title: Feasibility of percutaneous excision followed by ablation for local control in breast cancer.
abstract: OBJECTIVE
  Percutaneous ablation of breast cancer has shown promise as a treatment alternative to open lumpectomy. We hypothesized that percutaneous removal of breast cancer followed by percutaneous ablation to sterilize and widen the margins would not only provide fresh naive tissue for tumor marker and research investigation, but also better achieve negative margins after ablation.
  
  
  METHODS
  Patients diagnosed by percutaneous biopsy (ultrasound or stereotactic-guided) with breast cancer ≤1.5 cm, >1 cm from the skin, and ≤1 cm residual disease and no multicentric disease by magnetic resonance imaging were accrued to this institutional review board-approved study. Patients were randomized to laser versus radiofrequency ablation. The ultrasound-guided ablation was performed in the operating room and followed by immediate excision, whole-mount pathology with proliferating cell nuclear antigen staining, and reconstruction.
  
  
  RESULTS
  Twenty-one patients were enrolled onto the study. Fifteen patients received radiofrequency ablation, and all showed 100% ablation and negative margins. Magnetic resonance imaging was helpful in excluding multicentric disease but less so in predicting presence or absence of residual disease. Seven of these patients showed no residual tumor and eight showed residual dead tumor (0.5 ± 0.7 cm, range 0.1-2.5 cm) at the biopsy site with clear margins. The laser arm (3 patients) pathology demonstrated unpredictability of the ablation zone and residual live tumor.
  
  
  CONCLUSIONS
  This pilot study demonstrates the feasibility of a novel approach to minimally invasive therapy: percutaneous excision and effective cytoreduction, followed by radiofrequency ablation of margins for the treatment of breast cancer. Laser treatment requires further improvement.
authors: Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA. klimbergsuzanne@uams.edu
authors: V Suzanne
authors: VS
authors: Klimberg
authors: Cristiano
authors: C
authors: Boneti
authors: Laura L
authors: LL
authors: Adkins
authors: Maureen
authors: M
authors: Smith
authors: Eric
authors: E
authors: Siegel
authors: Vladimir
authors: V
authors: Zharov
authors: Scott
authors: S
authors: Ferguson
authors: Ronda
authors: R
authors: Henry-Tillman
authors: Brian
authors: B
authors: Badgwell
authors: Soheila
authors: S
authors: Korourian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000295:instrumentation*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D011379:Prognosis; D012307:Risk Factors; D018084:Ultrasonography, Interventional; D014618:Vacuum; D055815:Young Adult