Radiofrequency Ablation Potential Treatment For Small Breast Cancers

NEW YORK (Reuters Health) - Ultrasound-guided radiofrequency (RF) ablation for the local treatment of small invasive breast malignancies with clear borders appears to be feasible and safe, physicians report.

RF ablation is increasingly being tested as a minimally invasive means of destroying solid tumors (see Reuters Health reports, March 19, 2004, April 21, 2003). In the April issue of Radiology, Dr. Bruno D. Fornage and associates at the University of Texas M. D. Anderson Cancer Center in Houston describe their experience treating breast tumors of 2 cm or less in diameter.

They evaluated 20 patients who had already undergone histopathologic diagnosis (19 ductal carcinomas, 2 lobular carcinomas) and lumpectomy or mastectomy immediately after RF ablation. Under real-time ultrasound guidance, the umbrella-like prongs of the RF electrode were placed and maintained at 95 degrees for 5 minutes.

Histologic staining of the surgery specimens revealed complete loss of tumor cell viability in all the tumors that could be visualized by ultrasound, with minimum margins of 0.2 to 2.0 cm.

In one patient who had undergone neoadjuvant chemotherapy prior to surgery, microscopic examination revealed residual foci of viable invasive ductal carcinoma surrounding the ablated lesion that could not be visualized on sonograms or mammograms.

Therefore, Dr. Fornage's group no longer performs RF ablation that relies on the ultrasound visualization of tumors in patients who have undergone preoperative chemotherapy. They also advise against RF ablation for invasive lobular carcinomas or other tumors likely to harbor microscopic disease extension.

Another potential problem they identified was the inability to assess the margins of ablated lesions. They recommend multiple needle biopsy specimens and sentinel lymph node mapping about a month after the procedure to confirm successful destruction of the entire cancer. Because scar tissue may limit visibility, patients may need follow-up with MR or PET imaging.

It remains to be seen if scarring is less pronounced with this technique than that associated with standard surgery, the authors add. The level of anesthesia also needs to be determined, as well as whether long-term local tumor control can be attained.

Source: Radiology 2004;231:215-224. [ Google search on this article ]

MeSH Headings: Breast Neoplasms : Neoplasms : Neoplasms by Site : Diseases