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

Abstract

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.

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

“…108,111,114,132,135 Reported complications following the percutaneous procedures included bruising, skin burns and necrosis, 91,103,113,114,136 as well as similar complications to those expected from open surgery, including seromas 91,115,143 and haematomas. 105,115,125,136,140,141,143 The lack of adequate follow-up data reported within these studies makes it difficult to assess the recurrence risk, with only one study of RFA reporting three local recurrences in 21 patients with invasive breast cancer at 60 months of follow up. 101 Long-term follow up is difficult as the majority of studies conducted are window studies, with percutaneous ablation followed by standard surgical excision.…”

Subclinical Breast Cancer: Minimally Invasive Approaches. Our Experience with Percutaneous Radiofrequency Ablation vs. Cryotherapy

“…In 2008, van der Ploeg et al [9] published the first case of MRI-guided breast RFA in 3 patients with invasive ductal carcinoma and no artifacts around the needle electrode [9,10]. Although the iceball produced during cryoablation reduces the visibility in deeper tissues, it is much more regular, definite, and symmetric, allowing an easier comparison between the margins of the lesion and the ablation volume [11]. All RFAs were performed successfully, with no tissue impedance rising above 20 Ω from baseline during the procedure, independent of the breast composition pattern.…”

Image-Guided Ablation in Breast Cancer Treatment

“…[1][2][3][4] The greatest success in complete cell death has occurred in tumors o2 cm in diameter, and especially those that are 1.5 cm or smaller, without extensive ductal carcinoma in situ. 3,4 Patients with tumors 42 cm are generally considered poor candidates owing to the presence of sonographically occult tumor extension.…”

“…7 The most recent cryoablation clinical trial among 15 women with lesions 4-12 mm in diameter reported that MRI was accurate in detecting the solitary case of 3-mm residual tumor, considered owing to suboptimal eccentric probe positioning during cryoablation. 1 Cell death is achieved by freezing tissue with a percutaneous 3-mm probe, typically with ultrasound guidance (Fig. 1A and B).…”

“…However, the use of MRI during cryoablation is quite limited owing to logistical issues of working in an MRI suite and greater expense than ultrasound guidance. 1,8 A limitation of cryoablation using ultrasound guidance is visibility of the tumor during the ablation, because the posterior tumor is obscured by extensive shadowing from the ice ball. 9 Nonetheless, the location of the tumor can still be estimated within the ice ball.…”