Skip to main content

Advertisement

SpringerLink
Log in

MR-Guided High-Intensity Focused Ultrasound Ablation of Breast Cancer with a Dedicated Breast Platform

  • Review
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Optimizing the treatment of breast cancer remains a major topic of interest. In current clinical practice, breast-conserving therapy is the standard of care for patients with localized breast cancer. Technological developments have fueled interest in less invasive breast cancer treatment. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a completely noninvasive ablation technique. Focused beams of ultrasound are used for ablation of the target lesion without disrupting the skin and subcutaneous tissues in the beam path. MRI is an excellent imaging method for tumor targeting, treatment monitoring, and evaluation of treatment results. The combination of HIFU and MR imaging offers an opportunity for image-guided ablation of breast cancer. Previous studies of MR-HIFU in breast cancer patients reported a limited efficacy, which hampered the clinical translation of this technique. These prior studies were performed without an MR-HIFU system specifically developed for breast cancer treatment. In this article, a novel and dedicated MR-HIFU breast platform is presented. This system has been designed for safe and effective MR-HIFU ablation of breast cancer. Furthermore, both clinical and technical challenges are discussed, which have to be solved before MR-HIFU ablation of breast cancer can be implemented in routine clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Punglia RS, Morrow M, Winer EP et al (2007) Local therapy and survival in breast cancer. N Engl J Med 356(23):2399–2405

    Article  PubMed  CAS  Google Scholar 

  2. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241

    Article  PubMed  Google Scholar 

  3. Litiere S, Werutsky G, Fentiman IS et al (2012) Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20-year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 13(4):412–419

    Article  PubMed  Google Scholar 

  4. van Dongen JA, Bartelink H, Fentiman IS et al (1992) Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Eur J Cancer 28A(4–5):801–805

    Article  PubMed  Google Scholar 

  5. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232

    Article  PubMed  Google Scholar 

  6. Morin J, Traore A, Dionne G et al (2004) Magnetic resonance-guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results. Can J Surg 47(5):347–351

    PubMed  Google Scholar 

  7. Mumtaz H, Hall-Craggs MA, Wotherspoon A et al (1996) Laser therapy for breast cancer: MR imaging and histopathologic correlation. Radiology 200(3):651–658

    PubMed  CAS  Google Scholar 

  8. van den Bosch MA, Daniel B, Rieke V et al (2008) MRI-guided radiofrequency ablation of breast cancer: preliminary clinical experience. J Magn Reson Imaging 27(1):204–208

    Article  PubMed  Google Scholar 

  9. Kennedy JE (2005) High-intensity focused ultrasound in the treatment of solid tumours. Nat Rev Cancer 5(4):321–327

    Article  PubMed  CAS  Google Scholar 

  10. Orsi F, Arnone P, Chen W et al (2010) High intensity focused ultrasound ablation: a new therapeutic option for solid tumors. J Cancer Res Ther 6(4):414–420

    Article  PubMed  Google Scholar 

  11. Hynynen K (2010) MRI-guided focused ultrasound treatments. Ultrasonics 50(2):221–229

    Article  PubMed  Google Scholar 

  12. LeBlang SD, Hoctor K, Steinberg FL (2010) Leiomyoma shrinkage after MRI-guided focused ultrasound treatment: report of 80 patients. AJR Am J Roentgenol 194(1):274–280

    Article  PubMed  Google Scholar 

  13. Stewart EA, Gostout B, Rabinovici J et al (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110(2 Pt 1):279–287

    Article  PubMed  Google Scholar 

  14. Gianfelice D, Gupta C, Kucharczyk W et al (2008) Palliative treatment of painful bone metastases with MR imaging–guided focused ultrasound. Radiology 249(1):355–363

    Article  PubMed  Google Scholar 

  15. Liberman B, Gianfelice D, Inbar Y et al (2009) Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study. Ann Surg Oncol 16(1):140–146

    Article  PubMed  Google Scholar 

  16. Wijlemans JW, Bartels LW, Deckers R et al (2012) Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours. Cancer Imaging 12(2):387–394

    Article  PubMed  CAS  Google Scholar 

  17. Anderson WF, Jatoi I, Devesa SS (2006) Assessing the impact of screening mammography: breast cancer incidence and mortality rates in Connecticut (1943–2002). Breast Cancer Res Treat 99(3):333–340

    Article  PubMed  Google Scholar 

  18. Fracheboud J, Otto SJ, van Dijck JA et al (2004) Decreased rates of advanced breast cancer due to mammography screening in The Netherlands. Br J Cancer 91(5):861–867

    PubMed  CAS  Google Scholar 

  19. Weigel S, Batzler WU, Decker T et al (2009) First epidemiological analysis of breast cancer incidence and tumor characteristics after implementation of population-based digital mammography screening. Rofo 181(12):1144–1150

    Article  PubMed  CAS  Google Scholar 

  20. Landheer ML, Klinkenbijl JH, Pasker-de Jong PC et al (2004) Residual disease after excision of non-palpable breast tumours: analysis of tumour characteristics. Eur J Surg Oncol 30(8):824–828

    PubMed  CAS  Google Scholar 

  21. Faverly DR, Hendriks JH, Holland R (2001) Breast carcinomas of limited extent: frequency, radiologic-pathologic characteristics, and surgical margin requirements. Cancer 91(4):647–659

    Article  PubMed  CAS  Google Scholar 

  22. Rieke V, Butts PK (2008) MR thermometry. J Magn Reson Imaging 27(2):376–390

    Article  PubMed  Google Scholar 

  23. Peters NH, Borel RI, Zuithoff NP et al (2008) Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 246(1):116–124

    Article  PubMed  Google Scholar 

  24. Berg WA, Gutierrez L, NessAiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233(3):830–849

    Article  PubMed  Google Scholar 

  25. Boetes C, Mus RD, Holland R et al (1995) Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197(3):743–747

    PubMed  CAS  Google Scholar 

  26. Deurloo EE, Klein Zeggelink WF, Teertstra HJ et al (2006) Contrast-enhanced MRI in breast cancer patients eligible for breast-conserving therapy: complementary value for subgroups of patients. Eur Radiol 16(3):692–701

    Article  PubMed  Google Scholar 

  27. Uematsu T, Yuen S, Kasami M et al (2008) Comparison of magnetic resonance imaging, multidetector row computed tomography, ultrasonography, and mammography for tumor extension of breast cancer. Breast Cancer Res Treat 112(3):461–474

    Article  PubMed  Google Scholar 

  28. van Goethem M, Schelfout K, Dijckmans L et al (2004) MR mammography in the pre-operative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 14(5):809–816

    Article  PubMed  Google Scholar 

  29. Denis de Senneville B, Quesson B, Moonen CT (2005) Magnetic resonance temperature imaging. Int J Hyperthermia 21(6):515–531

    Article  PubMed  CAS  Google Scholar 

  30. Quesson B, de Zwart JA, Moonen CT (2000) Magnetic resonance temperature imaging for guidance of thermotherapy. J Magn Reson Imaging 12(4):525–533

    Article  PubMed  CAS  Google Scholar 

  31. Holland R, Veling SH, Mravunac M et al (1985) Histologic multifocality of Tis, T1–2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 56(5):979–990

    Article  PubMed  CAS  Google Scholar 

  32. Schmitz AC, van den Bosch MA, Loo CE et al (2010) Precise correlation between MRI and histopathology: exploring treatment margins for MRI-guided localized breast cancer therapy. Radiother Oncol 97(2):225–232

    Article  PubMed  Google Scholar 

  33. Jolesz FA (2009) MRI-guided focused ultrasound surgery. Annu Rev Med 60:417–430

    Article  PubMed  CAS  Google Scholar 

  34. Lynn JG, Zwemer RL, Chick AJ et al (1942) A new method for the generation and use of focused ultrasound in experimental biology. J Gen Physiol 26(2):179–193

    Article  PubMed  CAS  Google Scholar 

  35. Fan X, Hynynen K (1995) Control of the necrosed tissue volume during noninvasive ultrasound surgery using a 16-element phased array. Med Phys 22(3):297–306

    Article  PubMed  CAS  Google Scholar 

  36. Salomir R, Palussiere J, Vimeux FC et al (2000) Local hyperthermia with MR-guided focused ultrasound: spiral trajectory of the focal point optimized for temperature uniformity in the target region. J Magn Reson Imaging 12(4):571–583

    Article  PubMed  CAS  Google Scholar 

  37. Köhler MO, Mougenot C, Quesson B et al (2009) Volumetric HIFU ablation under 3D guidance of rapid MRI thermometry. Med Phys 36(8):3521–3535

    Article  PubMed  Google Scholar 

  38. Voogt MJ, Trillaud H, Kim YS et al (2012) Volumetric feedback ablation of uterine fibroids using magnetic resonance-guided high intensity focused ultrasound therapy. Eur Radiol 22(2):411–417

    Article  PubMed  CAS  Google Scholar 

  39. Hynynen K, Darkazanli A, Unger E et al (1993) MRI-guided noninvasive ultrasound surgery. Med Phys 20(1):107–115

    Article  PubMed  CAS  Google Scholar 

  40. Cline HE, Hynynen K, Watkins RD et al (1995) Focused US system for MR imaging-guided tumor ablation. Radiology 194(3):731–737

    PubMed  CAS  Google Scholar 

  41. Vimeux FC, de Zwart JA, Palussiere J et al (1999) Real-time control of focused ultrasound heating based on rapid MR thermometry. Invest Radiol 34(3):190–193

    Article  PubMed  CAS  Google Scholar 

  42. Diederich CJ, Hynynen K (1999) Ultrasound technology for hyperthermia. Ultrasound Med Biol 25(6):871–887

    Article  PubMed  CAS  Google Scholar 

  43. Diederich CJ (2005) Thermal ablation and high-temperature thermal therapy: overview of technology and clinical implementation. Int J Hyperthermia 21(8):745–753

    Article  PubMed  Google Scholar 

  44. Hynynen K, Pomeroy O, Smith DN et al (2001) MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology 219(1):176–185

    PubMed  CAS  Google Scholar 

  45. Huber PE, Jenne JW, Rastert R et al (2001) A new noninvasive approach in breast cancer therapy using magnetic resonance imaging-guided focused ultrasound surgery. Cancer Res 61(23):8441–8447

    PubMed  CAS  Google Scholar 

  46. Gianfelice D, Khiat A, Amara M et al (2003) MR imaging-guided focused US ablation of breast cancer: histopathologic assessment of effectiveness—initial experience. Radiology 227(3):849–855

    Article  PubMed  Google Scholar 

  47. Furusawa H, Namba K, Thomsen S et al (2006) Magnetic resonance-guided focused ultrasound surgery of breast cancer: reliability and effectiveness. J Am Coll Surg 203(1):54–63

    Article  PubMed  Google Scholar 

  48. Furusawa H, Namba K, Nakahara H et al (2007) The evolving non-surgical ablation of breast cancer: MR guided focused ultrasound (MRgFUS). Breast Cancer 14(1):55–58

    Article  PubMed  Google Scholar 

  49. Gianfelice D, Khiat A, Amara M et al (2003) MR imaging-guided focused ultrasound surgery of breast cancer: correlation of dynamic contrast-enhanced MRI with histopathologic findings. Breast Cancer Res Treat 82(2):93–101

    Article  PubMed  Google Scholar 

  50. Gianfelice D, Khiat A, Boulanger Y et al (2003) Feasibility of magnetic resonance imaging-guided focused ultrasound surgery as an adjunct to tamoxifen therapy in high-risk surgical patients with breast carcinoma. J Vasc Interv Radiol 14(10):1275–1282

    Article  PubMed  Google Scholar 

  51. Khiat A, Gianfelice D, Amara M et al (2006) Influence of post-treatment delay on the evaluation of the response to focused ultrasound surgery of breast cancer by dynamic contrast enhanced MRI. Br J Radiol 79(940):308–314

    Article  PubMed  CAS  Google Scholar 

  52. Zippel DB, Papa MZ (2005) The use of MR imaging guided focused ultrasound in breast cancer patients; a preliminary phase one study and review. Breast Cancer 12(1):32–38

    Article  PubMed  Google Scholar 

  53. Moonen CT, Mougenot C (2006) MRI-guided focused ultrasound, apparatus for novel treatment of breast cancer, vol 6. Springer, Philips Research Book Series, New York, pp 183–200

    Google Scholar 

  54. Payne A, Merrill R, Minalga E et al (2012) Design and characterization of a laterally mounted phased-array transducer breast-specific MRgHIFU device with integrated 11-channel receiver array. Med Phys 39(3):1552–1560

    Article  PubMed  CAS  Google Scholar 

  55. Mougenot C, Köhler M, Tillander M, Moonen C, Bartels W, Ehnholm GJ (2011) Large aperture transducer designed for MR-HIFU treatment of breast tumors. Paper presented at the ISMRM 2011 in the session Interventional MRI: MR-Guided Focused Ultrasound

  56. Mougenot C, Tillander M, Koskela J et al (2012) High intensity focused ultrasound with large aperture transducers: a MRI based focal point correction for tissue heterogeneity. Med Phys 39(4):1936–1945

    Article  PubMed  Google Scholar 

  57. Sprinkhuizen SM, Konings MK, van der Bom MJ et al (2010) Temperature-induced tissue susceptibility changes lead to significant temperature errors in PRFS-based MR thermometry during thermal interventions. Magn Reson Med 64(5):1360–1372

    Article  PubMed  Google Scholar 

  58. Sprinkhuizen SM, Bakker CJ, Ippel JH et al (2011) Temperature dependence of the magnetic volume susceptibility of human breast fat tissue: an NMR study. MAGMA 25(1):33–39

    Article  PubMed  Google Scholar 

  59. Peters NH, Bartels LW, Sprinkhuizen SM et al (2009) Do respiration and cardiac motion induce magnetic field fluctuations in the breast and are there implications for MR thermometry? J Magn Reson Imaging 29(3):731–735

    Article  PubMed  Google Scholar 

  60. Hey S, Maclair G, de Senneville BD et al (2009) Online correction of respiratory-induced field disturbances for continuous MR-thermometry in the breast. Magn Reson Med 61(6):1494–1499

    Article  PubMed  CAS  Google Scholar 

  61. Arnedos M, Nerurkar A, Osin P et al (2009) Discordance between core needle biopsy (CNB) and excisional biopsy (EB) for estrogen receptor (ER), progesterone receptor (PgR) and HER2 status in early breast cancer (EBC). Ann Oncol 20(12):1948–1952

    Article  PubMed  CAS  Google Scholar 

  62. Tamaki K, Sasano H, Ishida T et al (2010) Comparison of core needle biopsy (CNB) and surgical specimens for accurate preoperative evaluation of ER, PgR and HER2 status of breast cancer patients. Cancer Sci 101(9):2074–2079

    Article  PubMed  CAS  Google Scholar 

  63. Darby S, McGale P, Correa C et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716

    Article  PubMed  CAS  Google Scholar 

  64. Hurkmans CW, Borger JH, Pieters BR et al (2001) Variability in target volume delineation on CT scans of the breast. Int J Radiat Oncol Biol Phys 50(5):1366–1372

    Article  PubMed  CAS  Google Scholar 

  65. Landis DM, Luo W, Song J et al (2007) Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys 67(5):1299–1308

    Article  PubMed  Google Scholar 

  66. Struikmans H, Warlam-Rodenhuis C, Stam T et al (2005) Interobserver variability of clinical target volume delineation of glandular breast tissue and of boost volume in tangential breast irradiation. Radiother Oncol 76(3):293–299

    Article  PubMed  Google Scholar 

  67. van Mourik AM, Elkhuizen PH, Minkema D et al (2010) Multi-institutional study on target volume delineation variation in breast radiotherapy in the presence of guidelines. Radiother Oncol 94(3):286–291

    Article  PubMed  Google Scholar 

  68. Borger JH, Kemperman H, Smitt HS et al (1994) Dose and volume effects on fibrosis after breast conservation therapy. Int J Radiat Oncol Biol Phys 30(5):1073–1081

    Article  PubMed  CAS  Google Scholar 

  69. den Hartogh MD, van AB, Monninkhof EM (2011) Excised and irradiated volumes in relation to the tumor size in breast-conserving therapy. Breast Cancer Res Treat 129(3):857–865

    Article  PubMed  CAS  Google Scholar 

  70. Lagendijk JJ, Raaymakers BW, Raaijmakers AJ et al (2008) MRI/linac integration. Radiother Oncol 86(1):25–29

    Article  PubMed  Google Scholar 

  71. Raaymakers BW, Lagendijk JJ, Overweg J et al (2009) Integrating a 1.5 T MRI scanner with a 6 MV accelerator: proof of concept. Phys Med Biol 54(12):N229–N237

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This research was supported by the Center for Translational Molecular Medicine (VOLTA, Work Package 3).

Conflict of interest

This research was performed in collaboration with Philips Healthcare. Max O. Köhler is currently employed in this company. The other authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, University Medical Center Utrecht, HP E 01.132, P.O. Box 85500, 3584, CX Utrecht, The Netherlands

    Laura G. Merckel, Willem P. Th. M. Mali, Kenneth G. A. Gilhuijs & Maurice A. A. J. van den Bosch

  2. Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands

    Lambertus W. Bartels, Roel Deckers, Chrit T. Moonen & Kenneth G. A. Gilhuijs

  3. Philips Healthcare, Vantaa, Finland

    Max O. Köhler

  4. Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands

    H. J. G. Desirée van den Bongard

  5. Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland

    Christoph A. Binkert

Authors
  1. Laura G. Merckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lambertus W. Bartels
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max O. Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. J. G. Desirée van den Bongard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roel Deckers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Willem P. Th. M. Mali
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christoph A. Binkert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chrit T. Moonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kenneth G. A. Gilhuijs
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maurice A. A. J. van den Bosch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maurice A. A. J. van den Bosch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Merckel, L.G., Bartels, L.W., Köhler, M.O. et al. MR-Guided High-Intensity Focused Ultrasound Ablation of Breast Cancer with a Dedicated Breast Platform. Cardiovasc Intervent Radiol 36, 292–301 (2013). https://doi.org/10.1007/s00270-012-0526-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-012-0526-6

Keywords

Search

Navigation