Scientific paper
Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation

Presented at the 89th Annual Meeting of the North Pacific Surgical Association, Seattle, Washington, November 8–9, 2002
https://doi.org/10.1016/S0002-9610(03)00061-8Get rights and content

Abstract

Background

Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women.

Methods

Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability.

Results

The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again.

Conclusions

Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.

Section snippets

Subjects

Subjects were 22 women, aged 60 years or older, with core-biopsy proven invasive breast cancer less than 3 cm in diameter. Tumors had to be visible on ultrasound, at least 1 cm from the skin, mobile from the chest wall and have adequate histology on core biopsy to permit unequivocal identification of invasive disease, tumor grade and assessment of estrogen receptor status. Patients were required to complete a short quality of life form and those with pacemakers or taking anticoagulants were

Results

Among 29 patients approached for the study, 22 consented and were entered into study (Table 1). All patients were successfully treated as outpatients. The age range was 60 to 80 years with a median of 73 years. Most had mammographically detected, nonpalpable tumors <2 cm diameter and no palpable axillary nodes. All had histologically confirmed invasive breast cancer on core needle biopsy (Table 2). A majority had <50% glandular tissue on the mammogram. Three patients (14%) had a previous breast

Comments

Modern imaging technologies and breast screening programs have resulted in the identification of breast cancer at earlier stages and at smaller tumor sizes [13]. This has facilitated the expanded use of breast conservation and reduced the morbidity from systemic therapy [14]. While surgical therapy for breast cancer has evolved from radical mastectomy to lumpectomy, the concept of tumor ablation as a method of definitive local control would be a conceptual shift from traditional extirpation

Acknowledgements

This work was supported by a grant from the Canadian Breast Cancer Foundation, BC/Yukon Chapter.

References (24)

  • M. Morrow

    Breast disease in elderly women

    Surg Clin North Am

    (1994)
  • T. Smillie et al.

    Evaluation of feasibility and accuracy of sentinel node biopsy in early breast cancer

    Am J Surg

    (2001)
  • Surveillance, Epidemiology, and End Results (SEER) program cancer statistics review (1973-1995). Bethesda, MD: National...
  • U. Veronesi et al.

    Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer

    N Engl J Med

    (2002)
  • B. Fisher et al.

    Twenty year follow-up of a randomized trial comparing total mastectomy, lumpectomy, lumpectomy plus irradiation for the treatment of invasive breast cancer

    N Eng J Med

    (2002)
  • E.J. Patterson et al.

    Radiofrequency ablation in surgery

  • E. Berber et al.

    Initial clinical evaluation of the RITA 5 centimeter radiofrequency thermal ablation catheter in the treatment of liver tumors

    Cancer J Sci Am

    (2000)
  • A.N. Mirza et al.

    Radiofrequency ablation of solid tumors

    Cancer J

    (2001)
  • S.S. Jeffrey et al.

    Radiofrequency ablation of breast cancer. First report of an emerging technology

    Arch Surg

    (1999)
  • T. Bohm et al.

    Saline-enhanced radiofrequency ablation of breast tissuean in vitro feasibility study

    Invest Radiol

    (2000)
  • F. Izzo et al.

    Radiofrequency ablation in patients with primary breast carcinomaa pilot study in 26 patients

    Cancer

    (2001)
  • S.E. Singletary et al.

    Radiofrequency ablation of early-stage invasive breast tumorsan overview

    Cancer J

    (2002)
  • Cited by (136)

    • Surgical management of early breast cancer

      2018, The Breast: Comprehensive Management of Benign and Malignant Diseases
    • Tratamiento del cáncer de mama por técnicas mínimamente invasivas

      2015, Revista de Senologia y Patologia Mamaria
    • Breast-conservative surgery followed by radiofrequency ablation of margins decreases the need for a second surgical procedure for close or positive margins

      2014, Clinical Breast Cancer
      Citation Excerpt :

      Several approaches have been used to achieve negative margins at the initial surgical procedure, as this has been reported by multiple studies to decrease the incidence of LR.4-7 Ablative techniques via percutaneous needle have been introduced as a promising and minimally invasive alternative to BCS for local treatment in women with early breast cancer.11-14 The problem with the percutaneous RFA techniques is that they cannot achieve negative margins in 100% of cases.

    View all citing articles on Scopus
    View full text