghate, SV; Walsh, R; Litton, TP; Devalapalli, A; Kim, C; Soo, MS; Hyslop, T; Hwang, ES; Lo, JY
MLA Citation
Grimm, Lars J., et al. “Mixed-Methods Study to Predict Upstaging of DCIS to Invasive Disease on Mammography.Ajr Am J Roentgenol, vol. 216, no. 4, Apr. 2021, pp. 903–11. Pubmed, doi:10.2214/AJR.20.23679.
URI
https://scholars.duke.edu/individual/pub1456309
PMID
32783550
Source
pubmed
Published In
Ajr. American Journal of Roentgenology
Volume
216
Published Date
Start Page
903
End Page
911
DOI
10.2214/AJR.20.23679

Dreams prior to biopsy for suspected breast cancer: A preliminary survey.

Warning dreams prior to the onset of symptoms have been reported in a previous survey of self-selected women with breast cancer. There is no available data on how many women with suspected breast cancer have such dreams, so anonymous surveys were offered to women who came for biopsy at a university breast imaging center over a period of 3 months. 163 women completed the survey reporting that 64% usually remember their dreams, 41% have had dreams that came true, and 5% keep a dream diary. 5.5% reported dreaming the word "cancer," but only one woman was prompted to have a breast evaluation because of a dream. This pilot data will be used in planning a future study with pathological correlation.
Authors
Burk, L; Wehner, D; Soo, MS
MLA Citation
Burk, Larry, et al. “Dreams prior to biopsy for suspected breast cancer: A preliminary survey.Explore (Ny), vol. 16, no. 6, Nov. 2020, pp. 407–09. Pubmed, doi:10.1016/j.explore.2020.03.002.
URI
https://scholars.duke.edu/individual/pub1436865
PMID
32268982
Source
pubmed
Published In
Explore (Ny)
Volume
16
Published Date
Start Page
407
End Page
409
DOI
10.1016/j.explore.2020.03.002

Ductal Carcinoma In Situ Biology, Language, and Active Surveillance: A Survey of Breast Radiologists' Knowledge and Opinions.

<h4>Purpose</h4>To understand how breast radiologists perceive ductal carcinoma in situ (DCIS).<h4>Materials and methods</h4>A 19-item survey was developed by the Society of Breast Imaging Patient Care and Delivery Committee and distributed to all Society of Breast Imaging members. The survey queried respondents' demographics, knowledge of DCIS biology, language used to discuss a new diagnosis of DCIS, and perspectives on active surveillance for DCIS. Five-point Likert scales (1 = strongly disagree, 3 = neutral, 5 = strongly agree) were used.<h4>Results</h4>There were 536 responses for a response rate of 41%. There was agreement that DCIS is the primary driver of overdiagnosis in breast cancer screening (median 4), and respondents provided mean and median overdiagnosis estimates of 29.7% and 25% for low-grade DCIS as well as 4.2% and 0% for high-grade DCIS, respectively. Responses varied in how to describe DCIS but most often used the word "cancer" with a qualifier such as "early" (32%) or "pre-invasive" (25%). Respondents disagreed (median 2) with removing the word "carcinoma" from DCIS. Finally, there was agreement that current standard of care therapy for some forms of DCIS is overtreatment (median 4) and that active surveillance as an alternative management strategy should be studied (mean 4), but felt that ultrasound (median 4) and MRI (median 4) should be used to exclude women with occult invasive disease before active surveillance.<h4>Conclusions</h4>Breast radiologists' opinions about DCIS biology, language, and active surveillance are not homogenous, but general trends exist that can be used to guide research, education, and advocacy efforts.
Authors
Grimm, LJ; Destounis, SV; Rahbar, H; Soo, MS; Poplack, SP
MLA Citation
Grimm, Lars J., et al. “Ductal Carcinoma In Situ Biology, Language, and Active Surveillance: A Survey of Breast Radiologists' Knowledge and Opinions.Journal of the American College of Radiology : Jacr, vol. 17, no. 10, Oct. 2020, pp. 1252–58. Epmc, doi:10.1016/j.jacr.2020.03.004.
URI
https://scholars.duke.edu/individual/pub1436866
PMID
32278849
Source
epmc
Published In
Journal of the American College of Radiology : Jacr
Volume
17
Published Date
Start Page
1252
End Page
1258
DOI
10.1016/j.jacr.2020.03.004