VAB and MRI Following Percutaneous Ultra-Sound Guided Cryoablation for Primary Early-Stage Breast Cancer: A Pilot Study in Japan
2021
Objective: This study aimed to evaluate the feasibility, safety, and cosmetic
outcomes of percutaneous cryoablation (PCA) of breast intraductal carcinoma
(IDC) lesions, as well as post-cryoablation magnetic resonance imaging (MRI) as
a follow-up tool for detection of residual malignancies and local recurrences. Methods: Eight female patients
underwent percutaneous ultrasound-guided cryoablation of breast IDC
tumors under local anesthesia without subsequent resection. All patients
received radiation- and endocrine therapies (RT, ET). The patients were
followed using vacuum-assisted biopsy (VAB), mammography (MG), magnetic
resonance imaging (MRI), and Moire Topography for cosmetic outcomes. VAB was
performed 6 months following cryoablation treatment for cases 1 and 2 (after
starting radiation- and endocrine-therapies) or one month after PCA (cases 3,
4, 5, 6 and 7), prior to RT and ET. One patient declined VAB. Results: Mean
age of the patients was 61.9 years, SD 7.7, ages range 53 - 72 years. Mean
tumor size was 10.3 mm, SD 2.74, ranged 6.8 - 14.5 mm, median follow-up time
was 28 months (range 13 - 34 months). No residual or recurrent malignancies
were detected. One minor adverse event was observed: A skin
redness in the ablated area; MRI at one-month post-cryotherapy showed various
degrees of thermal burns in all patients in the pectoralis major muscle, which
were not symptomatic and were resolved by 6 months following PCA. Decrease of
fat necrosis areas in the vicinity of ablated ex-tumor was traced with MRI
(mean size 54.9 mm, mean decrease after 2 years was 58%) and validated with
VAB. Conclusions: Percutaneous
cryoablation of early-stage low-risk breast cancer tumors smaller than 15 mm
potentially presents a potential substitute for lumpectomy, offering
encouraging short- to mid-term oncology results with good cosmesis outcomes.
Patients would be able to benefit from local anesthesia in an outpatient setting
and a shorter recovery period.
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