Cryotherapy of breast cancer under ultrasound guidance: initial results and limitations

Abstract

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.

A Pilot Study of Ultrasound-Guided Cryoablation of Invasive Ductal Carcinomas up to 15 mm With MRI Follow-Up and Subsequent Surgical Resection

“…These findings are consistent with other reports in which DCIS is overrepresented in patients with an unsuccessful cryoablation outcome [5, 7, 8]. It is uncertain if the overrepresentation of DCIS in cryoablation failure is due to an inability to detect noncalcified DCIS with preablation imaging, as suggested by Sabel et al [7], or an intrinsic resistance of DCIS to cryoablation.…”

“…Based on the higher cryoablation failure rate of larger tumors [5, 7], we set the maximum tumor size eligibility criterion at 15 mm. However, in the one participant with residual invasive cancer, preablation tumor size was difficult to estimate owing to nondiscrete margination (Fig.…”

“…As an office-based minimally invasive procedure with intrinsic anesthesia, it is an attractive alternative to the surgical management of breast cancer. However, previous studies of cryoablation of breast cancer have had mixed results [5–9]. Although encouraging results have been reported for patients with small (≤ 15 mm) invasive ductal carcinoma (IDC), residual cancer at the cryoablation site has been seen more frequently in patients with larger IDC, cancer with invasive lobular or mucinous histology, or IDC with an extensive intraductal component.…”

“…Our study was designed to build on the experiences of other investigators and address some of the deficiencies they noted [5–9]. Our objectives were to confirm the effectiveness of ultrasound-guided cryoablation in participants with favorable malignancy characteristics, to evaluate the utility of CE-MRI in determining the outcome of cryoablation, to identify variables that may lead to cryoablation failure, and to systematically assess the clinical condition of participants after the cryoablation procedure.…”

Magnetic Resonance Imaging–Guided Breast Interventions

“…Although most breast ablation has been guided by US [30], MRI is particularly well suited for monitoring the growth of the iceball. The iceball appears as a signal void due to the short T2* of the crystalized water and, unlike with US, the tissue beyond the iceball is not subject to shadowing [31]. …”