Ultrasound-Guided Laser-Induced Thermal Therapy for Small Palpable Invasive Breast Carcinomas: A Feasibility Study

Abstract

BackgroundThe next step in breast-conserving surgery for small breast carcinomas could be local ablation. In this study, the feasibility of ultrasound-guided laser-induced thermal therapy (LITT) is evaluated.MethodsPatients with large-core needle biopsy-proven invasive, palpable breast carcinoma (clinically ≤2 cm) underwent ultrasound-guided LITT, followed by surgical excision. Completeness of ablation was determined by both hematoxylin and eosin staining and nicotinamide adenosine diaphorase staining.ResultsFourteen patients completed the treatment. The mean histological tumor size was 17 mm (range, 8–37 mm); 6 of 14 tumors were histologically larger than the clinical entry threshold of 2 cm. The power applied in all patients was 7 W, and the mean treatment time was 21.4 min (range, 15–30 min). In one patient, a skin burn occurred, and one patient had a localized pneumothorax that could be treated conservatively. In 7 (50%) of 14 patients, the tumor was completely ablated, as confirmed by nicotinamide adenosine diaphorase staining. In 11 cases, extensive in-situ carcinoma was present. In one case, the in-situ carcinoma was also completely ablated. A total of seven (88%) of eight tumors <2 cm in size were completely ablated versus one (17%) of six tumors that were ≥2 cm in size (P = .026).ConclusionsSuccessful LITT of invasive breast cancer seems to be feasible when confined to small (<2 cm) nonlobular carcinomas without surrounding extensive in-situ component and angioinvasion. However, to implement LITT in a curative setting, improvements in imaging to more reliably preoperatively assess tumor size and monitoring of fiber tip placement and treatment affect are essential.

Does the real-time thermal damage estimate allow for estimation of tumor control after MRI-guided laser-induced thermal therapy? Initial experience with recurrent intracranial ependymomas

“…6,12,18,26,29,30,36 Energy in the form of light is emitted through a saline-or water-cooled catheter and converted to thermal energy within the target tissue. 10,37 The resulting thermal coagulation and damage to intracellular proteins and DNA ultimately leads to cell death.…”

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

“…A total of 63 articles matched the selection criteria. The 63 articles included 16 feasibility studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], 12 phase I studies [29][30][31][32][33][34][35][36][37][38][39][40], nine phase II studies [41][42][43][44][45][46][47][48][49], three comparative studies [50][51][52], one retrospective study [53], and four randomised controlled trials [54][55][56]. In 18 studies the type of study was not reported [8,[57][58][59][60][61][62][63][64]…”

“…The ablation process involves two phases: freezing and thawing with four mechanisms destroying the tumour cells: direct damage by intracellular ice formation and osmotic dehydration and indirect damage due to ischemia and immunologic response. [36,78] Seven studies used laser-ablation (231 patients) [18,28,33,34,50,62,63], in which lesions are ablated due to direct heating with low-power laser light energy delivered percutaneously via thin optical fibres. Upon absorption in the tissue, heat is produced, inducing lethal thermal injury.…”

Image-Guided Ablation in Breast Cancer Treatment

“…[36][37][38] The light is both scattered and absorbed by the tissue. The absorption events are primarily near the laser and result in large heating near the laser applicator.…”