Ultrasound-guided laser-induced thermal therapy for small palpable invasive breast carcinomas: a feasibility study.
BACKGROUND
The next step in breast-conserving surgery for small breast carcinomas could be local ablation. In this study, the feasibility of ultrasound-guided laser-induced thermal therapy (LITT) is evaluated.


METHODS
Patients with large-core needle biopsy-proven invasive, palpable breast carcinoma (clinically <or=2 cm) underwent ultrasound-guided LITT, followed by surgical excision. Completeness of ablation was determined by both hematoxylin and eosin staining and nicotinamide adenosine diaphorase staining.


RESULTS
Fourteen patients completed the treatment. The mean histological tumor size was 17 mm (range, 8-37 mm); 6 of 14 tumors were histologically larger than the clinical entry threshold of 2 cm. The power applied in all patients was 7 W, and the mean treatment time was 21.4 min (range, 15-30 min). In one patient, a skin burn occurred, and one patient had a localized pneumothorax that could be treated conservatively. In 7 (50%) of 14 patients, the tumor was completely ablated, as confirmed by nicotinamide adenosine diaphorase staining. In 11 cases, extensive in-situ carcinoma was present. In one case, the in-situ carcinoma was also completely ablated. A total of seven (88%) of eight tumors <2 cm in size were completely ablated versus one (17%) of six tumors that were >or=2 cm in size (P = .026).


CONCLUSIONS
Successful LITT of invasive breast cancer seems to be feasible when confined to small (<2 cm) nonlobular carcinomas without surrounding extensive in-situ component and angioinvasion. However, to implement LITT in a curative setting, improvements in imaging to more reliably preoperatively assess tumor size and monitoring of fiber tip placement and treatment affect are essential.
van Esser
S
S
Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. s.vanesser@umcutrecht.nl
Stapper
G
G
van Diest
P J
PJ
van den Bosch
M A A J
MA
Klaessens
J H G M
JH
Mali
W P Th M
WP
Borel Rinkes
I H M
IH
van Hillegersberg
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D053685:Laser Therapy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary