title: Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Breast-conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review and meta-analysis to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer.
  
  
  METHODS
  A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded.
  
  
  RESULTS
  We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focussed ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6 ± 5.6 min) and the longest with HIFU (101.5 ± 46.6 min).
  
  
  CONCLUSIONS
  Minimally invasive ablative techniques are able to successfully induce coagulative necrosis in breast cancer with a low side effect profile. Adequately powered and prospectively conducted cohort trials are required to confirm complete pathological ablation in all patients.
authors: a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.
authors: Mirjam C L
authors: MCL
authors: Peek
authors: a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.
authors: Muneer
authors: M
authors: Ahmed
authors: b Department of Radiological Sciences , Sapienza University of Rome, School of Medicine , Roma , Italy.
authors: Alessandro
authors: A
authors: Napoli
authors: c Department of Radiology , St. Bartholomew's Hospital , London , Great Britain.
authors: Sasha
authors: S
authors: Usiskin
authors: d School of Business, 612, Maxwell Building, University of Salford , Salford , Great Britain.
authors: Rose
authors: R
authors: Baker
authors: a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.
authors: Michael
authors: M
authors: Douek
keywords: Ablative techniques; breast cancer; cryo ablation; high-intensity focussed ultrasound (HIFU); laser-ablation; microwave ablation; radiofrequency ablation (RFA)