MRI‐guided treatment in the breast

Abstract

In the last decades, an increasing interest has developed towards non‐invasive breast lesion treatments, which offer advantages such as the lack of surgery‐related complications, better cosmetic outcomes, and less psychological distress. In addition, these treatments could be an option for patients with poor health who are not candidates for surgery. Non‐surgical ablation can be performed under magnetic resonance (MR) or ultrasound (US) guidance. US is cheaper and easily available, while contrast‐enhanced MR is more accurate, ensuring better safety and efficacy for the patient. Overall results of studies about MRI‐guided tumor ablation reported complete ablation rates ranging between 20% and 100%. High‐intensity focused ultrasound (HIFU or FUS) is the most studied ablative technique and it is already established as a valid technique for ablation of benign and malignant tumors in various organs. Ultrasound‐guided FUS is very useful for young patients who refuse surgery or with multiple nodules; however, MR‐guided FUS is more sensitive and allows a better evaluation of thermal accumulation within the ablated tissue or the adjacent structures. Most MR‐guided FUS studies used a dedicated high‐field MR scanner and complete tumor ablation was reported in 17–90% of cases. Other techniques using thermal tissue destruction are radiofrequency ablation (RFA) and laser interstitial thermal therapy (LITT). Only a few studies assessed the efficacy of these treatments, all were performed with open MR devices. RFA showed complete tumor ablation in 30–96% of patients, while LITT in 10–71%, but all the studies had a small number of patients. Cryoablation obtains tissue ablation by a rapid decrease of temperature, with a complete tumor removal reported in 18–52% of cases with MR guidance. No serious complications were reported with these techniques. Currently, breast conservative surgery replaced radical surgery when possible. Therefore, future research should focus on these treatments to shift towards an even less invasive approach to breast neoplasms. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;48:1479–1488

Breast Cancer Cryoablation: Assessment of the Impact of Fundamental Procedural Variables in an In Vitro Human Breast Cancer Model

“…Simmons et al 7 published the results of a Phase II clinical trial (ACOSOG Z1072) on cryoablation of early stage breast tumors ⩽2.0 cm in diameter reporting an overall success rate of 75.9%, and when patients with multifocal disease were excluded, a 92% success rate. More recently, Pediconi et al 10 published a review of the use of ablation procedures (RFA, HiFu, Laser, and Cryo) using an magnetic resonance imaging (MRI) image guided approach and reported that “no serious complications were reported with these techniques and that these non-surgical approaches offer promise as a replacement to radical surgery when possible.” They also concluded that “further research utilizing these techniques should focus on the development of an even less invasive approach to breast neoplasms.” Finally, Pusceddu et al 18 recently reviewed the breast cancer cryoablation literature and concluded that “. .…”

“…With a continued rise in diagnosis and advances in biomarkers, the use of thermal ablation for pre-and metastatic breast cancer have experienced an increase in use and efficacy in the past 10 years. [6][7][8][9][10][11][12][13][14][15] Ablative techniques such as cryotherapy have been used for the treatment of solid tumors for over 100 years. 16,17 Thermal therapies include radiofrequency ablation (RFA), high-intensity focused ablation (HiFu), and cryoablation.…”

Efficacy of breast MRI for surgical decision in patients with breast cancer: ductal carcinoma in situ versus invasive ductal carcinoma

“…Although preoperative breast MRI can provide more information for determining the surgical range with high sensitivity, some investigators do not recommend breast MRI as a diagnostic imaging modality for breast cancer. Moreover, the detection rate can vary widely (40-100%) [26][27][28][29][30][31]. Therefore, breast MRI requires an experienced radiologist who can accurately interpret the images and determine the degree of suspicion of background breast parenchyma and contralateral breast parenchyma.…”

<p>Cryoablation In The Management Of Breast Cancer: Evidence To Date</p>

“…It has widely been used for planning surgical treatment in selected patients with invasive breast cancer and DCIS, and for assessing response to neoadjuvant systemic therapy 40,41. After cryoablation treatment, damaged cancer cells stay located in the treated area, thus MRI may be the most accurate image tool for evaluating responses to cryoablation 6,34,42. Manenti et al reported a good correlation between MRI volume and histological samples size in their series of 80 patients submitted to either radiofrequency ablation or cryoablation and surgical removal of the tumor 34.…”