Ultrasound-Guided Radiofrequency Ablation Helpful in Small Breast Cancers

Laurie Barclay, MD

March 30, 2004

March 30, 2004 — Ultrasound-guided radiofrequency (RF) ablation can completely destroy breast cancers less than 2 cm with no adverse effects and without the need for lumpectomy or mastectomy, according to the results of a pilot study published in the April issue of Radiology.

"This study has added another potential weapon to the breast cancer treatment arsenal," lead author Bruno D. Fornage, MD, from the University of Texas M.D. Anderson Cancer Center in Houston, says in a news release. "This is an experimental study, and additional long-term trials will be needed before RF ablation becomes available as an alternative to surgery in the treatment for early breast cancer."

The technique involves ultrasound guidance of a 15-gauge needle-electrode to the tumor's center, and application of heat at 95º C (approximately 200º F) for 15 minutes to destroy malignant tissue.

In this pilot study, 21 breast cancers in 20 patients underwent RF ablation immediately before surgical lumpectomy or mastectomy. There were no adverse effects.

In all 21 cancers, histopathology with NADH-diaphorase stain revealed complete ablation of the target tumor visualized on ultrasound. However, one of two patients who had received preoperative chemotherapy had evidence of residual microscopic cancer around the ablated target that was not visible before treatment by ultrasound or mammography.

Despite the encouraging results of the feasibility and safety study, the authors note that this minimally invasive procedure is limited as a treatment because it does not remove tissue surrounding the tumor site, and this tissue therefore cannot be tested to ensure destruction of all tumor cells.

Other issues include the need for careful follow-up and early identification of local failure, poor visibility of the ablated lesion on follow-up studies, the cosmetic result, the effect of radiotherapy on a thermally ablated tumor, optimal anesthesia, and long-term tumor control.

"Ultrasound-guided percutaneous ablation of small invasive breast cancers performed by using commercially available RF equipment is feasible and safe," the authors write, while urging that the procedure be performed only by those fully trained and experienced in interventional breast ultrasound. "Whether RF ablation can be used satisfactorily as a treatment replacement for lumpectomy of small breast cancer remains to be confirmed."

Radiology. 2004;231:215-244

Reviewed by Charlotte E. Grayson, MD

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