The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study

Abstract

Background and objectives: Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC).

Methods: Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC.

Results: At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure.

Conclusions: Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.

Figure 1

The device LA (introducer-needle and fiber) must be progressively inserted towards the target, choosing the best path to correctly position the tip of the fiber. It is necessary to ensure that the path of the applicator is as parallel as possible to the chest wall. The tip of the device should always be inserted at the center of the lesion and its position must always be controlled with two-plane ultrasound images.

Figure 2

Representative case of successful LA ablation in a patient with invasive ductal unifocal breast carcinoma of 18 mm of max diameter in the upper outer quadrant of the right breast. (a) The US image before treatment shows the hypoechoic lesion with ill-defined margins and the fine needle and the tip of the fiber in the outer third of the tumor mass. (b) The US image at the end of the treatment shows an evident shadow cone due to the presence of gas bubbles that completely cover the ablated area.

Figure 3

Another example of successful LA ablation in a patient with invasive ductal carcinoma of 15 mm of max diameter in the upper outer quadrant of the right breast. (a) The US image before treatment shows the hypoechoic lesion with blurred margins. (b) The US image shows the laser applicator (21G needle and fiber) which, with a course parallel to the chest wall, reaches the outer edge of the lesion. (c) Finally, the lesion is no longer appreciable, and in the treated area, there is an echogenic line with an evident shadow cone. (d) The US image of the ablated area in the first hours after treatment appears in the form of a heterogeneous predominantly hyperechoic zone (gas bubbles) with blurred margins.

Figure 4

Sequential mammograms showing the cystic oil formation by steatonecrosis over a period of 24 months. (a) Before LA (white arrow) and (b) 24 month after a single laser treatment (white arrow).