Microwave Ablation Versus Nipple Sparing Mastectomy for Breast Cancer ≤5 cm: A Pilot Cohort Study

Abstract

Objectives Compared with nipple sparing mastectomy (NSM), microwave ablation (MWA) is one relatively new modality indicated for selected breast cancer with nipple sparing and with little of evidence-based medical research for decision-making. The objective of this study was to compare the effect of ultrasound-guided percutaneous MWA and NSM for breast cancer. Materials and Methods A retrospective cohort study was conducted in a single institution from 2014 to 2020. Women with invasive ductal carcinoma of the breast ≤ 5cm treated by MWA or NSM were enrolled. The primary end point was tumor progression and secondary end points included survival, cosmetic results, and complications. Results 21 patients in the MWA group and 43 in the NSM group were evaluated. The mean tumor size was 2.3 cm (range, 0.3–5.0 cm). Median follow-up was 26.7 months (range, 14.6–62.5 months). The mean age of MWA was 24 years older than that of the NSM group. All the patients achieved technique effectiveness. One local tumor progression and one ipsilateral breast recurrence occurred at 42 and 28 months after MWA, respectively. One ipsilateral breast recurrence and two bone metastasis occurred at 31.2, 34, and 30.5 months after NSM. Two groups had no significant difference in tumor progression (P = 0.16). No participants in both groups developed cancer related death (P > 0.99) and major complications (P > 0.99). However, MWA needed less hospitalization time (P < 0.001) and achieved better cosmetic results (P < 0.001). Conclusions MWA achieved similar short term effect for breast cancer control and better cosmetic satisfaction compared with NSM in selected patients. MWA provides appropriate option for elderly patients who are unfit for surgery.

Ablative Therapies for Breast Cancer: State of Art

“…30 Yu et al published a retrospective cohort study that enrolled 64 patients (21 in the MWA group and 43 in the surgery group) to compare nipple-sparing mastectomy (NSM) and MWA ablation for the treatment of IDC ≤ 5 cm with no direct tumor involvement of the nipple, areola, skin, and pectoralis, and no extensive vascular carcinoma thrombus. 41 Median follow-up was 26.7 months (range, 14.6-62.5 months) and showed one local tumor progression and one ipsilateral breast recurrence, that occurred respectively at 42 and 28 months after MWA, and one ipsilateral breast recurrence and two bone metastases at 31.2, 34, and 30.5 months after NSM. The two groups had no significant difference in tumor progression.…”

Magnetic resonance imaging-guided radiofrequency ablation of breast cancer: a current state of the art review

“… 28 Thus, targeted agents based on MWA-induced systemic immune responses have aroused broad interest. Although it can accomplish a larger ablation volume within a short period, it is not clear if MWA offers more value than RFA, 29 , 30 and operational difficulties and high costs related to equipment maintenance could also be a hindrance.…”

Heat treatment-induced autophagy promotes breast cancer cell invasion and metastasis via TGF-β2-mediated epithelial-mesenchymal transitions

“…Other treatment modalities have also been developed, such as minimally invasive ablation techniques like cryotherapy, radiofrequency, and microwave and laser ablations ( Fleming, Holbrook & Newell, 2017 ; Peek & Douek, 2017 ; Brem, 2018 ; Peek et al, 2017 ). The advantages of BC ablation treatment include its low treatment cost, infrequent general anesthesia requirement, low complication rates and severities, short recovery time and satisfying cosmetic results, in addition to it being an appropriate option for elderly patients who have comorbidities and are unfit for surgery ( Peek et al, 2017 ; Roubidoux, Yang & Stafford, 2014 ; Yu et al, 2020 ).…”

“…However, for the MWA procedure to be considered technically successful, the tumor and a large enough safety margin of normal breast tissue both must be included within the ablation zone. The primary problem with using MWA is the difficulty of achieving complete tumor inactivation ( Roubidoux, Yang & Stafford, 2014 ; Yu et al, 2020 ; Zhou et al, 2012a ). Studies have shown that MWA can result in complete tumor destruction in most cases, but residual tumor tissues have remained present in some patients and animal models ( Zhou et al, 2012a ; Zhou et al, 2012b ; Song et al, 2016 ).…”