Ablation Of Breast Cancer Research Articles

Radiofrequency ablation (RFA) of breast cancer: A multicenter retrospective analysis.

1119 Background: Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We performed a retrospective study of ultrasound-guided percutaneous radiofrequency ablation (RFA) of breast cancers to determine safety and complication related to this treatment. Methods: Four hundred and ninety-seven patients with core biopsy proven breast carcinoma in 10 institutions of non-surgical ablaton study group underwent RFA without surgical excision were enrolled in this study. Results: Mean patient age was 54 years (range 22 - 92 years). Mean tumor size was 1.6 cm. Four hundred and twenty-five tumors ( 86 %) were ≤ 2 cm. The median follow-up period was 50 months (range 3 – 92 months). The mean required for ablation was 19 minutes (range, 4- 72 minutes), and the average temperature of the tumor after ablation was 91 degrees Celsius. The local recurrence rate after RFA was higher in tumors of negative estrogen receptor (8 of 78, 10%) than in tumors of positive estrogen receptor (17 of 437, 4%; p<0.05), and was higher in tumors of positive HER2/neu than in tumors of negative HER2/neu (14.9% vs. 3.2%; p<0.01). The local recurrence rate after RFA was higher in tumors of positive node than in tumors of negative node (9.8% vs. 3.6%), and was higher in tumors without irradiation than in tumors with irradiation (18.2% vs. 3.2%; p<0.001). The local recurrence rate after RFA was higher in tumors of > 2 cm (13 of 72, 18%) than in tumors of ≤ 2 cm (11 of 425, 3%; p<0.001). RFA-relating adverse events were observed in 17 patients of local pain, 14 patients of skin burn and 4 patients of retraction of nipple. Conclusions: RFA is considered to be a safe and promising minimally invasive treatment of small breast cancer ≤ 2 cm in diameter. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.

Analysis by MRI of Residual Tumor After Radiofrequency Ablation for Early Stage Breast Cancer

The objective of our study was to evaluate the effectiveness of MRI in the detection of possible residual lesions after radiofrequency ablation (RFA) in the treatment of breast cancer. We prospectively evaluated 14 patients who had undergone ultrasound-guided core biopsies diagnostic of invasive ductal carcinoma (IDC; range of diameters, 1.0-3.0 cm) and then ultrasound-guided percutaneous RFA with sentinel node biopsy as the primary treatment. Breast MRI was performed 1 week before RFA to evaluate tumor extension and again 3 weeks after RFA to verify the presence of possible residual lesions. Conventional surgical resection of the tumors was performed 1 week after RFA. The MRI findings were compared with histopathologic analyses to confirm the presence or absence of residual tumor. There was no residual enhancement in seven lesions on the postablation breast MRI scans. These findings were confirmed by negative histopathologic findings in the surgical specimens. The MRI scans of five patients showed small areas of irregular enhancement that corresponded to residual lesions. In the two remaining patients, we observed enhancement of almost the entire lesion, indicating that RFA had failed. Breast MRI is effective in detecting residual lesions after RFA in patients with IDC.

Abstract No. 369: MRI-guided high intensity focused ultrasound ablation of breast cancer

Abstract No. 369: MRI-guided high intensity focused ultrasound ablation of breast cancer

Feasibility of Percutaneous Excision Followed by Ablation for Local Control in Breast Cancer

Percutaneous ablation of breast cancer has shown promise as a treatment alternative to open lumpectomy. We hypothesized that percutaneous removal of breast cancer followed by percutaneous ablation to sterilize and widen the margins would not only provide fresh naive tissue for tumor marker and research investigation, but also better achieve negative margins after ablation. Patients diagnosed by percutaneous biopsy (ultrasound or stereotactic-guided) with breast cancer ≤1.5 cm, >1 cm from the skin, and ≤1 cm residual disease and no multicentric disease by magnetic resonance imaging were accrued to this institutional review board-approved study. Patients were randomized to laser versus radiofrequency ablation. The ultrasound-guided ablation was performed in the operating room and followed by immediate excision, whole-mount pathology with proliferating cell nuclear antigen staining, and reconstruction. Twenty-one patients were enrolled onto the study. Fifteen patients received radiofrequency ablation, and all showed 100% ablation and negative margins. Magnetic resonance imaging was helpful in excluding multicentric disease but less so in predicting presence or absence of residual disease. Seven of these patients showed no residual tumor and eight showed residual dead tumor (0.5 ± 0.7 cm, range 0.1-2.5 cm) at the biopsy site with clear margins. The laser arm (3 patients) pathology demonstrated unpredictability of the ablation zone and residual live tumor. This pilot study demonstrates the feasibility of a novel approach to minimally invasive therapy: percutaneous excision and effective cytoreduction, followed by radiofrequency ablation of margins for the treatment of breast cancer. Laser treatment requires further improvement.

MRI‐guided ablation of breast cancer: Where do we stand today?

The treatment of patients with localized breast cancer has changed considerably over the past few decades. The next challenge is to use image-guided minimally invasive tumor ablation techniques. The fact that MRI is the most accurate imaging modality for visualization and delineation of breast tumor margins in three dimensions and provides MRI-based temperature mapping, makes it particularly applicable for monitoring during minimally invasive ablation techniques. The overall result of the studies performed on MRI-guided minimally invasive tumor ablation studies are varying, with reported total tumor ablation rates ranging between 20% and 100%. Strict selection of patients, consensus on the treatment zone margin and optimization of MR-imaging, should make MRI-guided breast cancer tumor ablation a useful tool in clinical practice.

MRI-Guided Ablation of Breast Cancer: Where Do We Stand Today?

MRI-Guided Ablation of Breast Cancer: Where Do We Stand Today?

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

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. 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 lymph-node mapping and excision of the sentinel node. All the patients underwent surgical resection (lumpectomy) from 30 to 45 days after the percutaneous ablation. 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 cryo-ablated 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. 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.

Radiofrequency ablation of early breast cancer followed by delayed surgical resection – A promising alternative to breast-conserving surgery

To examine the radiofrequency ablation (RFA) reliability in early breast cancer, we performed RFA followed by delayed surgical resection on 41 patients with invasive or non-invasive breast carcinoma less than 2 cm. MRI scans were obtained before ablation and resection. Excised specimens were examined pathologically by haematoxylin-eosin and nicotinamide adenine dinucleotide-diaphorase staining. 40 patients completed 1 RFA session, which was sufficient to achieve complete tumour cell death. Overall complete ablation rate was 87.8% (36/41). There were no treatment-related complications other than that of a superficial burn in 1 case. After RFA, the tumour was no longer enhanced on MRI in 25/26 (96.2%) cases. Residual cancer, which was suspected on MRI in 1 case, was confirmed pathologically. MRI could be an applicable modality to evaluate therapeutic effect. RFA could be an alternate local treatment option to breast-conserving surgery for early breast cancer.

The potential role of dynamic MRI in assessing the effectiveness of high-intensity focused ultrasound ablation of breast cancer

Purpose: To retrospectively evaluate magnetic resonance imaging (MRI) features of breast cancer after high-intensity focused ultrasound (HIFU) ablation.Materials and methods: Six patients with invasive ductal carcinomas underwent HIFU ablation. In all patients, dynamic MRI was performed prior to and two weeks after HIFU. Serial follow-up studies were performed. Changes in signal intensity and size of the index tumour in addition to peripheral enhancement patterns were evaluated. Histopathological results were compared with MRI findings.Results: All patients had a single index tumour with a mean size 25.6 mm (range 12 to 37 mm) at the ablation time. In three of six patients, thin rim enhancement around the ablation zone was seen on the subtraction image after first ablation, which showed no change on follow-up MRI. Complete ablation was confirmed by the histopathology (biopsy in two and surgery in one). In the remaining three patients, nodular or irregular thick enhancement was shown on the subtraction image and viable tumour was confirmed by surgery and biopsy in two patients.Conclusion: The MR characteristics of successfully ablated breast cancers included central dark signal intensities with thin rim enhancement on subtraction images. Nodular or irregular thick enhancements should raise concern of partial ablation. We propose MRI plays a critical role in assessing the effectiveness of HIFU treatment.

Corrections: 2009 San Antonio Breast Cancer Symposium Abstracts

Corrections: 2009 San Antonio Breast Cancer Symposium Abstracts

Cryotherapy Ablation of Primary Breast Cancer

Cryotherapy Ablation of Primary Breast Cancer

Radiofrequency Ablation in Breast Cancer.

Abstract Background: Radiofrequency ablation (RFA) of breast tumors is characterized by variable efficiency. Cell viability is principally evaluated by NADH-diaphorase and Hematoxylin-eosin (H&E) staining techniques.Methods: Twenty patients with breast cancer, 20.7 ± 9.14mm in diameter, underwent RFA of the tumor and of the margin of surrounding breast tissue. RFA was based on the radiofrequency impedance-switching algorithm. The algorithm was based on an internally cooled probe, which carried out algorithm-guided deposition of heat in a pulse-cycle fashion and under continuous monitoring of the desiccation status of the ablated site to avoid tissue charring (until its impedance level reached 30Ω above the baseline level or a maximum time interval (tmax) was reached). A minimum time interval of 5 seconds was set as the duration of time that the electrode must be off. If the cycles of power application occurred too rapidly, the power was diverted to the 150Ω resistance load for the remainder of the 5-second interval. Surgical resection was the next step. Sixteen patients underwent quardzantectomy (five with axillary lymph node dissection) and four unilateral total mastectomy. In fifteen patients SLNB was searched and identified (ten negative, four positive and one failure). The ablated tumor tissue was histologically examined and Ki67 immunohistological staining was applied to evaluate cellular proliferation, invasion and survival.Results: The mean time of operation was 119.47 ± 23.35minutes.The mean time of RFA was 12 - 15minutes. One patient had a post-operative complication (trauma infection). All twenty patients had a positive Ki67 immunohistochemical staining mean value of 28.79 ± 21.42, before RFA. The post-RFA Ki67 expression was zero in sixteen patients. In three patients no residual tumor cells were found and in one patient the Ki67 expression was under five percent. Recurrence developed in zero patients, to date (follow up time: 22.5 ± 2.3 months).Conclusion: Ki67 evaluation is a targeting indicator of viability of malignant cells after lesion RFA of breast tumors. RFA is able to provide satisfactory local control in breast cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2106.

RFA for Small Breast Cancer — What Tumor Can Be Treated Safely?

Abstract Breast conserving surgery for small breast cancer has been acceptable as one of standard treatments. However, there are some patients who do not be satisfied with the cosmesis. The aim of this study is to verify the clinical safety and usefulness of the RadioFrequency Ablation (RFA) for small breast cancer without resection. Between January 2006 and Octobar 2007, 20 breast cancer patients were performed RFA with cool-tip RF system after sentinel LN biopsy under general anesthesia. All patients has consented as a clinical research, beforehand. MR mammography was performed after 3 and 6 months of follow-up. All patients were performed postoperative histological examination by 8G-needle mammotome biopsy after 6 months MRI evaluation.Tumor viability after RFA was assessed by hematoxylin -eosin and ssDNA staining. QOL after RFA was assessed both subjectively(QOL-ACD score) and objectively(JBCS cosmesis criterion). Preoperative mammotome revealed 4 patients had DCIS and 16 patients had IDC. The patients median age was 53 years old. The mean greatest dimension of tumors was 1.0 cm (range, 0.5-1.5 cm). MRI showed the dimention of coagulation necrotic area by RFA treatment was 3.5cm (range, 2.5-5.4 cm).All patients have been performed postoperative histlogical examination by 8G mammtome biopsy 6 month after RFA treatment. Coagulation necrosis of the tumor was complete in 20of 20 patients (100%).No patient was troubled skin burn. Neither local and distant recurrence has occurred in all patients (median follow up was 30 month). To treat RFA for breast cancer more safely, we analyzed factors which influenced the size of necrosis. Patient age, body mass index (BMI), background concentration measured by MMG, Fat involvement measured by CT did not influence with the size of nectosis (P=0.21,0.17,0.64,0.40). The state of posterior echo detected by ultrasonography was associated with the size of necrosis (p=0.045). Hence, RFA for the tumor with rich fiber such as scirrhous type tend to make necrosis wider than one with poor fiber such as solid tubular type.Most of patients were satisfied with the cosmesis of the RFA treated breast. Objective QOL score (JBCS cosmesis criterion) showed splendid cosmetic outcome. RFA is one of the effective local treatment for small breast cancer (< 1.5 cm in diameter), and bring breast cancer patients cosmetic satisfaction. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4119.

Radiofrequency ablation of breast cancer: a comparative study of two needle designs

Radiofrequency ablation (RFA) is an emerging minimally invasive technique for breast cancer treatment. There are two different needle designs. One is to deploy a series of arrays to allow an even distribution of heat within the tumor. A new design is a straight needle with continuous infusion of cold saline to prevent charring and ensure continuous heat delivery. We report the first comparative study using two different needles for ablation of breast cancer. Chinese patients with breast cancer less than 2cm were prospectively recruited. Multifocal tumor was excluded. RFA was performed under general anesthesia following sentinel node biopsy. Sequential allocation was used. In the first group, tumor was ablated by using the LeVeen needle. Cool-tip needle was used in the subsequent group. The tumor was then resected. Tumor viability was assessed by nicotinamide adenine dinucleotide-diaphorase (NADH) staining. Complete ablation rate was compared. Evidence of thermal damage to the skin was also assessed. Twenty patients were recruited. Mean tumor size was 14mm. Complete ablation rate was the same (90% versus 89% for the Cool-tip and the LeVeen, respectively). Cool-tip has a shorter ablation time when compared with LeVeen (12 versus 28min), and the Cool-tip needle was found to be easier to insert. There was no visible skin burn after RFA. Cool-tip and LeVeen systems had the same efficacy in ablation of breast cancer, but Cool-tip was easier to insert and had a shorter ablation time.

Ultrasound-Guided Bipolar Radiofrequency Ablation of Breast Cancer in Inoperable Patients: a Pilot Study

Radiofrequency ablation (RFA) is a promising minimal invasive modality to treat small breast cancer (BCA). In most studies cancers were surgically excised shortly after RFA. We present six patients inoperable when diagnosed with BCA, and performed RFA instead of surgery. Ultrasound-guided bipolar RFA was performed under local anesthesia in six women aged 63 - 85 years. They had core-biopsy proven T 1 - 2N0 M0, grade I or II, 1.0 - 2.7 cm sized invasive ductal cancers, with positive estrogen receptor status. Four tumors measured > 2 cm, and three 1.0 - 1.2 cm in diameter. Patients were at high-risk for general anesthesia and surgery because of severely impaired cardiac function, advanced age, or associated diseases (acute myeloid leukaemia (AML), diabetes, hypertension, depression) and/or refused surgery. Six tumors in five patients were completely ablated, without recurrence during follow-up (range: 9 - 49 months). One superficially located cancer was partially ablated; the patient died two months later from myocardial infarction. The Patient with AML and BCA had an infection of the treated breast after 4 months and postponed mastectomy to an AML remission status. There were no signs of malignancy in histopathology; the patient finally died of leukemia 42 months after RFA. The remaining four patients are well, without complications. Ultrasound-guided percutaneous RFA under local anesthesia is an effective alternative to surgery for BCA < 3 cm in patients with a high-risk for surgery.

5181 Ultrasound-guided radiofrequency ablation of early breast cancer in a resection specimen

5181 Ultrasound-guided radiofrequency ablation of early breast cancer in a resection specimen

Stereotactic radiofrequency ablation: A minimally invasive technique for nonpalpable breast cancer in postmenopausal patients

Background: The purpose of this study was to determine the feasibility of radiofrequency ablation (RFA) of nonpalpable breast cancer in postmenopausal women, and report on long-term follow-up with clinical examination and mammography. Methods: Since November 2000, we have performed RFA on stereotactically localized nonpalpable breast cancers (only mammographic densities) in women older than 65 years with other serious health problems. Results: The first patient had the procedure done in the office with sedation and local anesthesia. The radiofrequency probe was inserted by stereotactic localization, and the RFA proceeded for 20 min at 75 °C. Two weeks later, the lesion was not seen mammographically, but by palpation there was induration at the ablation site. Six weeks later, open excision of the area confirmed a prominent ablation site with no remaining viable tumor cells. The second patient had the same procedure, and has been followed without open biopsy. The third patient had DCIS and the probe arrays were not able to penetrate the lesion. The fourth and fifth patients had light sedation with an intercostal nerve block to eliminate discomfort and this approach was found to be a very effective office procedure. The last two patients’ ablation sites were injected with depo-medrol and they were placed on anti-inflammatory therapy to decrease the palpable induration caused by fat necrosis. Conclusion: We found RFA feasible for definitive therapy for nonpalpable breast cancer. If our results are confirmed by larger clinical trials, RFA would eliminate open surgery and decrease the morbidity associated with lumpectomy and radiation.

Surrounding rim formation and reduction in size after radiofrequency ablation for primary breast cancer

Radiofrequency ablation (RFA) has recently been used to treat small breast cancer. However, there are no data on the long-term morphological features after the procedure. The present study attempts to clarify the characteristics of and changes in the ablated lesion. A total of 17 breast cancer patients underwent RFA using a single needle featuring an internally cooled electrode; this was followed by whole-breast irradiation and adjuvant systemic therapy. Magnetic resonance imaging (MRI) using a 1.5-T system was performed before and 1, 3, 6, and 12 months after ablation, and the morphological characteristics and the size of the ablated lesion were evaluated. Mammography was also performed for a comparison with the MRI measurement. MRI displayed no residual enhancement of the tumor after RFA; there was an altered signal intensity with peripheral enhancement, however, and the area decreased in size gradually at a rate of 3.3% per month. Mammography showed a ring surrounding a roundish area whose size was equal to that seen with MRI. Our current series demonstrated the morphological characteristics on breast imaging after RFA plus radiation therapy. The size of the ablated area decreased over time. These findings are valuable for clinical follow-up of breast cancer patients undergoing RFA.

Radiofrequency Ablation Therapy for Small Breast Cancer

There is increasing demand for minimally invasive and nonsurgical treatment methods for patients with small breast cancer, and radiofrequency (RF) ablation seems the most promising nonsurgical ablation technique for the treatment of breast cancer. However, a number of problems remain to be resolved in the practical use of RF ablation. This review article discusses the relevance and applicability of RF ablation for small breast cancer. A review of the English language medical literature was performed using Medline database software cross-referencing major articles on the subject. Several feasibility studies indicated that RF ablation can effectively eradicate breast cancer cells, and early results of pilot studies have shown that this technique is promising for the local treatment of small breast cancer. However, a major problem of RF ablation is the inability to assess the margins of the treated lesion. RF ablation for breast cancer should still be considered in the investigative stage. We propose a new method of RF ablation followed by percutaneous excision of the ablated tumor. A combination of RF ablation and percutaneous en bloc excision using an Ovation breast biopsy device may provide clear margins and full histological workup with better cosmetic results. Further studies are needed to determine whether the use of RF ablation and breast irradiation for local treatment of primary breast cancer may result in local recurrence and can produce survival rates equivalent to those obtainable with conventional BCT.

0117 Radiofrequency ablation of early breast cancer followed by delayed surgical resection

0117 Radiofrequency ablation of early breast cancer followed by delayed surgical resection