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Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis

Abstract

Objectives

To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments.

Methods

An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome.

Results

Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94–97%) [laser=98% (95–99%); HIFU=96% (90–98%); radiofrequency=96% (93–97%); cryoablation=95% (90–98%); microwave=93% (81–98%)]. Pooled technique efficacy was 75% (67–81%) [radiofrequency=82% (74–88); cryoablation=75% (51–90); laser=59% (35–79); HIFU=49% (26–74)]. Major complications pooled rate was 6% (4–8). Minor complications pooled rate was 8% (5–13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142).

Conclusions

Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low.

Key Points

Imaging-guided ablation techniques for breast cancer are 96% technically successful.

Overall technique efficacy rate is 75% but largely inhomogeneous among studies.

Overall major and minor complication rates are low (6–8%).

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Acknowledgements

The scientific guarantor of this publication is Francesco Sardanelli MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because the present study did not involve patients. Methodology: Meta-analysis.

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Correspondence to Giovanni Mauri.

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Supplementary Fig. 6
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Funnel plot showing risk of publication bias for technical success (GIF 18 kb)

Supplementary Fig. 7
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Funnel plot showing risk of publication bias for technical effectiveness (GIF 17 kb)

Supplementary Fig. 8
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Funnel plot showing risk of publication bias for major complications (GIF 15 kb)

Supplementary Fig. 9
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Funnel plot showing risk of publication bias for minor complications (GIF 17 kb)

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Mauri, G., Sconfienza, L.M., Pescatori, L.C. et al. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. Eur Radiol 27, 3199–3210 (2017). https://doi.org/10.1007/s00330-016-4668-9

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Keywords

  • Breast cancer
  • Minimally-invasive treatment
  • Thermal ablation
  • Systematic review
  • Meta-analysis