Office-Based Cryoablation of Breast Fibroadenomas with Long-Term Follow-up

Abstract

Approximately 10% of women will experience a breast fibroadenoma in their lifetime. Cryoablation is a new treatment that combines the better attributes of the current standards: surveillance and surgery. It is a minimally invasive office-based procedure that is administered without the use of general anesthesia, involving minimal patient discomfort and little to no scarring. This work aimed to establish the long-term (2-3 years) efficacy, safety, and satisfaction of the procedure, as well as the impact of cryoablation on mammogram and ultrasound images. Thirty-seven treated fibroadenomas were available for assessment with an average follow-up period of 2.6 years. Of the original 84% that were palpable prior to treatment, only 16% remained palpable to the patient as of this writing. Of those fibroadenomas that were initially < or = 2.0 cm in size, only 6% remained palpable. A median volume reduction of 99% was observed with ultrasound. Ninety-seven percent of patients and 100% of physicians were satisfied with the long-term treatment results. Mammograms and ultrasounds showed cryoablation produced no artifact that would adversely affect interpretation. Cryoablation for breast fibroadenomas has previously been reported as safe and effective both acutely and at the 1-year follow-up mark, and thus has been implemented as a treatment option. At long-term follow-up, cryoablation as a primary therapy for breast fibroadenomas demonstrates progressive resolution of the treated area, durable safety, and excellent patient and physician satisfaction. The treatment is performed in an office setting rather than an operating room, resulting in a cost-effective and patient-friendly procedure. Cryoablation should be considered a preferred option for those patients desiring definitive therapy for their fibroadenomas without surgical intervention.

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

“…Based on these considerations, percutaneous breast cancer ablation techniques should be carefully avoided in DCIS, representing an ideal technique for tumours below 15-16 mm in diameter. 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].…”

Breast pathology after cryotherapy. Histological regression of breast cancer after cryotherapy

“…For benign breast tumors cryotherapy is a preferred method, particularly in women who want to have management without an open operation [19]. Similar results are also expected with management of malignant breast tumors.…”

“…In comparison with open surgery percutaneous cryotherapy provides better patient comfort, shorter hospitalization and lower costs. In addition, as the results of a 2-3 year follow-up showed, the tendency for scar formation can be reduced by cryotherapy of fibroadenomas without a detectable volume deficit by visual examination or on palpation [19]. In the case of malignant histological findings evaluation of HER-2 and hormone receptor status on a needle biopsy sample as well as a minimally invasive sentinel lymph node resection which are usual adjuvant processes in breast saving surgery have to be carried out.…”

Cryosurgery for Breast Fibroadenomas

“…Two of the fibroadenoma patients had their palpable residual nodule excised, both revealing necrotic debris and no viable tumor in the treated volume. One year later, Kaufman et al (12) further showed the effectiveness and safety of cryoablation as a primary therapy for breast fibroadenomas. Thirty-seven treated fibroadenomas received an average follow-up period of 2.6 years, only 16% remained palpable.…”