title: Cryotherapy for breast fibroadenomas.
abstract: OBJECTIVE
  To assess freezing protocols, imaging, and clinical outcomes of percutaneous ultrasonographically (US)-guided cryotherapy for breast fibroadenomas.
  
  
  METHODS
  Institutional review board approval and patient consent were obtained. Forty-two biopsy-confirmed fibroadenomas were treated in 29 patients (mean age, 27 years) by using a 2.4-mm cryoprobe inserted into the fibroadenoma with US guidance. The first seven patients underwent conscious sedation, but the other 22 patients required only local anesthesia. US and thermocouple monitoring of the procedure were performed to evaluate freeze protocols based on tumor size. Saline injections protected the skin and/or chest wall. US follow-up was performed at 1 week and at 1, 3, 6, and 12 months. Pre- and 12-month postcryotherapy mammograms were available for seven patients who were over 30 years old. chi(2) and Student t tests were used to assess frequency and mean differences, respectively.
  
  
  RESULTS
  The 22 patients who underwent local anesthesia reported minimal discomfort. No significant complications were noted, and patients were very pleased with the resolution of palpable mass effect and cosmetic results. The average pretreatment fibroadenoma volume of 4.2 cm(3)+/- 4.7 (standard deviation) was reduced to 0.7 cm(3)+/- 0.8 at 12-month follow-up (73% reduction, P < .001). US produced excellent ice visualization beyond tumor margins, while thermocouples confirmed cytotoxic temperatures approximately 5 mm behind the visible leading edge. Two patients elected to undergo either removal or biopsy of a residual mass, which revealed a shrunken hyaline matrix with preserved collagenous architecture. Mammograms showed comparable resolution of mass effects with mild surrounding parenchymal reaction.
  
  
  CONCLUSIONS
  Cryotherapy of fibroadenomas is a safe, effective, and virtually painless clinic-based (ie, outpatient) treatment option with good cosmesis.
authors.affiliation: Department of Radiology, and the Karmanos Cancer Center, Wayne State University School of Medicine, Harper University Hospital, 3990 John R St, Detroit, MI 48201, USA. peterlittrup@aol.com
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
authors.forename: Laurie
authors.initials: L
authors.lastname: Freeman-Gibb
authors.forename: Aleodor
authors.initials: A
authors.lastname: Andea
authors.forename: Michael
authors.initials: M
authors.lastname: White
authors.forename: Kathy Carolin
authors.initials: KC
authors.lastname: Amerikia
authors.forename: David
authors.initials: D
authors.lastname: Bouwman
authors.forename: Ted
authors.initials: T
authors.lastname: Harb
authors.forename: Wael
authors.initials: W
authors.lastname: Sakr
mesh_terms: D000293:Adolescent; D000328:Adult; D000772:Anesthesia, Local; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D016292:Procedural Sedation; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D018226:Fibroadenoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional