Cryoablation In The Management Of Breast Cancer: Evidence To Date

Abstract

Cryoablation has been successfully used to treat various type of solid tumors, including breast carcinomas. This ablation method has the advantage of being a minimally invasive procedure useful in various clinical situations, including early breast cancer and metastatic breast cancer, when co-morbidities preclude the use of surgical treatment. However, due to the small sample size of the available studies, reliable and definitive conclusions on the usefulness of cryoablation in patients with breast cancer could not be drawn. In fact, many aspects necessitate to be elucidated, regarding technical issues, indications, efficacy, imaging follow-up, and possible advantages over other percutaneous ablative methods. This review article has the aim to clarify the current evidence supporting cryoablation of breast cancer, and discuss the future perspectives, including those arising from the new studies on immunological effects related to cryoablation.

Keywords: ablation; breast cancer; cryoablation; interventional radiology; treatment.

Figure 1

Search strategy.

Figure 2

Cryoablation of invasive breast carcinoma in a 74-year-old woman presenting with distant metastases to the bones (Stage IV) at diagnosis. Axial (A) and coronal (B) contrast-enhanced CT scan showing a 4 cm mass in the left breast. (C–D). Contrast-enhanced CT scan 2 months after cryoablation showing tumor size reduction and absence of contrast enhancement.

Figure 3

Same patient as shown in Figure 2. She developed a local recurrence after 12 months from the cryoablation procedure that was treated with redo cryoablation. Axial (A) and coronal (B) contrast-enhanced CT scan images showing a 2 cm nodule with enhancement in the previous ablation zone. (C) Second cryoablation with insertion of two cryo-probes. (D) Complete tumor ablation with no contrast-enhancement at the end of the procedure.

Figure 4

CT-guided cryoablation of large invasive carcinoma of the right breast in 83-year-old woman not suitable for surgery due to co-morbidities. (A) Large tumor mass in the right breast with nipple retraction. (B) PET-FDG/CT imaging showing an abnormal area of¹⁸F-FDG uptake in the right breast. (C) CT-guided placement of the cryoprobe. (D) Complete ablation of the tumor during the freezing process.