Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study.

Hong Pan,Shui Wang,Jing Deng,Hao Chen,Hui Xie,Wenbin Zhou,Kai Zhang,Lijun Ling,Hui Wang,Mengjia Qian,Muxin Yu,Siqi Wang,Qiang Ding,Yi Xu

doi:10.3389/fonc.2021.680091

Hong Pan, Shui Wang + Show 12 more

Open Access

https://doi.org/10.3389/fonc.2021.680091

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Abstract

IntroductionNegative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins.MethodsFrom 2016 to 2018, 22 women with T1/T2 invasive breast cancer were enrolled for MWA prospectively in the guidance of BCS. US-guided MWA was performed under local anesthesia, followed by BCS and sentinel lymph node biopsy (SLNB) one week after ablation. Women who underwent palpation-guided BCS directly were included as control, and propensity score matching analysis was applied.ResultsMWA was performed in 22 patients. Of the 21 MWA cases with effect information, the mean tumor size in US was 20.9 ± 6.2 mm (6-37 mm). Compared with control group (BCS directly), a lower rate of positive/close margins was observed in MWA guidance group (P = 0.018), and MWA caused a higher rate of accurate surgery (the largest margin ≤ 3 cm and the smallest margin ≥ 1mm, P = 0.042). Of these 21 patients treated with MWA, 18 were candidates for SLNB. And sentinel lymph nodes were successfully identified in all cases, and no recurrence was found with a mean follow-up of 23 months.ConclusionFor patients with T1/T2 breast cancer, the application of preoperative MWA could guide BCS accurately without impairing SLNB. Clinical trials with long-term results are required to validate MWA in the guidance for breast cancer excision.

Highlights

Negative margins in breast-conserving surgery (BCS) are essential for preventing recurrence
We offered two options for patients who had microwave ablation (MWA) followed by delayed BCS, or BCS directly
Of these 370 patients, 94 patients with invasive breast cancer were candidates for BCS. Among these 94 patients, 22 underwent MWA followed by BCS one week later, and other 72 patients underwent palpation-guided BCS firstly

Summary

Introduction

Negative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins. Breast-conserving surgery (BCS) is accepted as a standard local therapy for early stage breast cancer [1]. Success of BCS is characterized by negative margins and a good cosmetic outcome for patient. BCS for breast cancer is associated with positive margins in up to 41% of cases [2] and usually require reexcision surgery to obtain negative margins [3, 4]. Most surgeons in our country would re-excise a close margin in patients intraoperatively [7]. One of the primary goals of BCS is to obtain negative resection margins

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