Percutaneous cryotherapy is a feasible and safe procedure in minimally invasive therapy for small breast cancers. Residual ductal carcinoma in situ may be attributable to the beginning of a learning curve or by false-negative detection in pre-interventional imaging. Magnetic resonance mammography might aid in treatment planning and for therapy monitoring to better define target tissue and to correlate the tumor margin with the ice-ball.

The aim of this study was to investigate the potential and feasibility of ultrasound-guided cryotherapy in breast cancer. Fifteen female patients with 16 breast cancers (mean tumour diameter 21±7.8 mm) were treated. A 3-mm cryo probe was placed in the tumour under ultrasound guidance. Two freeze/thaw cycles with durations of 7-10 min and 5 min, respectively, were performed. The size of the iceballs was measured sonographically in 1-min intervals. The patients underwent surgery within 5 days and the specimens were evaluated histologically. The mean diameter of the iceball was 28±2.7 mm after the second freezing cycle. No severe side effects were observed. Five tumours with a diameter below 16 mm did not show any remaining invasive cancer after treatment. Two of these had ductal carcinoma in situ (DCIS) in the surrounding tissue. In 11 patients cryotherapy of tumours reaching diameters of 23 mm or more resulted in incomplete necrosis. This study shows that the invasive components of small tumours can be treated using cryotherapy. Remnant DCIS components which may not be detected preinterventionally represent a challenging problem for complete ablation. In tumours larger than 15 mm two or more cryo probes should be used to achieve larger iceballs.

In premenopausal women, HS leads to increased BE of breast tissue, independent of CP. Distinct BE and less pronounced, non-optimal CP may lead to an increased number of false positive findings.

MR-Mammography reaches a high sensitivity in detecting breast carcinomas of 3 mm in size at least. In cooperation with the Institute of Diagnostic and Interventional Radiology of the Friedrich-Schiller-University of Jena, a manipulator has been developed by the IMB, which combines the advantages of MRM imaging with a minimal invasive biopsy and a possible subsequent therapy. Referring to this ROBITOM I was introduced in November 1999 as worldwide first, precise operating manipulator system in the ISO center of a closed MR, at RSNA in Chicago. Clinical trials started at 22. November 2000. The experiences and results of these tests were brought into the following prototype ROBITOM II, that is currently developed at the IMB. The completion of this Prototype is planned at the end of 2002.

MRI has proven to be a very reliable diagnostic tool in the detection and differential diagnosis of breast lesions. Some lesions are, even in retrospect, not detectable in x-ray or ultrasound images but MRI is able to detect lesions at a much smaller size than the average size of lesions depicted by x-ray and ultrasound. The aim in the future is to develop combined procedures where imaging, biopsy, and interventional therapies are combined in a single outpatient procedure. As a step toward this goal different interventional procedures are useful that include interstitial laser therapy (ILT), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), microwave ablation therapy, and cryotherapy. In this overview the main features and initial results of these procedures are described and discussed.