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:

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

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

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

Unmet spiritual care needs in women undergoing core needle breast biopsy

Objective: Spiritual care is an important part of healthcare, especially when patients face a possible diagnosis of a life-threatening disease. This study examined the extent to which women undergoing core-needle breast biopsy desired spiritual support and the degree to which women received the support they desired. Methods: Participants (N = 79) were women age 21 and older, who completed an ultrasound- or stereotactic-guided core-needle breast biopsy. Participants completed measures of spiritual needs and spiritual care. Medical and sociodemographic information were also collected. Independent sample t-tests and chi-square tests of examined differences based on demographic, medical, and biopsy-related variables. Results: Forty-eight participants (48/79; 60.8%) desired some degree of spiritual care during their breast biopsy, and 33 participants (33/78; 42.3%) wanted their healthcare team to address their spiritual needs. African American women were significantly more likely to desire some type of spiritual support compared to women who were not African American. Among the 79 participants, 16 (20.3%) reported a discrepancy between desired and received spiritual support. A significant association between discrepancies and biopsy results was found, χ2(1) = 4.19, P = .04, such that 2 (7.4%) of 27 participants with results requiring surgery reported discrepancies, while 14 (26.9%) of 52 participants with a benign result reported discrepancies. Conclusion: Most women undergoing core-needle breast biopsy desired some degree of spiritual care. Although most reported that their spiritual needs were addressed, a subset of women received less care than desired. Our results suggest that healthcare providers should be aware of patients' desires for spiritual support, particularly among those with benign results.
Authors
van Denburg, AN; Shelby, RA; Winger, JG; Zhang, L; Soo, AE; Pearce, MJ; Soo, MS
MLA Citation
van Denburg, A. N., et al. “Unmet spiritual care needs in women undergoing core needle breast biopsy.” Journal of Breast Imaging, vol. 2, no. 1, Mar. 2020, pp. 134–40. Scopus, doi:10.1093/jbi/wbz089.
URI
https://scholars.duke.edu/individual/pub1430842
Source
scopus
Published In
Journal of Breast Imaging
Volume
2
Published Date
Start Page
134
End Page
140
DOI
10.1093/jbi/wbz089

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