Cryotherapy for breast cancer: a feasibility study without excision.
OBJECTIVE
To assess the feasibility of percutaneous multiprobe breast cryoablation (BC) for diverse presentations of cancers that remained in situ after BC.


METHODS
After breast magnetic resonance (MR) imaging and thorough consultation, patients underwent BC after giving informed consent. This study was approved by the institutional review board. In 12 BC sessions, 22 breast cancer foci (stages I-IV) were treated in 11 patients who refused surgery by using multiple 2.4-mm cryoprobes. Five patients had recurrent disease and six had new diagnoses. With use of only local anesthesia, six patients were treated with ultrasonographic (US) guidance and five were treated with both computed tomographic (CT) and US guidance. Saline injections and warming bags were used to protect the skin. Procedure success was defined as 1 cm visible ice beyond all tumor margins. MR imaging and/or clinical follow-up were available for up to 72 months after BC.


RESULTS
US produced sufficient ice visualization for small tumors, whereas CT helped confirm overall ice extent. The mean pretreatment breast tumor diameter was 1.7 cm +/- 1.2 (range, 0.5-5.8 cm), and an average of 3.1 cryoprobes produced 100% procedural success with mean ice diameters of 5.1 cm +/- 2.2 (range, 2.0-10.0 cm). No significant complications, retraction, or scarring were noted. Biopsies at the margins of the cryoablation site immediately after BC and at follow-up were all negative. No local recurrences have been noted at an average imaging follow-up of 18 months.


CONCLUSIONS
In conjunction with thorough pre- and postablation MR imaging, CT/US-guided multiprobe BC safely achieved 1 cm visible ice beyond tumor margins with minimal discomfort, good cosmesis, and no short-term local tumor recurrences.
Littrup
Peter J
PJ
Department of Radiology, Karmanos Cancer Institute, 721 Harper Prof. Bldg Detroit, MI 48201, USA. littrupp@karmanos.org
Jallad
Bassel
B
Chandiwala-Mody
Priti
P
D'Agostini
Monica
M
Adam
Barbara A
BA
Bouwman
David
D
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome