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

Abstract

LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the minimally invasive approaches to breast cancer diagnosis and treatment.2. List the strengths and weaknesses of minimally invasive diagnostic and treatment procedures.3. Select appropriate patients for minimally invasive approaches to breast cancer diagnosis and treatment.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTBreast cancer management has been evolving toward minimally invasive approaches. Image-guided percutaneous biopsy techniques provide accurate histologic diagnosis without the need for surgical biopsy. Breast conservation therapy has become the treatment standard for earlystage breast cancer. Sentinel lymph node biopsy is a new procedure that can predict axillary lymph node status without the need of axillary lymph node dissection. The next challenge is to treat primary tumors without surgery. For this purpose, several new minimally invasive procedures, including radiofrequency ablation, interstitial laser ablation, focused ultrasound ablation, and cryotherapy, are currently under development and may offer effective tumor management and provide treatment options that are psychologically and cosmetically more acceptable to the patients than are traditional surgical therapies. In this review, we give an overview of minimally invasive approaches for the diagnostic and therapeutic management of early-stage breast cancer. The Oncologist 2007;12: [1][2][3][4][5][6][7][8][9][10]

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

“…Some of the signs found at T0 regressed spontaneously without therapy; others persisting the same at the TI observation, or modified as permanent cosmetic changes. At TI, in the 5 cases associated with skin rash and clinically appreciable nodular thickening, a permanent nodular thickening was observed in 2 cases, it was the only case of nodular thickening at the procedure's site constantly palpable up to the surgical excision; in 3 cases of the skin bruising appearance, the appearance of a skin hyperpigmentation area was recorded advantages compared to RF thermoablation [8] .We obtained optimal results in 9 patients, in whom no sign was observed, and good results in 6 patients, with signs of slight hyperpigmentation persistent in 3 patients and mild nodular thickening in 3 other patients. The fully recover was also moderately faster and significantly more complete.…”

Cryoablation and Meriva have strong therapeutic effect on triple-negative breast cancer

“…18,38,39 Their results indicate that cryoablation may prevent surgery, and is less invasive with lower side effects than surgery, chemotherapy or radiation. Our preclinical results strongly suggest that cryoablation combined with Meriva might be also effective in a later stage when lung metastases have already been spread, and deserves further analysis in humans.…”

“…[18][19][20][21] Cryoablation involves the insertion of a probe into a tumor nodule in order to administer tissue ablative freezing temperatures, which will lead to immediate disruption of the tissue structure and cellular damage. 22 The necrosis observed in the ablated lesion is mediated by mechanical disruption from crystallization, osmotic changes, and vascular stasis.…”

Spectral-domain low coherence interferometry/optical coherence tomography system for fine needle breast biopsy guidance

“…Among these tests, biopsy was proven to be the best way of finding out whether a suspicious area seen in an image is actually cancer. [3][4][5] Breast biopsy represents the first surgical intervention in the treatment of breast cancer. Breast biopsies provide very useful diagnostic information and can be comfortably performed with intravenous sedation and local anesthesia.…”

“…6 FNAB is the most minimally invasive and best tolerated procedure, typically using a 23 gauge needle or smaller. 4 The results are rapidly available for cytopathologic analysis and the patient may have a diagnosis at the time of biopsy. The number of FNAB procedure varies from one clinic to another within a range of a few hundred to thousands, 7 but even for small clinics it is usually over 100 per year.…”