Feasibility of percutaneous excision followed by ablation for local control in breast cancer

Abstract

Purpose: 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.

Figures

Figure 1

Protocol Design in Phase II with for percutaneous excision followed by radiofrequency ablation.

Figure 2

Ultrasound visualization of hematoma in cavity created by percutaneous biopsy.

Figure 3

a. Percutaneous RFA deployed into patient, b. Diagram of PeRFA Procedure demonstrating RFA deployed around hematoma and showing the 5 active heating tines of the RF probe.

Figure 4

Color Doppler using a 12.5MHz ultrasound probe.

Figure 5

Sectioned Pathology: a. 3mm serial sections of the lumpectomy specimen post PeRFA b. Xray demonstrating clip in biopsy cavity. c. Magnified view of biopsy cavity. d. Magnified view of xray of biopsy cavity demonstrating clip. e. Pathology PeRFA cavity site demonstrating no residual tumor and pericavitary ablation.

Figure 5

Sectioned Pathology: a. 3mm serial sections of the lumpectomy specimen post PeRFA b. Xray demonstrating clip in biopsy cavity. c. Magnified view of biopsy cavity. d. Magnified view of xray of biopsy cavity demonstrating clip. e. Pathology PeRFA cavity site demonstrating no residual tumor and pericavitary ablation.