In the past 2 decades, new and improved imaging technologies and the use of breast cancer screening have led to the detection of smaller and earlier-stage breast cancers. Furthermore, there has been a trend toward less aggressive treatment of small breast cancers, which has led to the development of less invasive alternatives than surgery with promising effectiveness, and a decrease in the loss of lives. Many patients are not satisfied with the cosmetic outcome after breast-conservation therapy. Better cosmesis can be achieved with less invasive techniques. Moreover, less aggressive treatment options would be very useful in patients older than 70 years with comorbidities that make surgery a difficult and sometimes life-threatening treatment. In addition, better cosmesis can be achieved in the younger population and those interested in the integrative approach. This form of minimally invasive surgery and treatment offers an option to those who are opposed to conventional approach to the treatment of breast cancer. Minimally invasive ablation techniques have been studied in early-stage small tumors with the goal of attaining efficacy similar to that of breast-conservation therapy. These techniques would have less scarring and pain, lower costs, better preservation of breast tissue, superior cosmesis, and faster recovery time. Breast lesions can be destroyed by thermal methods, that is, by heating or freezing the tissue and by chemoembolization/radioembolization (direct deposit of chemotherapy or radiation particles into the blood vessels which feed the tumor. There are 5 types of thermal ablations that have been or currently are in research clinical trials: cryoablation, radiofrequency, laser, microwave, and high-intensity focused ultrasound ablation. The first 4 methods destroy cancers using percutaneous image-guided probe placement. High-intensity focused ultrasound is noninvasive, performed without any skin opening. The 5th method of destroying cancer may play a role in patients with stage IV breast cancer and inflammatory breast cancer with chemoembolization or radioembolization of inflammatory breast cancer.
Pseudoaneurysm of the breast
 >>>
Needle in breast 
Thrombin injected no further flow
|
RFA (super heating) of a breast cancer under MRI guidance
RFA of breast cancer under ultrasound guidance |
Schematic of ultrasound guided cryoablation of a breast cancer 
Cryoablation (freezing) a breast cancer under ultrasound guidance 
Ice ball as a result of cryoablation of a breast cancer
|
References
1. Breast cancer new cases and deaths from breast cancer in the United States in 2013: American Cancer Society, Inc., Surveillance research, 2013. http://www.cancer.org/cancer/breastcancer. Accessed February 10, 2013.
2. Postma, E.L., van Hillegersberg, R., Daniel, B.L. et al. MRI-guided ablation of breast cancer: Where do we stand today?. J Magn Reson Imaging. 2011; 34: 254–261
3. Vlastos, G., Mirza, N.Q., Meric, F. et al. Breast conservation therapy as a treatment option for the elderly: The M.D. Anderson experience. Cancer. 2001; 92: 1092–1100
4. Louwman, W.J., Janssen-Heijnen, M.L.G., Houterman, S. et al. Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: A population based study. Eur J Cancer. 2005; 41: 779–785
5. Izzo, F., Thomas, R., Delrio, P. et al. Radiofrequency ablation in patients with primary breast carcinoma. A pilot study in 26 patients. Cancer. 2001; 92: 2036–2044
6. Burak, W.E., Agnese, D.M., Povoski, S.P. et al. Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision. Cancer. 2003; 98: 1369–1376
7. Vilar, V.S., Goldman, S.M., Ricci, M.D. et al. Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer. Am J Roentgenol. 2012; 198: W285–W291
8. Zhou, W., Sha, X., Liu, X. et al. US-guided percutaneous microwave coagulation of small breast cancers: A clinical study. Radiology. 2012; 263: 364–373
9. Fornage, B.D., Sneige, N., and Ross, M.I. Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: Feasibility study. Radiology. 2004; 231: 215–224
10. van der Ploeg, I.M., van Esser, S., van den Bosch, M.A. et al. Radiofrequency ablation for breast cancer: A review of the literature. Eur J Surg Oncol. 2007; 33: 673–677
11. Marcy, P.Y., Magne, N., Castadot, P. et al. Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: Preliminary institutional experience. Br J Radiol. 2007; 80: 267–273
12. Palussiere, J., Henriques, C., Mauriac, L. et al. Radiofrequency ablation as a substitute for surgery in elderly patients with nonresected breast cancer: Pilot study with long-term outcomes. Radiology. 2012; 264: 597–605
13. Vargas, H.I., Dooley, W.C., Gardner, R.A. et al. Success of sentinel lymph node mapping after breast cancer ablation with focused microwave phased array thermotherapy. Breast Cancer. 2003; 186: 330–332
14. van den Bosch, M.A., Daniel, B., Rieke, V. et al. MRI-guided radiofrequency ablation of breast cancer: Preliminary clinical experience. J Magn Reson Imaging. 2008; 27: 204–208
15. Manenti, G., Bolacchi, F., Perretta, T. et al. Small breast cancers: In vivo percutaneous US-guided radiofrequency ablation with dedicated cool-tip radiofrequency system. Radiology. 2009; 251: 339–346
16. Susini, T., Nori, J., and Oliviere, S. Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients. Gynecol Oncol. 2007; 104: 304–310
17. Ann M. Leylek, MD; Gary J. Whitman, MD; Vanessa S. Vilar, MD, PhD; Nestor Kisilevzky, MD, MSc; Salomao Faintuch, MD, MSc Radiofrequency Ablation for Breast Cancer Techniques in Vascular and Interventional Radiology December 2013 Volume 16, Issue 4, Pages 269–276
18. Marilyn A. Roubidoux, Wei Yang, Roger Jason Stafford Image-Guided Ablation in Breast Cancer Treatment Techniques in Vascular and Interventional Radiology 2014; Volume 17, Issue 1, p49-54
1. Breast cancer new cases and deaths from breast cancer in the United States in 2013: American Cancer Society, Inc., Surveillance research, 2013. http://www.cancer.org/cancer/breastcancer. Accessed February 10, 2013.
2. Postma, E.L., van Hillegersberg, R., Daniel, B.L. et al. MRI-guided ablation of breast cancer: Where do we stand today?. J Magn Reson Imaging. 2011; 34: 254–261
3. Vlastos, G., Mirza, N.Q., Meric, F. et al. Breast conservation therapy as a treatment option for the elderly: The M.D. Anderson experience. Cancer. 2001; 92: 1092–1100
4. Louwman, W.J., Janssen-Heijnen, M.L.G., Houterman, S. et al. Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: A population based study. Eur J Cancer. 2005; 41: 779–785
5. Izzo, F., Thomas, R., Delrio, P. et al. Radiofrequency ablation in patients with primary breast carcinoma. A pilot study in 26 patients. Cancer. 2001; 92: 2036–2044
6. Burak, W.E., Agnese, D.M., Povoski, S.P. et al. Radiofrequency ablation of invasive breast carcinoma followed by delayed surgical excision. Cancer. 2003; 98: 1369–1376
7. Vilar, V.S., Goldman, S.M., Ricci, M.D. et al. Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer. Am J Roentgenol. 2012; 198: W285–W291
8. Zhou, W., Sha, X., Liu, X. et al. US-guided percutaneous microwave coagulation of small breast cancers: A clinical study. Radiology. 2012; 263: 364–373
9. Fornage, B.D., Sneige, N., and Ross, M.I. Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: Feasibility study. Radiology. 2004; 231: 215–224
10. van der Ploeg, I.M., van Esser, S., van den Bosch, M.A. et al. Radiofrequency ablation for breast cancer: A review of the literature. Eur J Surg Oncol. 2007; 33: 673–677
11. Marcy, P.Y., Magne, N., Castadot, P. et al. Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: Preliminary institutional experience. Br J Radiol. 2007; 80: 267–273
12. Palussiere, J., Henriques, C., Mauriac, L. et al. Radiofrequency ablation as a substitute for surgery in elderly patients with nonresected breast cancer: Pilot study with long-term outcomes. Radiology. 2012; 264: 597–605
13. Vargas, H.I., Dooley, W.C., Gardner, R.A. et al. Success of sentinel lymph node mapping after breast cancer ablation with focused microwave phased array thermotherapy. Breast Cancer. 2003; 186: 330–332
14. van den Bosch, M.A., Daniel, B., Rieke, V. et al. MRI-guided radiofrequency ablation of breast cancer: Preliminary clinical experience. J Magn Reson Imaging. 2008; 27: 204–208
15. Manenti, G., Bolacchi, F., Perretta, T. et al. Small breast cancers: In vivo percutaneous US-guided radiofrequency ablation with dedicated cool-tip radiofrequency system. Radiology. 2009; 251: 339–346
16. Susini, T., Nori, J., and Oliviere, S. Radiofrequency ablation for minimally invasive treatment of breast carcinoma. A pilot study in elderly inoperable patients. Gynecol Oncol. 2007; 104: 304–310
17. Ann M. Leylek, MD; Gary J. Whitman, MD; Vanessa S. Vilar, MD, PhD; Nestor Kisilevzky, MD, MSc; Salomao Faintuch, MD, MSc Radiofrequency Ablation for Breast Cancer Techniques in Vascular and Interventional Radiology December 2013 Volume 16, Issue 4, Pages 269–276
18. Marilyn A. Roubidoux, Wei Yang, Roger Jason Stafford Image-Guided Ablation in Breast Cancer Treatment Techniques in Vascular and Interventional Radiology 2014; Volume 17, Issue 1, p49-54