title: Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments.
  
  
  METHODS
  An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome.
  
  
  RESULTS
  Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142).
  
  
  CONCLUSIONS
  Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low.
  
  
  CONCLUSIONS
  • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).
authors.affiliation: Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100, Milano, Italy. vanni.mauri@gmail.com.
authors.forename: Giovanni
authors.identifier: http://orcid.org/0000-0003-4726-2692
authors.initials: G
authors.lastname: Mauri
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.|Unità Operativa di Radiologia / Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milano, Italy.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
authors.forename: Lorenzo Carlo
authors.initials: LC
authors.lastname: Pescatori
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Fedeli
authors.affiliation: Integrative Biomedical Research PhD Program, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Alì
authors.affiliation: Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.|Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery*; D003452:Cryosurgery; D057086:High-Intensity Focused Ultrasound Ablation; D006801:Humans; D008872:Microwaves / Q000009:adverse effects / Q000627:therapeutic use; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications
keywords: Breast cancer; Meta-analysis; Minimally-invasive treatment; Systematic review; Thermal ablation