Cryosurgery of Breast Cancer

Staren, Edgar D.; Sabel, Michael S.; Gianakakis, Louis M.; Wiener, Gregory A.; Hart, Vanessa; Gorski, Marie; Dowlatshahi, Kambiz; Corning, Brian F.; Haklin, Michael; Koukoulis, George Κ.

doi:10.1001/archsurg.1997.01430250030005

Cited by 157 publications

(48 citation statements)

References 12 publications

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“…Experiences with excellent results for breast expansion of significantly greater dimensions are reported for the fibroadenomas [14,15] .The main disadvantage of in situ breast cancer ablation techniques not followed by surgical resection consists on the impossibility to assess anatomo-pathological changes, the excisional surgical specimen, the extent and completeness of ablation. Literature reported a cryotherapy experience not followed by surgical excision performed on animals [16]. In the opinion of the authors, although the percutaneous tumour ablation could lead to a partial tumour response, the adjuvant radiotherapy is used to clean up residual cancer cells.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

et al. 2011

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Objectives To assess the ablative effectiveness, the oncological and cosmetic efficacy of image-guided percutaneous cryoablation in the treatment of single breast nodules with subclinical dimensions after identification with ultrasonography (US), mammography, magnetic resonance (MRI) and characterization by vacuum assisted biopsy. Materials Fifteen women with a mean age of 73±5 years (range 64-82 years) and lesion diameter of 8±4 mm were undergoing cryotherapy technology with a single probe under US-guidance associated with intra-procedural lymphnode mapping and excision of the sentinel node. All the patients underwent surgical resection (lumpectomy) from 30 to 45 days after the percutaneous ablation. Results The iceball size generated by the cryoprobe during the procedure at minus 40°C was 16×41 mm. In 14 of the 15 patients was observed a complete necrosis of the cryoablated lesion both in post-procedural MRI follow-up and anatomo-pathological evaluation after surgical resection. In one case there was a residual disease in post-procedural MRI and postoperative histological examination, probably justified by an incorrect positioning of the probe. Conclusion The percutaneous cryoablation as a "minimally invasive" technique can provide excellent oncological and cosmetic results on selected cases handled by experienced operators by using the tested devices.

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Section: Discussionmentioning

confidence: 99%

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

et al. 2011

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“…The next logical step in this evolution is less invasive (nonsurgical) image-guided treatment of tumors. Various minimally invasive heating techniques (i.e., radio frequency ablation, 1,2 laser ablation, 3,4 cryoablation, 5,6 as well as noninvasive high-intensity focused ultrasound [7][8][9][10][11][12][13][14][15][16] ) are currently under study in animal and human trials. While performing any of these procedures under MRI guidance can provide real-time images to improve procedure accuracy, magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) is a breast conserving therapy that can ablate tissue completely noninvasively.…”

Section: Introductionmentioning

confidence: 99%

Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array

et al. 2012

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Purpose: This work presents the design and preliminary evaluation of a new laterally mounted phased-array MRI-guided high-intensity focused ultrasound (MRgHIFU) system with an integrated 11-channel phased-array radio frequency (RF) coil intended for breast cancer treatment. The design goals for the system included the ability to treat the majority of tumor locations, to increase the MR image's signal-to-noise ratio (SNR) throughout the treatment volume and to provide adequate comfort for the patient. Methods: In order to treat the majority of the breast volume, the device was designed such that the treated breast is suspended in a 17-cm diameter treatment cylinder. A laterally shooting 1-MHz, 256-element phased-array ultrasound transducer with flexible positioning is mounted outside the treatment cylinder. This configuration achieves a reduced water volume to minimize RF coil loading effects, to position the coils closer to the breast for increased signal sensitivity, and to reduce the MR image noise associated with using water as the coupling fluid. This design uses an 11-channel phased-array RF coil that is placed on the outer surface of the cylinder surrounding the breast. Mechanical positioning of the transducer and electronic steering of the focal spot enable placement of the ultrasound focus at arbitrary locations throughout the suspended breast. The treatment platform allows the patient to lie prone in a face-down position. The system was tested for comfort with 18 normal volunteers and SNR capabilities in one normal volunteer and for heating accuracy and stability in homogeneous phantom and inhomogeneous ex vivo porcine tissue. Results: There was a 61% increase in mean relative SNR achieved in a homogeneous phantom using the 11-channel RF coil when compared to using only a single-loop coil around the chest wall. The repeatability of the system's energy delivery in a single location was excellent, with less than 3% variability between repeated temperature measurements at the same location. The execution of a continuously sonicated, predefined 48-point, 8-min trajectory path resulted in an ablation volume of 8.17 cm 3 , with one standard deviation of 0.35 cm 3 between inhomogeneous ex vivo tissue samples. Comfort testing resulted in negligible side effects for all volunteers. Conclusions: The initial results suggest that this new device will potentially be suitable for MRgHIFU treatment in a wide range of breast sizes and tumor locations.

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“…This not only would improve cosmetic outcomes, but also could greatly decrease operating room and anesthesia needs, recovery times, surgical complications, and health-care costs. Several methods are presently being investigated for the in situ ablation of breast cancer, including radiofrequency ablation, 4 -7 cryosurgery, 8,9 laser interstitial therapy, 10 -17 high-intensity focused ultrasound, 18 -25 and focused microwave thermotherapy. 26 -29 Cryosurgery has been successfully used for the ablation of tumors in the liver, 30,31 prostate, 32,33 and kidney 34,35 ; the palliative treatment of locally advanced breast cancers 36,37 ; and the treatment of breast fibroadenomas.…”

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confidence: 99%

Cryoablation of Early-Stage Breast Cancer: Work-in-Progress Report of a Multi-Institutional Trial

et al. 2004

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Background: With recent improvements in breast imaging, our ability to identify small breast tumors has markedly improved, prompting significant interest in the use of ablation without surgical excision to treat early-stage breast cancer. We conducted a multi-institutional pilot safety study of cryoablation in the treatment of primary breast carcinomas.Methods: Twenty-nine patients with ultrasound-visible primary invasive breast cancer Յ2.0 cm were enrolled. Twenty-seven (93%) successfully underwent ultrasound-guided cryoablation with a tabletop argon gas-based cryoablation system with a double freeze/thaw cycle. Standard surgical resection was performed 1 to 4 weeks after cryoablation. Patients were monitored for complications, and pathology data were used to assess efficacy.Results: Cryoablation was successfully performed in an office-based setting with only local anesthesia. There were no complications to the procedure or postprocedural pain requiring narcotic pain medications. Cryoablation successfully destroyed 100% of cancers Ͻ1.0 cm. For tumors between 1.0 and 1.5 cm, this success rate was achieved only in patients with invasive ductal carcinoma without a significant ductal carcinoma-in-situ (DCIS) component. For unselected tumors Ͼ1.5 cm, cryoablation was not reliable with this technique. Patients with noncalcified DCIS were the cause of most cryoablation failures.Conclusions: Cryoablation is a safe and well-tolerated office-based procedure for the ablation of early-stage breast cancer. At this time, cryoablation should be limited to patients with invasive ductal carcinoma Յ1.5 cm and with Ͻ25% DCIS in the core biopsy. A multicenter phase II clinical trial is planned.

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Cryosurgery of Breast Cancer

Cited by 157 publications

References 12 publications

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array

Cryoablation of Early-Stage Breast Cancer: Work-in-Progress Report of a Multi-Institutional Trial

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