Image-guided surgery of small breast cancers
Section snippets
Tumor size: image/pathologic assessment
The most important factor in predicting outcome of patients with invasive breast carcinoma is the size of the primary tumor as assessed by the pathologist. Most pathologists measure the maximal tumor size based on gross examination and then adjust the measurement following review of the microscopic slides. Studies by Tresserra et al [3] and Abner et al [4] showed that the tumor size assessed microscopically was larger than that measured grossly in 16% and 34% of their cases, respectively. The
Pathologic margins
One of the most important decisions prior to percutaneous treatment of early breast cancer, whether excisional or by using an in-situ ablation technique, will be to determine the extent of the tumor and thus define the area to treat. Based on our current standards this will not be easy, since experience with excisional biopsy has shown that surgical margins of resection are frequently involved by tumor [9]. Alternative techniques will need to be developed to aid the surgeon in delineating the
Removal of breast cancer with vacuum-assisted stereotactic breast biopsy
Vacuum-assisted breast biopsy has become a well established diagnostic tool equal in sensitivity and specificity to open needle-localized procedures for the diagnosis of mammographically detected lesions. Thus far, however, this technology has not been used for the definitive surgical treatment of early breast cancer. Two observations suggest that it may be possible to use vacuum-assisted tumor removal to treat early breast cancer. Jewell, in a personal series, noted that in approximately 25%
Stereotactic large core cannulae for conservation treatment of breast cancer
Large core cannulae employed in conjunction with stereotactic table (Avanced Breast Biopsy Instrumentation [ABBI]) were originally introduced in 1996 as a diagnostic tool. Nonpalpable mammographic breast lesions could be removed as a nonfragmented single large core specimen. Pathological examination was equivalent to that of a needle localization excisional breast biopsy, allowing not only for determination of histology but also tumor size and margins. Evaluation of margins was noted in an
Radiofrequency ablation of breast tumors
Destruction of solid tumors by radiofrequency ablation (RFA) results from the frictional heat generated by intracellular ions moving in response to an alternating current. The current flows from an uninsulated electrode implanted in the tumor to a grounding pad applied externally to the skin. Hyperthermia from RFA is thought to induce cell death by affecting cell membrane fluidity, cytoskeletal protein and nuclear structure, including disruption of DNA replication [21].
The physics of the
Cryosurgery of breast cancer
Cryotherapy as an in-situ technique of destroying tumors has been extensively applied to patients with liver and prostate cancers [26], [27]. Staren et al [28] were first to report their experience with cryoablation of carcinogen-induced mammary tumors in rats and mice and tested the effect on sheep and dog mammary tissues. They then treated a patient with two adjacently located (0.8 cm and 0.5 cm) infiltrating lobular carcinoma. The cryoprobe was directed to the target area either under direct
Laser therapy of small breast tumors
In-situ ablation of mammographically detected, well-defined breast tumors by laser is a potential alternative to lumpectomy. The photobiologic mechanisms of laser-induced tissue injury can be separated into three categories: photochemical, photothermal, and photomechanical [29]. The photothermal effect is the principal mechanism used in the interstitial laser therapy (ILT) of the breast cancer. The laser light energy may be precisely directed to a target in the breast by stereotactic technique
Summary
As outlined in this overview, several excisional and in-situ ablative techniques are emerging for percutaneous treatment of mammographically detected breast cancer. The technical details, safety, and efficacy of each one will be the subject of further investigation and ensuing clinical trial. It is estimated that between 60,000 and 90,000 patients who have undergone a small core biopsy of a circumscribed infiltrating carcinoma or a cluster of microcalcifications no more than 1.5 cm. in diameter
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Cited by (19)
Model-updated image-guided liver surgery: Preliminary results using surface characterization
2010, Progress in Biophysics and Molecular BiologyCitation Excerpt :Image-guided surgery has been used with success in the treatment of brain tumors (Jolesz et al., 2001; Nabavi et al., 2001), breast cancer (Dowlatshahi et al., 2001; Gould et al., 1998) and more recently in deep brain stimulations (D’Haese et al., 2005; Lunsford et al., 1983).
MR-guided interventions of the breast
2005, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :As a consequence, there has been a major shift toward less invasive local treatment of breast cancer. Currently, the standard surgical treatment for T1 N0 M0 cancer is lumpectomy followed by radiation therapy [35]. The goal of breast-conservation surgery is complete removal of the malignant breast tumor and a surrounding rim of normal breast tissue, with a secondary goal being improved cosmesis and reduced morbidity.
Ablative therapies for the treatment of malignant diseases of the breast
2005, American Journal of SurgeryCitation Excerpt :Local anesthesia is injected into the skin overlying the tumor and then an insulated 15-G probe is inserted. With the probe in proper position, a star-like array of prongs is deployed to allow even distribution of the thermal energy [4,8]. The temperature of the surrounding breast tissue is monitored by sensors are located within the prongs.
Nonsurgical ablation of primary breast cancer
2005, Surgical Oncology Clinics of North AmericaCitation Excerpt :Table 1 summarizes the advantages and disadvantages of ablation technologies. The potential for these therapies is overwhelming when one considers that as many as 90,000 patients may be candidates annually in the United States [62]. The ideal therapy should be safe, as painless as possible, accessible, and effective in reducing local recurrence.
Emerging Local Treatment Modalities for Breast Cancer
2005, Breast CancerAblative techniques in the treatment of benign and malignant breast disease
2003, Journal of the American College of Surgeons