Magnetic resonance-guided percutaneous cryosurgery of breast carcinoma: technique and early clinical results.
OBJECTIVE
This phase I study was designed to demonstrate the feasibility, safety, efficacy and predictability of percutaneous cryosurgery, guided under magnetic resonance (MR) imaging, in the treatment of invasive breast carcinoma.


METHODS
Under the guidance of near-real-time T1-weighted FSE images of a 0.5-T open-configuration MR system, percutaneous cryosurgery was performed in 25 patients with operable invasive breast carcinoma, 4 weeks prior to their scheduled mastectomy. Predictive assessments by interventional radiologists using 4 breast-imaging techniques (mammography, sonography, scintigraphy and MR) were correlated with postmastectomy results of histopathology and assessed for predictability. Local and systemic morbidity were also evaluated during the month of follow-up preceding mastectomy.


RESULTS
Percutaneous cryosurgery resulted in no serious complications, either local or systemic. All tumoural tissues included in the cryogenic "iceball" were destroyed, with no viable histologic residues. Ablation was total in 13 of the 25 tumours treated. Combining periprocedural MR images with postprocedure scintimammographic findings enabled a 96% rate for predicting the cryosurgical results.


CONCLUSIONS
MR-guided cryosurgery of breast carcinoma is feasible, safe and efficient, with predictable results. Major drawbacks are that the cryolesion (a palpable iceball) persists for a month or more after the procedure, undermining the reliability of the physical examination; and that breast imaging (mammography, ultrasound and MR) presents the same difficulty of interpretation as the physical exam even 1 month after the procedure. More studies are required to refine this treatment method.
Morin
Jacques
J
iMRI unit, Quebec City University Hospital, Quebec City, Que.
Traoré
Amidou
A
Dionne
Guy
G
Dumont
Marcel
M
Fouquette
Bertrand
B
Dufour
Marie
M
Cloutier
Sonia
S
Moisan
Christian
C
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary