Cryoablation and cryolocalization in the management of breast disease

Abstract

Cryotechnology is currently used for both treatment and diagnosis of breast disease. Due to the natural analgesic effect of cold, cryoablation is potentially more patient-friendly than other technologies which raise tissue temperature. Freezing produces a predictable volume of necrosis and is easily observed and controlled during treatment. Recent studies have demonstrated that, as a primary therapy for breast fibroadenoma, cryoablation is safe and effective with durable results that can be reproduced in community practices. Certain barriers do exist before cryoablation, or any other in situ ablation, can become a standard therapy for the treatment of localized breast malignancy. Investigations are underway to refine patient selection criteria and develop valid confirmatory assays so that clinical trials can begin. Cryolocalization, which creates a well-delineated, palpable mass of frozen tissue encompassing a tumor, is a relatively new application of cold in medicine. This strategy promises to reduce positive margin rates during lumpectomy of non- or barely-palpable tumors. Finally, cryotechnology now also aids in the collection of tissue for histological analysis.

Minimally Invasive Approaches for Diagnosis and Treatment of Early-Stage Breast Cancer

“…Cryotherapy uses coldness to achieve tumor destruction [46]. Energy is produced by an external generator composed of an argon or nitrogen freezing system and a helium heating system.…”

Cryoablation of Early-stage Breast Cancer

“…Together, the ischemia and lack of nutrients supply could cause necrosis in the frozen area. 28,29 Hong et al demonstrated that breast carcinoma cells are more resistant to freezing when compared with normal breast tissue cells. The tightly arranged structure of cancer cells with less extracellular space makes them more resistant to the dehydration process.…”

“…With time, it was learned that neither general anesthesia nor intravenous (IV) sedation was required. While the freezing procedure itself generates anesthesia to the breast tissue 29 it allows the procedure to be an office-based modality. 10,15 Cryoablation-induced anesthesia differs from heat-based tissue destruction in that the latter causes enough discomfort to require general anesthesia or significant IV sedation to be provided in an operating room (OR).…”

“…The need for narcotics for post-operative pain is minimal. 10,20,35 This procedure is easily followed by ultrasound, because the proximal edge of the ice ball is clearly visible as a hyperechoic rim, 29 which therefore permits skin protection. It should be mentioned that although the ultrasound clearly shows the freezing process the posterior acoustic shadowing prevents imaging of the interior of the ice ball and the area posterior to it, not allowing a precise measurement of the exact size of the ice ball and the distance to the chest wall.…”

“…29, 41 Sabel et al suggested that the cryoablation of breast cancer should be restricted to patients with isolated invasive ductal carcinomas up to 1.5cm in size, without an extensive intraductal component in the core needle biopsy specimen. 20 There are several reported studies that analyze cryoablation in small human breast carcinomas; all but one performed excision of the tumor after the freezing procedure.…”