The Role of Image-Guided Surgery in Breast Cancer

  • Kambiz Dowlatshahi
  • Rosalinda Alvarado
  • Katherine Kopckash
Reference work entry


The surgical management of breast cancer has changed drastically over the past three decades. These improvements have been possible due to advances in imaging and ablative therapies. This chapter gives a brief overview of the historical management of breast cancer and describes the modern imaging techniques of the breast and axilla, including digital mammography, ultrasound, magnetic resonance imaging (MRI), and positron emission mammography (PEM). We discuss the devices currently used for breast biopsy and the techniques employed for minimally invasive surgery. Finally, the chapter provides a summary of the available ablative therapies, which include cryoablation, laser therapy, radiofrequency ablation, microwave thermotherapy, and high-intensity focused ultrasound.


Breast Cancer Dense Breast Radical Mastectomy Digital Mammography Breast Magnetic Resonance Imaging 
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  1. 1.
    Halsted W. The results of radical operations for the cure of carcinoma of the breast. Ann Surg. 1907;46:1.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Urban JA. Current cancer concepts. What is the rationale for an extended radical procedure in early cases? JAMA. 1967;199(10):742–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Patey DH, Dyson WH. The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer. 1948;2(1):7–13.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Crile Jr G. Results of simple mastectomy without irradiation in the treatment of operative stage I cancer of the breast. Ann Surg. 1968;168(3):330–6.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Turner L, Swindell R, Bell WG, et al. Radical versus modified radical mastectomy for breast cancer. Ann R Coll Surg Engl. 1981;63:239.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Maddox WA, Carpenter JT, Laws HL, et al. A randomized prospective trial of radical (Halsted) mastectomy versus modified radical mastectomy in 311 breast cancer patients. Ann Surg. 1983;198:207.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Fisher B, Redmond C, Fisher E, et al. Ten year result of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without irradiation. N Engl J Med. 1985;312:674.CrossRefPubMedGoogle Scholar
  8. 8.
    Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347:567.CrossRefPubMedGoogle Scholar
  9. 9.
    Fisher B. Laboratory and clinical research in breast cancer–a personal adventure: the David A Karnofsky memorial lecture. Cancer Res. 1980;40(11):3863–74.PubMedGoogle Scholar
  10. 10.
    Fisher B, Anderson S, Bryant J, et al. 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. 2002;347:1233.CrossRefPubMedGoogle Scholar
  11. 11.
    Veronesi U, Cascinelli N, Mariani L, 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;347:1227.CrossRefPubMedGoogle Scholar
  12. 12.
    van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 Trial. J Natl Cancer Inst. 2000;92:1143.CrossRefPubMedGoogle Scholar
  13. 13.
    Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332:907.CrossRefPubMedGoogle Scholar
  14. 14.
    Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003;98:697.CrossRefPubMedGoogle Scholar
  15. 15.
    Shapiro S, Strax P, Venet L. Periodic breast cancer screening. The first two years of screening. Arch Environ Health. 1967;15:547–53.CrossRefPubMedGoogle Scholar
  16. 16.
    Tabar L, Fagerberg CJ, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet. 1985;1:829–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Baker LH. Breast Cancer Detection Demonstration Project: five-year summary report. CA Cancer J Clin. 1982;32:194–225.CrossRefPubMedGoogle Scholar
  18. 18.
    Bolmgren J, Jacobson B, Nordenstrom B. Stereotaxic instrument for needle biopsy of the mamma. AJR Am J Roentgenol. 1977;129:121–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Svane G, Silfversward C. Stereotaxic needle biopsy of non-palpable breast lesions. Cytologic and histopathologic findings. Acta Radiol Diagn (Stockh). 1983;24:283–8.CrossRefGoogle Scholar
  20. 20.
    Azavedo E, Svane G, Auer G. Stereotactic fine-needle biopsy in 2594 mammographically detected non-palpable lesions. Lancet. 1989;1(8646):1033–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Gent HJ, Sprenger E, Dowlatshahi K. Stereotaxic needle localization and cytological diagnosis of occult breast lesions. Ann Surg. 1986;204(5):580–4.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Dowlatshahi K, Yaremko ML, Kluskens LF, Jokich PM. Nonpalpable breast lesions: findings of stereotaxic needle-core biopsy and fine-needle aspiration cytology. Radiology. 1991;181:745–50.CrossRefPubMedGoogle Scholar
  23. 23.
    Parker SH, Lovin JD, Jobe WE, Burke BJ, Hopper KD, Yakes WF. Nonpalpable breast lesions: stereotactic automated large-core biopsies. Radiology. 1991;180:403–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Doyle AJ, Murray KA, Nelson EW, Bragg DG. Selective use of image-guided large-core needle biopsy of the breast: accuracy and cost-effectiveness. AJR Am J Roentgenol. 1995;165(2):281–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Jackman RJ, Nowels KW, Shepard MJ, Finkelstein SI, Marzoni Jr FA. Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Radiology. 1994;193(1):91–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Kettritz U, Rotter K, Schreer I, Murauer M, Schulz-Wendtland R, Peter D, et al. Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer. 2004;100(2):245–51.CrossRefPubMedGoogle Scholar
  27. 27.
    Pisano ED, Yaffe MJ. Digital mammography. Radiology. 2005;234:353–62.CrossRefPubMedGoogle Scholar
  28. 28.
    Skaane P, Skjennald A. Screen-film mammography versus full-field digital mammography with soft-copy reading: randomized trial in a population-based screening program–the Oslo II Study. Radiology. 2004;232(1):197–204.CrossRefPubMedGoogle Scholar
  29. 29.
    Bassett L, Winchester DP, Caplan RB, Dershaw DD, Dowlatshahi K, Evans 3rd WP, et al. Stereotactic core-needle biopsy of the breast: a report of the Joint Task Force of the American College of Radiology, American College of Surgeons, and College of American Pathologists CA. Cancer J Clin. 1997;47(3):171–90.CrossRefGoogle Scholar
  30. 30.
    Kerlikowske K, Grady D, Barclay J, et al. Variability and accuracy in mammographic interpretation using the American College of Radiology Breast Imaging Reporting and Data System. J Natl Cancer Inst. 1998;90:1801–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Staren ED, Fine R. Breast ultrasound for surgeons. Am Surg. 1996;62:108–12.PubMedGoogle Scholar
  32. 32.
    Jackson VP, Reynolds HE, Hawes DR. Sonography of the breast Semin. Ultrasound CT MR. 1996;17(5):460–75.CrossRefGoogle Scholar
  33. 33.
    Kopans DB, Feig SA, Sickles EA. Malignant breast masses detected only by ultrasound: a retrospective review. Cancer. 1996;77(1):208–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Dowlatshahi K, Dieschbourg J. Shift in the surgical treatment of non-palpable breast cancer: tactile to visual. Breast Cancer Online. 2005;9:1–10.CrossRefGoogle Scholar
  35. 35.
    Smith LF, Rubio IT, Henry-Tillman R, Korourian S, Klimberg VS. Intraoperative ultrasound-guided breast biopsy. Am J Surg. 2000;180(6):419–23.CrossRefPubMedGoogle Scholar
  36. 36.
    Kaufman CS, Jacobson L, Bachman B, Kaufman L. Intraoperative ultrasound facilitates surgery for early breast cancer. Ann Surg Oncol. 2002;9(10):988–93.CrossRefPubMedGoogle Scholar
  37. 37.
    Kaufman CS, Bachman B, Littrup PJ, White M, Carolin KA, Freman-Gibb L, Francescatti D, Stocks LH, Smith S, Henry CA, Bailey L, Harness JK, Simmons R. Office-based ultrasound-guided cryoablation of breast fibroadenomas. Am J Surg. 2002;184:394–400.CrossRefPubMedGoogle Scholar
  38. 38.
    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;11:542–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Littrup PJ, Jallad B, Chandiwala-Mody P, D’Agostini M, Adam BA, Bouwman D. Cryotherapy for breast cancer: a feasibility study without excision. J Vasc Interv Radiol. 2009;20(10):1329–41.CrossRefPubMedGoogle Scholar
  40. 40.
    Nunes LW, Schnall MD, Orel SG, et al. Breast MR imaging: interpretation model. Radiology. 1997;202:833–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Morris EA, Liberman L, Ballon DJ, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol. 2003;181:619–26.CrossRefPubMedGoogle Scholar
  42. 42.
    Eby PR, Lehman CD. Magnetic resonance imaging–guided breast interventions. Top Magn Reson Imaging. 2008;19(3):151–62.CrossRefPubMedGoogle Scholar
  43. 43.
    Leach MO. Breast cancer screening in women at high risk using MRI. NMR Biomed. 2009;22:17–27.CrossRefPubMedGoogle Scholar
  44. 44.
    Pickles MD, Lowry M, Manton DJ, Gibbs P, Turnbull LW. Role of dynamic contrast enhanced MRI in monitoring early response of locally advanced breast cancer to neoadjuvant chemotherapy. Breast Cancer Res Treat. 2005;91(1):1–10.CrossRefPubMedGoogle Scholar
  45. 45.
    Breast Cancer: Early Detection, Diagnosis, and Staging. Available at: (2010). Accessed 27 Sep 2010.
  46. 46.
    Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med. 2004;351(5):427–37.CrossRefPubMedGoogle Scholar
  47. 47.
    Berg WA, Weinberg IN, Narayanan D, Lobrano ME, Ross E, Amodei L, et al. High-resolution fluorodeoxyglucose positron emission tomography with compression (“positron emission mammography”) is highly accurate in depicting primary breast cancer. Breast J. 2006;12(4):309–23.CrossRefPubMedGoogle Scholar
  48. 48.
    Tafra L. Positron Emission Tomography (PET) and Mammography (PEM) for breast cancer: importance to surgeons. Ann Surg Oncol. 2007;14:3–13.CrossRefPubMedGoogle Scholar
  49. 49.
    Fine RE, Staren ED. Percutaneous radiofrequency-assisted excision of fibroadenomas. Am J Surg. 2006;192:545–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Fine RE, Whitworth PW, Kim JA, Harness JK, Boyd BA, Burak Jr WE. Low-risk palpable breast masses removed using a vacuum-assisted hand-held device. Am J Surg. 2003;186:362–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Kim MJ, Park BW, Kim SI, Youk JH, Kwak JY, Moon HJ, et al. Long-term follow-up results for ultrasound-guided vacuum-assisted removal of benign palpable breast mass. Am J Surg. 2010;199(1):1–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Corn CC. Review of 125 SiteSelect stereotactic large-core breast biopsy procedures. Breast J. 2003;9:147–52.CrossRefPubMedGoogle Scholar
  53. 53.
    Sie A, Bryan DC, Gaines V, et al. Multicenter evaluation of the breast lesion excision system, a percutaneous, vacuum-assisted, intact-specimen breast biopsy device. Cancer. 2006;107:945–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Sabel MS, Nehs MA, Su G, Lowler K, Ferrara JLM, Chang AE. Immunologic response to cryoablation of breast cancer. Breast Cancer Res Treat. 2005;90(1):97–104.CrossRefPubMedGoogle Scholar
  55. 55.
    Dowlatshahi K, Dieschbourg JJ, Bloom KJ. Laser therapy of breast cancer with 3-year follow-up. Breast J. 2004;10:240–3.CrossRefPubMedGoogle Scholar
  56. 56.
    Dowlatshahi K, Fan M, Gould VE, Bloom KJ, Ali A. Stereotactically guided laser therapy of occult breast tumors: work-in-progress report. Arch Surg. 2000;135:1345–52.CrossRefPubMedGoogle Scholar
  57. 57.
    Dowlatshahi K, Francescatti DS, Bloom KJ. Laser therapy for small breast cancers. Am J Surg. 2002;184:359–63.CrossRefPubMedGoogle Scholar
  58. 58.
    Goldstein NS. Laser therapy for small breast cancers. Am J Surg. 2004;187:149–50.CrossRefPubMedGoogle Scholar
  59. 59.
    Mumtaz H, Hall-Craggs MA, Wotherspoon A, et al. Laser therapy for breast cancer: MR imaging and histopathologic correlation. Radiology. 1996;200:651–8.CrossRefPubMedGoogle Scholar
  60. 60.
    Izzo F, Thomas R, Delrio P, et al. Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients. Cancer. 2001;92:2036–44.CrossRefPubMedGoogle Scholar
  61. 61.
    Singletary SE. Applications of radiofrequency ablation in the treatment of breast cancer. Breast Cancer Online. 2005;8(9):1–4.CrossRefGoogle Scholar
  62. 62.
    Burak Jr WE, Agnese DM, Povoski SP, et al. Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision. Cancer. 2003;98:1369–76.CrossRefPubMedGoogle Scholar
  63. 63.
    Klimberg VS, Kepple J, Shafirstein G, Adkins L, Henry-Tilman R, Youssef E, Brito J, Talley L, Korourian S. eRFA: excision followed by RFA-a new technique to improve local control in breast cancer. Ann Surg Oncol. 2006;13(11):1422–33.CrossRefPubMedGoogle Scholar
  64. 64.
    Vargas HI, Dooley WC, Gardner RA, Gonzalez KD, Venegas R, Heywang-Kobrunner SH, Fenn AJ. Focused microwave phased array thermotherapy for ablation of early-stage breast cancer: results of thermal dose escalation. Ann Surg Oncol. 2004;11:139–46.CrossRefPubMedGoogle Scholar
  65. 65.
    Wu F, Wang ZB, Cao YD, et al. Heat fixation of cancer cells ablated with high-intensity-focused ultrasound in patients with breast cancer. Am J Surg. 2006;192:179–84.CrossRefPubMedGoogle Scholar
  66. 66.
    Wu F, Wang ZB, Zhu H, Chen WZ, Zou JZ, Bai J, Li KQ, Jin CB, Xie FL, Su HB. Extracorporeal high intensity focused ultrasound treatment for patients with breast cancer. Breast Cancer Res Treat. 2005;92(1):51–60.CrossRefPubMedGoogle Scholar
  67. 67.
    Dowlatshahi K, Snider H, Lerner AG. Who should perform image-guided breast biopsy and treatment? Am J Surg. 2007;194(3):275–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kambiz Dowlatshahi
    • 1
  • Rosalinda Alvarado
    • 2
  • Katherine Kopckash
    • 3
  1. 1.Department of General SurgeryRush University Medical CenterChicagoUSA
  2. 2.Department of General SurgeryRush University Medical CenterChicagoUSA
  3. 3.Department of SurgeryRush University Medical CenterChicagoUSA

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