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. 2013 Oct;8(5):356-60.
doi: 10.1159/000355707.

Subclinical Breast Cancer: Minimally Invasive Approaches. Our Experience with Percutaneous Radiofrequency Ablation vs. Cryotherapy

Guglielmo Manenti  1 , Angela L Scarano  1 , Chiara A Pistolese  1 , Tommaso Perretta  1 , Elena Bonanno  2 , Augusto Orlandi  2 , Giovanni Simonetti  1
Affiliations

Subclinical Breast Cancer: Minimally Invasive Approaches. Our Experience with Percutaneous Radiofrequency Ablation vs. Cryotherapy

Guglielmo Manenti et al. Breast Care (Basel). 2013 Oct.

Abstract
in English, German

Background: The aim of this study was to compare the efficacy of radiofrequency ablation vs. cryoablation in the treatment of early breast cancer.

Patients and methods: 80 women (mean age 73 ± 5 years) with early breast cancer were retrospectively evaluated. 40 patients underwent cryoablation and 40 patients underwent radiofrequency ablation, both with sentinel lymph node excision. Tumor volume and histopatological data were compared by means of postprocedural 3.0-T magnetic resonance imaging (MRI). 30-45 days after the percutaneous ablation, all patients underwent surgical resection of the tumor. The mean follow-up was 18 months without any local recurrences.

Results: Both techniques allow good correlation with histopathological data. In 75 patients (93.8%) we observed complete necrosis; in 5 cases there was residual disease in the postprocedural MRI and postoperative histological examination. There was a good correlation between MRI volume and histologic samples. Cosmetic results were good in all patients but 2.

Conclusion: Both percutaneous radiofrequency ablation and cryotherapy are minimally invasive techniques with a good clinical and cosmetic outcome in selected cases. MRI examination is an ideal method to assess breast neoplasms in terms of quality and quantity as well as residual tumor extent after percutaneous ablation. Cryotherapy is the preferred method because of the analgesic effect of freezing with better patients compliance.

Hintergrund: Ziel dieser Studie war es, die Effizienz der Radiofrequenzablation im Vergleich zur Cryoablation zur Behandlung des frühen Mammakarzinoms zu vergleichen.

Patientinnen und methoden: 80 Frauen (mittleres Alter 73 ± 5 Jahre) mit einem primären Mammakarzinom wurden retrospektiv evaluiert. Bei 40 Patientinnen wurde eine Cryoablation und bei weiteren 40 eine Radiofrequenzablation durchgeführt (jeweils mit Sentinelknoten-entfernung). Tumorvolumen und histopatologische Daten wurden mittels 3.0-T-Magnetresonanztomogra-phie (MRT) im Anschluss an den Eingriff bestimmt. 30–45 Tage nach der perkutanen Ablation wurde bei allen Patientinnen eine chirurgische Tumorentfernung vorgenommen. Das mittlere Follow-up war 18 Monate; während dieser Zeit traten keine Lokalrezidive auf.

Ergebnisse: Für beide Methoden konnte eine gute Korrelation mit histopathologischen Daten gezeigt werden. Bei 75 (93,8%) Patientinnen wurde eine komplette Nekro-tisierung beobachtet; in 5 Fällen zeigten das Kontroll-MRT und die postoperative histologische Untersuchung Resttumorgewebe. Es bestand eine gute Korrelation zwischen MRT-Volumen und den histologischen Proben. Das kosmetische Outcome war bis auf 2 Fälle gut.

Schlussfolgerung: Die perkutane Radiofrequenzablation und die Cryotherapie sind minimalinvasive Methoden mit einem guten klinischen und kosmetischen Outcome in ausgewählten Fällen. MRT ist eine ideale Methode zur qualitativen und quantitativen Charakterisierung von Mammakarzinomen sowie dem Ausmaß von Resttumorgewebe nach perkutaner Ablation. Cryotherapie wird der RFA vorgezogen, da der analgetische Effekt des Vereisens mit besserer Patientcompliance einhergeht.

Keywords: Breast cancer; Cryoablation; MRI; Minimally invasive techniques; Percutaneous ablation; Radiofrequency ablation.

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Figures

Fig. 1
Fig. 1
Radiofrequency ablation, histological examination, and cosmetic evaluation. a Axial T1-weighted magnetic resonance imaging (MRI) showing an enhancing lesion in the upper-outer left breast; b ablation volume after percutaneous ablation; c absence of enhancement at a delayed MRI; d hemorrhagic/necrotic areas (hematoxylin and eosin) without viable epithelial cells; e NADH diaphorase; f excellent cosmetic results at Time 0 after percutaneous ablation, g at Time 1 prior to surgical excision with evidence of mild pigmentation of the skin.
See this image and copyright information in PMC

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