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Image-Guided Procedures
Image-Guided Thermal Ablation, Breast
Image-Guided Thermal Ablation, Breast
R. Jason Stafford, PhD; Marilyn Roubidoux, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Outcomes

      TERMINOLOGY

      • Definitions

        • Thermal ablation: Targeted in situ tissue destruction via exposure to extreme high or low temperatures using nonionizing modalities
          • Thresholds for damage approximately > 50°C for heating and < -20°C for cooling
            • Depend on heat/cool rate and exposure time
          • Thermal dose models estimate tissue damage using tissue temperature history
        • Focused ultrasound surgery (FUS): Conformal heating of target tissue using highly focused acoustic energy
          • Generally delivered noninvasively using extracorporeal transducer array (1–2 MHz)
            • Acoustic coupling to patient and path to target
            • Damage small & requires multiple shots for conformal volume coverage
        • Interstitial ablative therapies: Image-guided percutaneous placement of treatment applicators for minimally invasive local heating/cooling
        • Radiofrequency ablation (RFA): Heating mediated by radiofrequency-induced current in conductive tissue
          • High current density induced near interstitial metal electrode attached to RF generator
            • Power ~ 200 W operating at 400-800 kHz
            • Joule (resistive) heating via ionic agitation
          • Grounding pad on skin disperses current density in tissue away from electrode
          • Electrode cooling employed to minimize conduction loss and generate larger lesions
        • Microwave ablation (MWA): Heating mediated by electromagnetic agitation of tissue water (dielectric heating)
          • Dielectric heating less effective in low water-content tissue (i.e., adipose)
          • MW generator attached to metal antenna
            • Power 10-200 W operating at 0.9-2.5 GHz
            • Interstitial cooled antenna for controlling lesion shape and size
          • External antenna can be used for noninvasive "focal" approach to MWA
        • Laser ablation (LA): Heating mediated via local tissue light absorption
          • Laser fibers deliver high-power density of light (800-1,064 nm)
          • Cooled applicators facilitate rapid, large lesion formation
        • Cryoablation: Freezing mediated by rapid cooling of metal probe
          • 2 cool-thaw (< -40°C) cycles for biological effectiveness
          • Cooling: Rapid argon gas expansion (Joule-Thompson effect) or liquid nitrogen
          • Thaw: Passive or active (rapid helium gas expansion)

      PRE-PROCEDURE

      • Requirements

        • Patient Preparation for Interstitial Image-Guided Therapy

          PROCEDURE

          • Image Guidance

            • Treatment Monitoring

              • Focused Ultrasound Surgery

                • Radiofrequency Ablation

                  • Microwave Ablation Therapy

                    • Laser Ablation

                      • Cryoablation

                        OUTCOMES

                        • Problems

                          • Complications

                            • Summary of Limitations and Disadvantages

                              • Advantages

                                Selected References

                                1. Vilar VS et al: Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer. AJR Am J Roentgenol. 198(3):W285-91, 2012
                                2. Zhou W et al: US-guided percutaneous microwave coagulation of small breast cancers: a clinical study. Radiology. 263(2):364-73, 2012
                                3. Ahmed M et al: Principles of and advances in percutaneous ablation. Radiology. 258(2):351-69, 2011
                                4. Manenti G et al: Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy. Eur Radiol. 21(11):2344-53, 2011
                                5. Ohtani S et al: Radiofrequency ablation of early breast cancer followed by delayed surgical resection--a promising alternative to breast-conserving surgery. Breast. 20(5):431-6, 2011
                                6. Sharma R et al: Ablative therapies of the breast. Surg Oncol Clin N Am. 20(2):317-39, viii, 2011
                                7. Tempany CM et al: Focused ultrasound surgery in oncology: overview and principles. Radiology. 259(1):39-56, 2011
                                8. Tsuda H et al: A histopathological study for evaluation of therapeutic effects of radiofrequency ablation in patients with breast cancer. Breast Cancer. 18(1):24-32, 2011
                                9. Zhao Z et al: Minimally-invasive thermal ablation of early-stage breast cancer: a systemic review. Eur J Surg Oncol. 36(12):1149-55, 2010
                                10. Goldberg SN et al: Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 20(7 Suppl):S377-90, 2009
                                11. Littrup PJ et al: Cryotherapy for breast cancer: a feasibility study without excision. J Vasc Interv Radiol. 20(10):1329-41, 2009
                                12. Noguchi M: Radiofrequency ablation therapy for small breast cancer. Semin Ultrasound CT MR. 30(2):105-12, 2009
                                13. Kaiser WA et al: MRI-guided interventions of the breast. J Magn Reson Imaging. 27(2):347-55, 2008
                                14. Rieke V et al: MR thermometry. J Magn Reson Imaging. 27(2):376-90, 2008
                                15. Punglia RS et al: Local therapy and survival in breast cancer. N Engl J Med. 356(23):2399-405, 2007
                                16. van Esser S et al: Minimally invasive ablative therapies for invasive breast carcinomas: an overview of current literature. World J Surg. 31(12):2284-92, 2007
                                17. Vlastos G et al: Minimally invasive approaches for diagnosis and treatment of early-stage breast cancer. Oncologist. 12(1):1-10, 2007
                                18. Agnese DM et al: Ablative approaches to the minimally invasive treatment of breast cancer. Cancer J. 11(1):77-82, 2005
                                19. Huston TL et al: Ablative therapies for the treatment of malignant diseases of the breast. Am J Surg. 189(6):694-701, 2005
                                20. Kaufman CS et al: Office-based cryoablation of breast fibroadenomas with long-term follow-up. Breast J. 11(5):344-50, 2005
                                21. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                22. Copeland EM 3rd et al: Are minimally invasive techniques for ablation of breast cancer ready for "Prime Time"? Ann Surg Oncol. 11(2):115-6, 2004
                                23. Fornage BD et al: Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study. Radiology. 231(1):215-24, 2004
                                24. Kacher DF et al: MR imaging--guided breast ablative therapy. Radiol Clin North Am. 42(5):947-62, vii, 2004
                                25. Morin J et al: Magnetic resonance-guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results. Can J Surg. 47(5):347-51, 2004
                                26. Roubidoux MA et al: Small (< 2.0-cm) breast cancers: mammographic and US findings at US-guided cryoablation--initial experience. Radiology. 233(3):857-67, 2004
                                27. Sabel MS et al: Cryoablation of early-stage breast cancer: work-in-progress report of a multi-institutional trial. Ann Surg Oncol. 11(5):542-9, 2004
                                28. Gianfelice D et al: MR imaging-guided focused US ablation of breast cancer: histopathologic assessment of effectiveness-- initial experience. Radiology. 227(3):849-55, 2003
                                29. Singletary ES: Feasibility of radiofrequency ablation for primary breast cancer. Breast Cancer. 10(1):4-9, 2003
                                30. Dowlatshahi K et al: Laser therapy for small breast cancers. Am J Surg. 184(4):359-63, 2002
                                31. Pfleiderer SO et al: Cryotherapy of breast cancer under ultrasound guidance: initial results and limitations. Eur Radiol. 12(12):3009-14, 2002
                                32. Faverly DR et al: Breast carcinomas of limited extent: frequency, radiologic-pathologic characteristics, and surgical margin requirements. Cancer. 91(4):647-59, 2001
                                33. Huber PE et al: A new noninvasive approach in breast cancer therapy using magnetic resonance imaging-guided focused ultrasound surgery. Cancer Res. 61(23):8441-7, 2001
                                34. Hynynen K et al: MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology. 219(1):176-85, 2001
                                35. Hynynen K et al: Temperature monitoring in fat with MRI. Magn Reson Med. 43(6):901-4, 2000
                                36. Jeffrey SS et al: Radiofrequency ablation of breast cancer: first report of an emerging technology. Arch Surg. 134(10):1064-8, 1999
                                37. Mumtaz H et al: Biopsy and Intervention Working Group report. J Magn Reson Imaging. 10(6):1010-5, 1999
                                38. Ablin RJ: The use of cryosurgery for breast cancer. Arch Surg. 133(1):106, 1998
                                39. Kuroda K et al: Temperature mapping using the water proton chemical shift: a chemical shift selective phase mapping method. Magn Reson Med. 38(5):845-51, 1997
                                40. Mumtaz H et al: Laser therapy for breast cancer: MR imaging and histopathologic correlation. Radiology. 200(3):651-8, 1996
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Outcomes

                                    TERMINOLOGY

                                    • Definitions

                                      • Thermal ablation: Targeted in situ tissue destruction via exposure to extreme high or low temperatures using nonionizing modalities
                                        • Thresholds for damage approximately > 50°C for heating and < -20°C for cooling
                                          • Depend on heat/cool rate and exposure time
                                        • Thermal dose models estimate tissue damage using tissue temperature history
                                      • Focused ultrasound surgery (FUS): Conformal heating of target tissue using highly focused acoustic energy
                                        • Generally delivered noninvasively using extracorporeal transducer array (1–2 MHz)
                                          • Acoustic coupling to patient and path to target
                                          • Damage small & requires multiple shots for conformal volume coverage
                                      • Interstitial ablative therapies: Image-guided percutaneous placement of treatment applicators for minimally invasive local heating/cooling
                                      • Radiofrequency ablation (RFA): Heating mediated by radiofrequency-induced current in conductive tissue
                                        • High current density induced near interstitial metal electrode attached to RF generator
                                          • Power ~ 200 W operating at 400-800 kHz
                                          • Joule (resistive) heating via ionic agitation
                                        • Grounding pad on skin disperses current density in tissue away from electrode
                                        • Electrode cooling employed to minimize conduction loss and generate larger lesions
                                      • Microwave ablation (MWA): Heating mediated by electromagnetic agitation of tissue water (dielectric heating)
                                        • Dielectric heating less effective in low water-content tissue (i.e., adipose)
                                        • MW generator attached to metal antenna
                                          • Power 10-200 W operating at 0.9-2.5 GHz
                                          • Interstitial cooled antenna for controlling lesion shape and size
                                        • External antenna can be used for noninvasive "focal" approach to MWA
                                      • Laser ablation (LA): Heating mediated via local tissue light absorption
                                        • Laser fibers deliver high-power density of light (800-1,064 nm)
                                        • Cooled applicators facilitate rapid, large lesion formation
                                      • Cryoablation: Freezing mediated by rapid cooling of metal probe
                                        • 2 cool-thaw (< -40°C) cycles for biological effectiveness
                                        • Cooling: Rapid argon gas expansion (Joule-Thompson effect) or liquid nitrogen
                                        • Thaw: Passive or active (rapid helium gas expansion)

                                    PRE-PROCEDURE

                                    • Requirements

                                      • Patient Preparation for Interstitial Image-Guided Therapy

                                        PROCEDURE

                                        • Image Guidance

                                          • Treatment Monitoring

                                            • Focused Ultrasound Surgery

                                              • Radiofrequency Ablation

                                                • Microwave Ablation Therapy

                                                  • Laser Ablation

                                                    • Cryoablation

                                                      OUTCOMES

                                                      • Problems

                                                        • Complications

                                                          • Summary of Limitations and Disadvantages

                                                            • Advantages

                                                              Selected References

                                                              1. Vilar VS et al: Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer. AJR Am J Roentgenol. 198(3):W285-91, 2012
                                                              2. Zhou W et al: US-guided percutaneous microwave coagulation of small breast cancers: a clinical study. Radiology. 263(2):364-73, 2012
                                                              3. Ahmed M et al: Principles of and advances in percutaneous ablation. Radiology. 258(2):351-69, 2011
                                                              4. Manenti G et al: Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy. Eur Radiol. 21(11):2344-53, 2011
                                                              5. Ohtani S et al: Radiofrequency ablation of early breast cancer followed by delayed surgical resection--a promising alternative to breast-conserving surgery. Breast. 20(5):431-6, 2011
                                                              6. Sharma R et al: Ablative therapies of the breast. Surg Oncol Clin N Am. 20(2):317-39, viii, 2011
                                                              7. Tempany CM et al: Focused ultrasound surgery in oncology: overview and principles. Radiology. 259(1):39-56, 2011
                                                              8. Tsuda H et al: A histopathological study for evaluation of therapeutic effects of radiofrequency ablation in patients with breast cancer. Breast Cancer. 18(1):24-32, 2011
                                                              9. Zhao Z et al: Minimally-invasive thermal ablation of early-stage breast cancer: a systemic review. Eur J Surg Oncol. 36(12):1149-55, 2010
                                                              10. Goldberg SN et al: Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 20(7 Suppl):S377-90, 2009
                                                              11. Littrup PJ et al: Cryotherapy for breast cancer: a feasibility study without excision. J Vasc Interv Radiol. 20(10):1329-41, 2009
                                                              12. Noguchi M: Radiofrequency ablation therapy for small breast cancer. Semin Ultrasound CT MR. 30(2):105-12, 2009
                                                              13. Kaiser WA et al: MRI-guided interventions of the breast. J Magn Reson Imaging. 27(2):347-55, 2008
                                                              14. Rieke V et al: MR thermometry. J Magn Reson Imaging. 27(2):376-90, 2008
                                                              15. Punglia RS et al: Local therapy and survival in breast cancer. N Engl J Med. 356(23):2399-405, 2007
                                                              16. van Esser S et al: Minimally invasive ablative therapies for invasive breast carcinomas: an overview of current literature. World J Surg. 31(12):2284-92, 2007
                                                              17. Vlastos G et al: Minimally invasive approaches for diagnosis and treatment of early-stage breast cancer. Oncologist. 12(1):1-10, 2007
                                                              18. Agnese DM et al: Ablative approaches to the minimally invasive treatment of breast cancer. Cancer J. 11(1):77-82, 2005
                                                              19. Huston TL et al: Ablative therapies for the treatment of malignant diseases of the breast. Am J Surg. 189(6):694-701, 2005
                                                              20. Kaufman CS et al: Office-based cryoablation of breast fibroadenomas with long-term follow-up. Breast J. 11(5):344-50, 2005
                                                              21. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                                              22. Copeland EM 3rd et al: Are minimally invasive techniques for ablation of breast cancer ready for "Prime Time"? Ann Surg Oncol. 11(2):115-6, 2004
                                                              23. Fornage BD et al: Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study. Radiology. 231(1):215-24, 2004
                                                              24. Kacher DF et al: MR imaging--guided breast ablative therapy. Radiol Clin North Am. 42(5):947-62, vii, 2004
                                                              25. Morin J et al: Magnetic resonance-guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results. Can J Surg. 47(5):347-51, 2004
                                                              26. Roubidoux MA et al: Small (< 2.0-cm) breast cancers: mammographic and US findings at US-guided cryoablation--initial experience. Radiology. 233(3):857-67, 2004
                                                              27. Sabel MS et al: Cryoablation of early-stage breast cancer: work-in-progress report of a multi-institutional trial. Ann Surg Oncol. 11(5):542-9, 2004
                                                              28. Gianfelice D et al: MR imaging-guided focused US ablation of breast cancer: histopathologic assessment of effectiveness-- initial experience. Radiology. 227(3):849-55, 2003
                                                              29. Singletary ES: Feasibility of radiofrequency ablation for primary breast cancer. Breast Cancer. 10(1):4-9, 2003
                                                              30. Dowlatshahi K et al: Laser therapy for small breast cancers. Am J Surg. 184(4):359-63, 2002
                                                              31. Pfleiderer SO et al: Cryotherapy of breast cancer under ultrasound guidance: initial results and limitations. Eur Radiol. 12(12):3009-14, 2002
                                                              32. Faverly DR et al: Breast carcinomas of limited extent: frequency, radiologic-pathologic characteristics, and surgical margin requirements. Cancer. 91(4):647-59, 2001
                                                              33. Huber PE et al: A new noninvasive approach in breast cancer therapy using magnetic resonance imaging-guided focused ultrasound surgery. Cancer Res. 61(23):8441-7, 2001
                                                              34. Hynynen K et al: MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology. 219(1):176-85, 2001
                                                              35. Hynynen K et al: Temperature monitoring in fat with MRI. Magn Reson Med. 43(6):901-4, 2000
                                                              36. Jeffrey SS et al: Radiofrequency ablation of breast cancer: first report of an emerging technology. Arch Surg. 134(10):1064-8, 1999
                                                              37. Mumtaz H et al: Biopsy and Intervention Working Group report. J Magn Reson Imaging. 10(6):1010-5, 1999
                                                              38. Ablin RJ: The use of cryosurgery for breast cancer. Arch Surg. 133(1):106, 1998
                                                              39. Kuroda K et al: Temperature mapping using the water proton chemical shift: a chemical shift selective phase mapping method. Magn Reson Med. 38(5):845-51, 1997
                                                              40. Mumtaz H et al: Laser therapy for breast cancer: MR imaging and histopathologic correlation. Radiology. 200(3):651-8, 1996