Ultrasound-Guided Laser Ablation After Excisional Vacuum-Assisted Breast Biopsy for Small Malignant Breast Lesions: Preliminary Results

Abstract

Background: The purpose of this preliminary study is to evaluate the feasibility of the excisional ultrasound (US) guided vacuum-assisted breast biopsy (VAE), followed by US-guided Laser Interstitial Thermal Therapy (LITT) in the treatment of unifocal ductal breast carcinomas ≤ 1 cm and estimate the ablation rate analyzing the final histopathological results after subsequent surgical excision. Methods: In a single session 11 female patients with unifocal less than a centimeter breast cancer underwent 2 different minimally invasive percutaneous US-guided techniques: a VAE breast biopsy with an 8 G needle to remove the lesion and, immediately after, a LITT ablation in the biopsy site. Four weeks later, all patients underwent radiological follow-up. Afterward, a systematic surgery was performed, the ablation rate was calculated, and iconographic and histological features were correlated. Results: Average maximum diameter of the lesions was 7.6 mm (5-10 mm). No patient reported pain or discomfort during procedure. 1/11 patient (9.1%) reported an early minor complication (a small superficial skin burn). After surgical excision, the histopathological evaluation reported in 10/11 cases (90.9%) complete ablation of the target lesion. In only one case (9.1%) residual cancer was detected. The necrotic-hemorrhagic cavities showed a mean maximum diameter of 27.3 mm (20-35 mm). Conclusions: Laser ablation performed after excisional biopsy could be considered a valid alternative to surgical excision for the treatment of lesions ≤ 1 cm, if carried out by expert radiologists. The association of these minimally invasive percutaneous methods has proven to be reliable, fast, and safe with an ablation rate of 90.9% and excellent aesthetic results. RM and CESM are potentially able to quantifying treatment results and to follow-up the ablation effects.

Complete Surgical Excision Is Necessary following Vacuum-Assisted Biopsy for Breast Cancer

“…Ablation techniques using thermal energy can complement VABB. In a study that reported 11 cases treated with VABB combined with laser ablation, 90% of the treated patients did not show residual tumors after surgical excision [ 20 ]. In a study using a novel breast lesion excision system that combined radiofrequency with VABB, complete excision was possible for 95.8% of subcentimeter breast cancers [ 21 ].…”

Combination of shear wave elastography and BI-RADS in identification of solid breast masses

“…It suggests that all malignant masses present more than one characteristic of malignant masses; moreover, some benign masses also show malignant signs such as microcalcification, which may be caused by secondary calcification in inflammatory lesions, so careful screening should be conducted. Although two-dimensional ultrasonography has many advantages, it needs to be supplemented by other methods to confirm the nature of masses due to the fact that the malignant masses have unclear morphological characteristics in the early-stage [17][18][19][20]. The advancing of ultrasound technology allows for a wide application of Color Doppler in numerous diseases; this approach has a high sensitivity to blood flow and can reflect the the hemodynamics of the lesions, with a promising clinical application prospect.…”

The Use of Pneumocystography for Navigation of Stereotaxic Core-needle Biopsy in Complex Breast Cysts: Case Report

“…Since the late 1990s, vacuum-assisted breast bi- opsy (VABB) has become increasingly popular due to its high diagnostic efficiency and the ability to treat benign neoplasms of acceptable size as well as minimal (up to 1.0 cm) carcinomas [11,12]. At the same time, negative aspects of VABB are also known, in particular, a relatively high (up to 9.0%) frequency of false negative results, incomplete removal of high-risk lesions, and the impossibility of assessing the margins of the lesion [11,13].…”