Abstract
Background
Local ablative therapy of breast cancer represents the next frontier in the evolution of minimally-invasive breast conservation therapy. We performed this Phase II trial to determine the efficacy and safety of Radiofrequency (RF) ablation of small invasive breast carcinomas.
Methods
Seventeen patients with biopsy-proven invasive breast cancer, ≤ 1.5 cm in diameter were enrolled in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RF electrode followed by surgical resection. Pathologic and immunohistochemical stains were performed to assess tumor viability. We examined whether loss of ER, PR receptor and pancytokeratin expression following RF ablation would correlate with non-viability.
Results
Fifteen patients completed the treatment. The mean tumor size was 1.28 cm. The mean ablation time was 21 minutes using a mean power of 35.5 watts. During ablation, the tumors became progressively echogenic that corresponded with the region of severe electrocautery injury at pathological examination. Of the 15 treated patients, NADPH viability staining was available for 14 patients and in 13 (92.8%), there was no evidence of viable malignant cells. ER, PR expression and pancytokeratin immunohistochemistry analysis were unreliable surrogates for determining non-viability. Following RF ablation, 2 patients developed skin puckering.
Conclusions
RF ablation is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further research is necessary to optimize this image-guided technique and evaluate its future role as the sole local therapy.
Similar content being viewed by others
References
Fisher B. From Halsted to prevention and beyond: advances in the management of breast cancer during the twentieth century. Eur J Cancer 1999; 35(14):1963–73
Giuliano AE, Jones RC, Brennan M, Statman R. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15(6):2345–50
Vrieling C, Collette L, Fourquet A, et al. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol 2000; 55(3):219–32
Singletary SE. Minimally invasive techniques in breast cancer treatment. Semin Surg Oncol 2001; 20(3):246–50
Cady B, Stone MD, Schuler JG, et al. The new era in breast cancer. Invasion, size, and nodal involvement dramatically decreasing as a result of mammographic screening. Arch Surg 1996; 131(3):301–8
McGahan JP, Griffey SM, Schneider PD, et al. Radio-frequency electrocautery ablation of mammary tissue in swine. Radiology 2000; 217(2):471–6
Park JK, Halperin BD, Kron J, et al. Analysis of body surface area as a determinant of impedance during radiofrequency catheter ablation in adults and children. J Electrocardiol 1994; 27(4):329–32
Wang D, Hulse JE, Walsh EP, Saul JP. Factors influencing impedance during radiofrequency ablation in humans. Chin Med J (Engl) 1995; 108(6):450–5
Izzo F, Thomas R, Delrio P, et al. Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients. Cancer 2001; 92(8):2036–44
Fornage BD, Sneige N, Ross MI, et al. Small ( < or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study. Radiology 2004; 231(1):215–24
Burak WE Jr, Agnese DM, Povoski SP, et al. Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision. Cancer 2003; 98(7):1369–76
Dowlatshahi K, Fan M, Gould VE. Stereotactically guided laser therapy of occult breast tumors. Work in progress report. Arch Surg 2000; 135:1345–52
Sabel MS, Kaufman CS, Whitworth P, et al. Cryoablation of early-stage breast cancer: work-in-progress report of a multi-institutional trial. Ann Surg Oncol 2004; 11(5):542–9
Raman SS, Lu DS, Vodopich DJ, et al. Creation of radiofrequency lesions in a porcine model: correlation with sonography, CT, and histopathology. AJR Am J Roentgenol 2000; 175(5):1253–8
Brookes JA, Redpath TW, Gilbert FJ, et al. Accuracy of T1 measurement in dynamic contrast-enhanced breast MRI using two- and three-dimensional variable flip angle fast low-angle shot. J Magn Reson Imaging 1999; 9(2):163–71
Tafra L, Cheng Z, Uddo J, et al. Pilot clinical trial of 18F-fluorodeoxyglucose positron-emission mammography in the surgical management of breast cancer. Am J Surg 2005; 190(4):628–32
Jan ML, Chuang KS, Chen GW, et al. A three-dimensional registration method for automated fusion of micro PET-CT-SPECT whole-body images. IEEE Trans Med Imaging 2005; 24(7):886–93
Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 2002; 184(5):383–93
Acknowledgement
This study was supported by grant from the University of California, Davis Health System
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khatri, V.P., McGahan, J.P., Ramsamooj, R. et al. A Phase II Trial of Image-Guided Radiofrequency Ablation of Small Invasive Breast Carcinomas: Use of Saline-Cooled Tip Electrode. Ann Surg Oncol 14, 1644–1652 (2007). https://doi.org/10.1245/s10434-006-9315-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-006-9315-2