First clinical experience with a dedicated MRI-guided high-intensity focused ultrasound system for breast cancer ablation

Merckel, Laura G.; Knuttel, Floortje M.; Deckers, Roel; Dalen, Thijs van; Schubert, G.; Peters, Niek A.; Weits, T; Diest, Paul J. van; Mali, Willem P.Th.M.; Vaessen, Paul H. H. B.; Gorp, Joost M. H. H. van; Moonen, Chrit; Bartels, Lambertus W.; Bosch, Maurice A.A.J. van den

doi:10.1007/s00330-016-4222-9

Cited by 80 publications

(74 citation statements)

References 26 publications

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“…The characteristics of the studies are summarized per technique in table's 1a-e. Radiofrequency ablation (RFA) was used in 27 studies (657 patients) [13-17, 26, 27, 29-32, 42-48, 51, 64-71], in which a needle electrode is percutaneously inserted under ultrasound J U S T A C C E P T E D (US) guidance to deliver an alternating current that generates ionic agitation, localised tissue heating and cell death. [32, 46,74] Twelve studies used high intensity focused ultrasound (HIFU) (227 patients) [8,23,24,38,52,[55][56][57][58][59][60]72], a completely non-invasive ablative technique in which a focused US beam propagates through tissue as a high frequency pressure wave causing the temperature to rise, leading to protein denaturation and coagulative necrosis. [55,[75][76][77] Ten studies used cryo-ablation (269 patients) [19-22, 35-37, 49, 61, 73], in which a probe is inserted into the tumour under US guidance.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In five studies [21,24,49,59,63], patients withdrew from the study during or after treatment and in another six studies [15,26,44,48,49,72] patients withdrew before the start of the treatment. The overall STROBE score ranged from four to seven (mean…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Delayed surgical excision was performed within a week of treatment in four studies [19,33,50,72] (most often following laser ablation), within two weeks of treatment in ten studies [8,20,27,34,36,38,55,56,58,59] (most often following HIFU), within three weeks of treatment in eight studies [17,28,39,41,46,47,54,62] (most often following RFA), within four weeks of treatment in four studies [37,40,49,67] and longer than four weeks of…”

Section: J U S T a C C E P T E Dmentioning

confidence: 99%

“…With laser ablation 6.3% of patients (12/191) developed complications, which included skin burns (n=7) [18,33,63], necrosis (n=2) [34], haemorrhage (n=1) [28], pneumothorax (n=1) [18] and rupture of the tumour (n=1) [33] (table 1b). With HIFU complications occurred in 6.5% of patients (12/185) which included skin burns (n=8) [8,23,38,55,57,60], fever (n=3) [56] and white lumps at the treatment site (n=1) [72] [54] (table 1e).…”

Section: Axillary Lymph Nodesmentioning

confidence: 99%

“…HIFU was used to treat tumours of 2.1±0.9 cm (seven studies) [8,23,24,38,52,55,72], and cryoablation was used to treat tumours with a mean size of 1.6±0.7 cm (eight studies) [19, 21, (1/197). Cosmesis was collected using a 1-4 point scaling system (n=4), a 1-10 point scaling system (n=1) or it was not reported (n=2).…”

Section: Treated Tumour Sizesmentioning

confidence: 99%

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Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

Peek

Ahmed

Napoli

et al. 2016

International Journal of Hyperthermia

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Purpose: Breast conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer.Methods: A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded. Results:We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focused ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6±5.6 minutes) and the longest with HIFU (101.5±46.6 minutes).

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: J U S T a C C E P T E Dmentioning

confidence: 99%

Section: Axillary Lymph Nodesmentioning

confidence: 99%

Section: Treated Tumour Sizesmentioning

confidence: 99%

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Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

Peek

Ahmed

Napoli

et al. 2016

International Journal of Hyperthermia

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Landscape of the Peripheral Immune Response Induced by Local Microwave Ablation in Patients with Breast Cancer

Zhou

Mao

et al. 2022

Advanced Science

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Minimally invasive thermal therapies have been attempted in the treatment of breast cancer, and the immune response induced by these therapies has not been fully reported. A clinical trial is performed to determine the effect of microwave ablation (MWA) in the treatment of early‐stage breast cancer. The authors perform single‐cell RNA sequencing on peripheral blood mononuclear cells (PBMCs) from six patients before and after ablation. NK and CD8+T cells are activated by MWA of breast cancer, with the increased inhibitory signature of CD8+T cells but not dysfunctional. Enhanced co‐stimulatory signature of CD4+ T cells is observed and increased frequency of ICOS+CD4+ T cells after MWA is confirmed by flow cytometric analysis. After ablation, T‐cell clones expand with increased T‐cell receptor diversities. Activated antigen receptor‐mediated signaling pathways are found in B cells. Enhanced interactions between B cells and CD4+ T cells are found, indicating that B cells are important antigen‐presenting cells that initiate CD4+T cells in MWA‐induced immune response. Blockade of CTLA‐4 or PD‐1 of post‐MWA PBMCs show higher T‐cell activity than that of pre‐MWA PBMCs. This study provide global characteristics of MWA‐induced systemic immune response and pave a way for the identification of potential targets to improve the immune response.

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MRI‐guided treatment in the breast

Pediconi

Marzocca

Marincola

et al. 2018

Magnetic Resonance Imaging

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In the last decades, an increasing interest has developed towards non‐invasive breast lesion treatments, which offer advantages such as the lack of surgery‐related complications, better cosmetic outcomes, and less psychological distress. In addition, these treatments could be an option for patients with poor health who are not candidates for surgery. Non‐surgical ablation can be performed under magnetic resonance (MR) or ultrasound (US) guidance. US is cheaper and easily available, while contrast‐enhanced MR is more accurate, ensuring better safety and efficacy for the patient. Overall results of studies about MRI‐guided tumor ablation reported complete ablation rates ranging between 20% and 100%. High‐intensity focused ultrasound (HIFU or FUS) is the most studied ablative technique and it is already established as a valid technique for ablation of benign and malignant tumors in various organs. Ultrasound‐guided FUS is very useful for young patients who refuse surgery or with multiple nodules; however, MR‐guided FUS is more sensitive and allows a better evaluation of thermal accumulation within the ablated tissue or the adjacent structures. Most MR‐guided FUS studies used a dedicated high‐field MR scanner and complete tumor ablation was reported in 17–90% of cases. Other techniques using thermal tissue destruction are radiofrequency ablation (RFA) and laser interstitial thermal therapy (LITT). Only a few studies assessed the efficacy of these treatments, all were performed with open MR devices. RFA showed complete tumor ablation in 30–96% of patients, while LITT in 10–71%, but all the studies had a small number of patients. Cryoablation obtains tissue ablation by a rapid decrease of temperature, with a complete tumor removal reported in 18–52% of cases with MR guidance. No serious complications were reported with these techniques. Currently, breast conservative surgery replaced radical surgery when possible. Therefore, future research should focus on these treatments to shift towards an even less invasive approach to breast neoplasms. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;48:1479–1488

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First clinical experience with a dedicated MRI-guided high-intensity focused ultrasound system for breast cancer ablation

Cited by 80 publications

References 26 publications

Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis

Landscape of the Peripheral Immune Response Induced by Local Microwave Ablation in Patients with Breast Cancer

MRI‐guided treatment in the breast

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