Feasibility study on the treatment of small breast carcinoma using percutaneous US-guided preferential radiofrequency ablation (PRFA)

Abstract

The purpose of this study was to determine the safety and efficacy of percutaneous ultrasound (US) guided preferential radiofrequency ablation (PRFA) of unifocal human invasive breast carcinoma with largest radiological diameters of up to 16 mm. Thirty-three patients were enrolled in a study to be treated prior to scheduled partial mastectomy. A needle-shaped treatment electrode, successively developed in two different sizes, was placed into the center of the lesions using ultrasound guidance. A temperature of 85 degrees C was maintained for 10 min. The analysis of the resected specimen was performed using conventional histopathological methods with the aim to determine the size of the lesion as well as the potential viability of tumor cells. Of the 33 patients enrolled 31 were treated. In 26 (84%) patients a complete ablation of the tumor was achieved. Ultrasound guided preferential radiofrequency ablation of small breast carcinoma is feasible and patient friendly. The success rate depends on accurate preoperative diagnostic imaging as well as an exact position of the needle electrode.

Minimally-invasive treatment of early stage breast cancer: A feasibility study using radiofrequency ablation under local anesthesia

“…Finally, although precision placement of the electrode is crucial [8] there are currently no means available to facilitate the cumbersome process of manual large diameter electrode placement. Based on initial institutional experience in the use of PRFA in breast cancer patients [2,9] the goal of this study was to move the treatment into an outpatient setting and tackle the identified shortcomings. The radiological protocol for patient selection and treatment follow-up was improved by including MRI and CEUS.…”

Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

“…In five studies [21,24,49,59,63], patients withdrew from the study during or after treatment and in another six studies [15,26,44,48,49,72] patients withdrew before the start of the treatment. The overall STROBE score ranged from four to seven (mean…”

“…A total of 63 articles matched the selection criteria. The 63 articles included 16 feasibility studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], 12 phase I studies [29][30][31][32][33][34][35][36][37][38][39][40], nine phase II studies [41][42][43][44][45][46][47][48][49], three comparative studies [50][51][52], one retrospective study [53], and four randomised controlled trials [54][55][56]. In 18 studies the type of study was not reported [8,[57][58][59][60][61][62][63][64]…”

“…Considering RFA, in 87.1±12.8% (491/564) of all patients who underwent surgical excision, complete ablation of the tumour was achieved [13][14][15][16][17]26 Using a random effect logistic model given the wide-variation in complete ablation rates between studies, the probabilities of success to achieve complete pathological response for the five ablative techniques with 95% CI were calculated. The highest estimate was for RFA (0.87 (0.82, 0.91)), followed by microwave ablation (0.81 (0.70, 0.93)), cryo-ablation …”

“…Axillary treatment was performed prior to ablative treatment (n=17), after ablative treatment (n=2), along with surgical excision (n=14), or the timing was not specified (n=7). Sentinel lymph node biopsy (SLNB) in immediate surgical excision studies was often performed just prior to the ablative treatment, [14,15,48], five cases of blistering [51], four of coagulative changes to the skin [51], three were cases of ecchymosis [27,46], three cases of nipple retraction, [31] two case of pneumothorax [15,64], two incidences of skin puckering [44], two infections [42,44] and single cases of overreaction [30] and fistula [47] (table 1a). With cryo-ablation 10.9% of patients (20/183) J U S T A C C E P T E D developed a complication, these were skin necrosis (n=5) [61], haematoma (n=5) [22,73], ecchymosis (n=4) [22], skin retraction (n=2) [73], seroma (n=2) [19,20], arterial bleeding (n=1) [20] and skin ulceration (n=1).…”