title: Office-based ultrasound-guided cryoablation of breast fibroadenomas.
abstract: BACKGROUND
  Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas.
  
  
  METHODS
  A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation.
  
  
  RESULTS
  Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent.
  
  
  CONCLUSIONS
  With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.
authors.affiliation: Department of Surgery, University of Washington, Bellingham Breast Center, 2940 Squalicum Pkwy., Suite 101, Bellingham, WA 98225, USA. Breastcare@aol.com
authors.forename: Cary S
authors.initials: CS
authors.lastname: Kaufman
authors.forename: Barbara
authors.initials: B
authors.lastname: Bachman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
authors.forename: Michael
authors.initials: M
authors.lastname: White
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carolin
authors.forename: Laurie
authors.initials: L
authors.lastname: Freman-Gibb
authors.forename: Darius
authors.initials: D
authors.lastname: Francescatti
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Stocks
authors.forename: J Stanley
authors.initials: JS
authors.lastname: Smith
authors.forename: C Alan
authors.initials: CA
authors.lastname: Henry
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey
authors.forename: Jay K
authors.initials: JK
authors.lastname: Harness
authors.forename: Rache
authors.initials: R
authors.lastname: Simmons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000772:Anesthesia, Local; D001706:Biopsy; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D018226:Fibroadenoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010146:Pain; D017060:Patient Satisfaction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional