Abstract
Image-guided focussed ultrasound (FUS) ablation is a non-invasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breast-conserving surgery remains the gold standard for breast cancer treatment.
Highlights
Evolution of breast cancer treatmentBreast cancer is the most frequently occurring malignant disease and leading cause of cancer-related death in women in the Western world
Image-guided focussed ultrasound (FUS) ablation is a noninvasive procedure that has been used for treatment of benign or malignant breast tumours
Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented
Summary
Breast cancer is the most frequently occurring malignant disease and leading cause of cancer-related death in women in the Western world. After results of randomized studies demonstrated similar survival rates for both treatment groups, breast-conserving surgery combined with radiotherapy became standard treatment for patients with localized breast cancer [3]. Parallel to this development, nationwide breast cancer screening programmes were implemented in many Western countries in the 1990s, resulting in an increased proportion of small carcinomas at time of diagnosis [5]. Nationwide breast cancer screening programmes were implemented in many Western countries in the 1990s, resulting in an increased proportion of small carcinomas at time of diagnosis [5] This further facilitated the implementation of breast-conserving surgery in clinical practice. This review outlines the current status and future directions of image-guided FUS ablation for treatment of breast cancer
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