Guglielmo Manenti MD, Presenter: Nothing to Disclose

Tommaso Perretta MD, Abstract Co-Author: Nothing to Disclose

Elsa Cossu MD, Abstract Co-Author: Nothing to Disclose

Chiara Adriana Pistolese, Abstract Co-Author: Nothing to Disclose

Francesca Bolacchi, Abstract Co-Author: Nothing to Disclose

Giovanni Simonetti MD, Abstract Co-Author: Nothing to Disclose

Salvatore Masala MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate efficacy, procedural acceptability, technical success, completeness of ablation on marginal clearance and cosmesis of radiofrequency ablation versus cryoablation in non-palpable VAB assessed ≤ 2 cm small breast cancer without significant intra-ductal component.  

40 patients with VAB assessed unique invasive breast carcinomas (mean diameter 1.5 ± 0,38 cm) underwent sonographically guided cryo or radiofrequency ablation after i.v. sedation. Standard of care delayed breast conserving therapy surgical tumor removal after sentinel node excision was performed in all patients. Linear dimensions and volume of pre-treatment lesion and post-treatment ablative cavum were quantified by 3T breast DCE- MRI using an automated segmentation software. Pathologic analysis of H&E and NADH-stained specimens as gold standard was performed to verify the completeness of tumor necrosis and the marginal clearance. Technical success, completeness of ablation, size of ablative cavum, correlation of MRI with histopathology, skin damage, patient reports of pain and procedural acceptability and tolerability along with cosmesis immediately after the ablation and before surgery were tabulated in a five-score evaluation scale in all patients.

Technical success of percutaneous ablation with single probe cooled-tip RFA electrode and double probe cryotherapy was the same (96%). DCE-MRI sensibility (89%) and specificity (77%) allowed to identify residual enhancement consistent with vital tumor cells in the lesion margins that were histologically confirmed with NADH-staining and CK-7. The 18 cryoablated patients gained higher evaluation scores. The residual 22 patients treated with RFA presented treatment-related complications (moderate to deep skin burns, breast swelling, persistent heaviness sensation), treatment related pain with a definitive cosmesis equal to surgical lumpectomy in 35% cases.

US-guided percutaneous ablation of small selected invasive breast carcinoma is feasible, reliable and effective without significant complications. Moderate patient discomfort and local skin burns are common with RFA. Cryoablation is more expensive but has better cosmetic score and patient acceptability.

Percutaneous ablation is a feasible and effective tecnique for selected small invasive breast cancers reducing operative risks with a better cosmetic outcome.

Manenti, G, Perretta, T, Cossu, E, Pistolese, C, Bolacchi, F, Simonetti, G, Masala, S, et al, , Percutaneous Ablation of Small Breast Carcinoma: 5-year Single-center Experience.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6015127.html