Feasibility of Percutaneous Excision Followed by Ablation for Local Control in Breast Cancer
- 229 Downloads
Percutaneous ablation of breast cancer has shown promise as a treatment alternative to open lumpectomy. We hypothesized that percutaneous removal of breast cancer followed by percutaneous ablation to sterilize and widen the margins would not only provide fresh naive tissue for tumor marker and research investigation, but also better achieve negative margins after ablation.
Patients diagnosed by percutaneous biopsy (ultrasound or stereotactic-guided) with breast cancer ≤1.5 cm, >1 cm from the skin, and ≤1 cm residual disease and no multicentric disease by magnetic resonance imaging were accrued to this institutional review board–approved study. Patients were randomized to laser versus radiofrequency ablation. The ultrasound-guided ablation was performed in the operating room and followed by immediate excision, whole-mount pathology with proliferating cell nuclear antigen staining, and reconstruction.
Twenty-one patients were enrolled onto the study. Fifteen patients received radiofrequency ablation, and all showed 100% ablation and negative margins. Magnetic resonance imaging was helpful in excluding multicentric disease but less so in predicting presence or absence of residual disease. Seven of these patients showed no residual tumor and eight showed residual dead tumor (0.5 ± 0.7 cm, range 0.1–2.5 cm) at the biopsy site with clear margins. The laser arm (3 patients) pathology demonstrated unpredictability of the ablation zone and residual live tumor.
This pilot study demonstrates the feasibility of a novel approach to minimally invasive therapy: percutaneous excision and effective cytoreduction, followed by radiofrequency ablation of margins for the treatment of breast cancer. Laser treatment requires further improvement.
KeywordsProliferate Cell Nuclear Antigen Radiofrequency Ablation Doppler Imaging Ablation Zone Percutaneous Biopsy
Supported by the Tenenbaum Breast Cancer Research Fund, Little Rock, Arkansas Supported by the Fashion Footwear Association of New York (FFANY/QVC) Supported by the National Institute of Health (NIH) Grant #5 R21-CA097715 in collaboration with Ethicon Endo-surgical, Inc and RITA/AngioDynamics.
V.S. Klimberg, MD has a grant with Angiodynamics for another project, “Multicenter Registry for eRFA.” Angiodynamics bought the RITA company that supplied the probes for this study through an NIH grant.
- 1.Toi M, Winer EP, Inamoto T, et al. Identifying gaps in the locoregional management of early breast cancer: highlights from the Kyoto Consensus Conference. Ann Surg Oncol. In press.Google Scholar
- 3.Spivak B, Khanna MM, Tafra L, Juillard G, Giulano AB. Margin status and local recurrence after breast-conserving surgery. Arch Surg. 1994;129:952–7.Google Scholar
- 24.Bland KL, Gass J, Klimberg VS. Radiofrequency, cryoablation, and other modalities for breast cancer ablation. Surg Clin North Am. 2007;87:539–50, xii.Google Scholar
- 29.Fishbein MC, Meerbaum S, Rit J, et al. Early phase acute myocardial infarct size quantification: validation of the triphenyl tetrazolium chloride tissue enzyme staining technique. Am Heart J. 1981;101:593.Google Scholar
- 34.Manenti G, Bolacchi F, Perretta T, el. Small breast cancers: in vivo percutaneous US-guided radiofrequency ablation with dedicated cool-tip radiofrequency system. Radiology. 2009;251:339–46.Google Scholar
- 38.Susini T, Nori J, Olivieri S, et al. Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients. Gynecol Oncol. 2007;104:304–10.Google Scholar