Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study

Abstract

IntroductionNegative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins.MethodsFrom 2016 to 2018, 22 women with T1/T2 invasive breast cancer were enrolled for MWA prospectively in the guidance of BCS. US-guided MWA was performed under local anesthesia, followed by BCS and sentinel lymph node biopsy (SLNB) one week after ablation. Women who underwent palpation-guided BCS directly were included as control, and propensity score matching analysis was applied.ResultsMWA was performed in 22 patients. Of the 21 MWA cases with effect information, the mean tumor size in US was 20.9 ± 6.2 mm (6-37 mm). Compared with control group (BCS directly), a lower rate of positive/close margins was observed in MWA guidance group (P = 0.018), and MWA caused a higher rate of accurate surgery (the largest margin ≤ 3 cm and the smallest margin ≥ 1mm, P = 0.042). Of these 21 patients treated with MWA, 18 were candidates for SLNB. And sentinel lymph nodes were successfully identified in all cases, and no recurrence was found with a mean follow-up of 23 months.ConclusionFor patients with T1/T2 breast cancer, the application of preoperative MWA could guide BCS accurately without impairing SLNB. Clinical trials with long-term results are required to validate MWA in the guidance for breast cancer excision.

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

“…Our result showed no signi cance for MRI evaluation itself but NME on MRI and maximum diameter on MRI showed tendency for positive RM. Also, preoperative microwave ablation is reported to be another technique which could guide BCS with better result of resection margin and without impairing sentinel lymph node biopsy [10]. In the operation, tumor localization using intraoperative ultrasound can help attaining negative margins without removal of much healthy breast tissue [11][12][13].…”

Construction of Prognostic Risk Model of 5-Methylcytosine-Related Long Non-Coding RNAs and Evaluation of the Characteristics of Tumor-Infiltrating Immune Cells in Breast Cancer

“…Although a variety of therapeutic options (surgery, chemotherapy, radiotherapy, and immunotherapy, etc.) have made significant progress in recent years (Zhou et al, 2012;Pan et al, 2021), the prognosis of BC requires further improvement. Precise diagnosis and treatment are essential for improving the survival of patients with BC.…”

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

“…Under local anesthesia, MWA was performed according to previous studies. [ 7 , 14 , 16 ] The microwave irradiation frequency of the system (Nanjing Yigao Microwave Electric Institute, Nanjing, China) was 2450 MHz with an output power set at 40 W, and 1–5 min were needed for complete ablation on ultrasound. Complete ablation was defined as no viable tumor cells determined by pathological assessments after surgery.…”

“…Due to the advantages in comparison to other techniques, [ 15 ] MWA has been reported in the treatment of early‐stage breast cancer, with a high complete ablation rate. [ 7 , 14 , 16 ] Interestingly, MWA in the treatment of breast cancer induces Th1‐type immune response and elevated proportions of activated NK cells in limited cases, unlike the systemic inflammatory and immunosuppressive microenvironments induced by surgery. [ 11 , 14 , 17 ] To the best of our knowledge, the landscape of thermal ablation‐induced immune response has not been reported.…”