BackgroundAn institutional review board-approved, multicenter clinical trial was designed to determine the efficacy and outcome of percutaneous laser ablation (PLA) in the treatment of invasive ductal breast carcinoma (IDC). Post-ablation magnetic resonance imaging (MRI) was compared with surgical pathology in evaluation of residual post-ablation IDC and ductal carcinoma in situ.MethodsPatients with a single focus of IDC 20 mm or smaller by pre-ablation MRI were treated with PLA. The patients underwent a 28-day post-ablation MRI, followed by surgical resection. Cell viability criteria were applied to pre- and post-ablation pathology specimens, which evaluated hematoxylin–eosin (H&E), cytokeratin (CK) 8/18, estrogen receptor, and Ki67 staining patterns.ResultsIn this study, 61 patients were reported as the intention-to-treat cohort for determination of PLA efficacy. Of these 61 patients, 51 (84%) had complete tumor ablation confirmed by pathology analysis. One subject’s MRI imaging was not performed per protocol, which left 60 subjects evaluable for MRI pathology correlation. Five patients (8.3%) had residual IDC shown by both MRI and pathology. Post-ablation discordance was noted between MRI and pathology, with four patients (6.7%) false-positive and four patients (6.7%) false-negative. The negative predictive value (NPV) of MRI for all the patients was 92.2% (95% confidence interval [CI], 71.9–91.9%). Of the 47 patients (97.9%) with tumors 15 mm or smaller, 46 were completely ablated, with an MRI NPV of 97.7% (95% CI, 86.2–99.9%).ConclusionsPercutaneous laser ablation is a potential alternative to surgery for treatment of early-stage IDC. Strong correlations exist between post-ablation MRI and pathologic alterations in CK8/18, ER, and Ki67 staining.
watery diarrhoea. The patient also had positive blood cultures for Streptococcus bovis-an organism often associated with gastrointestinal malignancy. He was referred to the general surgical team for further investigation. An ileofemoral deep vein thrombosis was suspected and this was confirmed with duplex. CT, done to investigate the abdominal pain and diarrhoea, revealed a 6.5 cm right internal iliac artery aneurysm, with no evidence of rupture, compressing the right iliac venous system. Thrombus was noted in the right common iliac vein and inferior vena cava. A filter was placed in the inferior vena cava and the right internal iliac artery aneurysm was treated by coil embolization. At six months the lower limb oedema had completely resolved. Despite endoscopic and radiographic examinations the cause of the anaemia was never found.
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