Minimally invasive ablative therapies for invasive breast carcinomas: an overview of current literature.
BACKGROUND
Minimally invasive treatment may be an alternative to breast-conserving surgery.


METHODS
A structured PubMed, Embase, Cochrane, and Web of Science search was performed. Endpoints studied were feasibility, completeness of ablation, timing of the sentinel node biopsy (SNB), imaging modalities, and treatment-related complications.


RESULTS
A total of 24 articles were retrieved, and the level of evidence varied (2B-4). Mainly phase II studies with a treat-and-resect protocol were analyzed. Up to 100% completeness of ablation was reported for radiofrequency ablation (RFA), cryosurgery, and focused ultrasound (FUS). The oncologic results need further evaluation. Dynamic contrast enhanced MRI seems to be the best method for monitoring treatment response (77% sensitivity, 100% specificity). Ultrasound is suitable for guiding probes into the tumor. There is no consensus on the timing of the SNB.


CONCLUSIONS
All studies on minimally invasive ablative modalities published so far show that these techniques are feasible and safe. At this stage only T1 tumors should be ablated in a clinical trial setting; it is unclear which of the modalities is most suitable.
van Esser
Stijn
S
Department of Surgery, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands. s.vanesser@umcutrecht.nl
van den Bosch
Maurice A A J
MA
van Diest
Paul J
PJ
Mali
Willem Th M
WT
Borel Rinkes
Inne H M
IH
van Hillegersberg
Richard
R
D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D003452:Cryosurgery; D006801:Humans; D053685:Laser Therapy; D008872:Microwaves / Q000627:therapeutic use; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D014464:Ultrasonic Therapy