Peter John Littrup MD, Presenter: Founder, CryoMedix, LLC Research grant, Galil Medical Ltd Research grant, Endo Pharmaceuticals Holdings, Inc

1. Understand the breast cancer biology related to stage and treatment options. 2. Describe breast imaging considerations for initial work-up, guidance options and follow-up. 3. Describe the major pros and cons related to ablation technologies that have been used for breast cancer: radiofrequency, microwave, high intensity focused ultrasound (HIFU), interstitial laser and cryoablation. 4. As the 2 best visualized ablation technologies, highlight the major socioeconomic issues related to broadening the acceptance/use of MR-guided HIFU and cryoablation. 5. Understand basic cryotechnology aspects that will likely affect broader utilization and improved MR-compatibility.  

Thermal ablation devices, which cause tissue necrosis through freezing or heat, are being studied as local treatment for primary breast cancer. To date, the US Food and Drug Administration (FDA) has not granted disease-specific approval or clearance for image-guided thermal ablation as local therapy for breast cancer. Some ablation techniques have FDA clearance for treatment of benign tumors or use during general oncologic procedures. Ongoing trials are studying the feasibility of ablating small primary tumors, using predominantly pathological confirmation to determine if the tumor has been completely destroyed. Literature reports have described use of cryoablation, radiofrequency ablation, focused ultrasound, interstitial laser, and microwave thermal ablation devices, incorporating real-time imaging to guide the thermal ablation of breast cancer procedures. Breast MR is crucial to pretreatment planning and follow-up as the most accurate breast imaging modality for both tumor and ablation zone size and extent. Procedural guidance is most easily done by US or CT but may require transition to improved MR compatible cryotechnology with single phased liquid cooling. Future imaging may also be more cost-effective with US tomography rather than reliance on MR alone.

Littrup, P, Ablation of Breast Tumors.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003428.html