Gary Michael Levine MD, Presenter: Nothing to Disclose

Steven P. Poplack MD, Abstract Co-Author: Nothing to Disclose

Richard Barth MD, Abstract Co-Author: Nothing to Disclose

Scott Heinemann MD, Abstract Co-Author: Nothing to Disclose

Wendy Wells, Abstract Co-Author: Nothing to Disclose

Lincoln Snyder MD, Abstract Co-Author: Nothing to Disclose

Colleen Coleman MD, Abstract Co-Author: Nothing to Disclose

Melvin Silverstein MD, Abstract Co-Author: Consultant, Beekley Corp Consultant, Vector Surgical Consultant, Johnson & Johnson

To evaluate the ability of breast CEMRI to assess the effectiveness of US guided cryoablation for the local treatment of small, unifocal IDC.

Patients with unifocal ≤ 15mm newly diagnosed IDC underwent an "early" pre-ablation CEMRI to insure the small unifocal nature of the tumor and establish its MR enhancement pattern. US guided cryoablation was then performed using a Visica® Treatment System to ablate the malignant tumor and a margin of surrounding tissue. A "delayed" CEMRI was performed approximately 4 weeks post-ablation followed 1-3 days later by a standard surgical lumpectomy. The early and delayed CEMRI findings were correlated with the surgical histopathology.

Fifteen patients underwent tumor cryoablation and subsequent lumpectomy with histopathologic-CEMRI correlation. In all cases, the post-ablation MRI's showed no suspicious contrast enhancement remaining at the targeted tumor site and histopathology confirmed complete tumor kill within the intended ablation zone. In 3 cases histopathology confirmed residual DCIS and/or small (≤ 3mm) satellite lesions outside the cryoablation zone that were occult on both the early and delayed CEMRI. In one of these 3 cases a residual focus of invasive cancer of 4mm was also found on histopathology, occult on the early MRI, but predicted by the delayed MRI. At delayed CEMRI, previously unreported characteristic and reproducible findings of signal void on post-contrast subtraction images ("black hole") correlates with an area of coagulation necrosis at the cryoablation site and a surrounding uniform thin rim enhancement ("cryohalo") corresponds to a zone of inflammation at the cryoablation margin.

Preliminary results confirm the effectiveness of US guided cryoablation to completely eradicate small, unifocal IDC. Lack of residual suspicious enhancement on post-cryoablation CEMRI appears to correlate with complete tumor kill within the targeted ablation zone, though CEMRI may be unable to resolve ≤ 3mm foci of IDC/DCIS outside the ablation zone. Novel MR findings termed "black hole" and "cryohalo" serve as markers for successful ablation.

In selected "early" IDC breast cancers, US guided cryoablation with MRI confirmation may offer the same therapeutic benefit as lumpectomy with less morbidity, improved cosmesis and less cost.

Levine, G, Poplack, S, Barth, R, Heinemann, S, Wells, W, Snyder, L, Coleman, C, Silverstein, M, New Findings on Contrast-enhanced Magnetic Resonance Imaging (CEMRI), the "Black Hole" and "Cryohalo" are Markers for the Efficacy of Ultrasound (US)-guided Cryoablation of Small (≤15mm) Unifocal Invasive Ductal Breast Cancer (IDC).  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012933.html