Image-guided Microinvasive Percutaneous Treatment of Breast Lesion: Where Do We Stand?
The 2021 edition of the Radiographics journal published an article titled "Minimally Invasive Percutaneous Treatment of Breast Lesions Guided by Imaging: Current Developmental Status" by Shima Roknsharifi and colleagues from the Montefiore Medical Center Radiology Department. The article discusses the current status of minimally invasive treatment techniques for breast lesions. The full text is lengthy and provides detailed introductions to each treatment method. If you're interested, you can read the original article. Today, let's summarize the key information from the article in a more accessible format and address questions from both patients' and physicians' perspectives, aiming to provide some insights in a shorter timeframe. Make sure to read till the end.
Firstly, the article introduces various minimally invasive treatment methods for breast lesions, including cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound ablation, laser therapy, vacuum-assisted excision, and irreversible electroporation. These methods involve minimal invasion, require less anesthesia, and result in minimal scarring, offering better cosmetic outcomes and shorter recovery times.
The Food and Drug Administration (FDA) has approved the use of cryoablation and vacuum-assisted excision for treating fibroadenomas (a common benign breast condition). Although the overall advantages of these minimally invasive methods in breast cancer patients compared to traditional surgery have yet to be confirmed through randomized clinical trials, several clinical studies have been conducted in breast cancer patients with encouraging results. Data shows that radiofrequency ablation and cryoablation hold more promise for treating early-stage breast cancer compared to other minimally invasive methods. MRI is the most effective imaging method for postoperative follow-up, as its enhanced mode can differentiate between residual or recurrent disease and postoperative changes.
Key Learning Points:
Longer thawing times after the initial freeze in cryoablation are considered more important than rapid freezing because ice crystals formed during thawing can maximally damage cells.
Many studies describe cryoablation as a safe and effective method for treating fibroadenomas, accepted by the American Society of Breast Surgeons (ASBrS) for clinical use. However, according to ASBrS guidelines, this technology has not been accepted for clinical treatment of breast cancer.
Enhanced MRI can predict early postoperative responses to radiofrequency ablation and demonstrate tumor volume before breast X-ray or ultrasound examination, with MRI results closely correlated with histopathological results.
Although uncommon, risks associated with minimally invasive surgery include local pain, infection, skin damage, adjacent structure damage, incomplete ablation, and bleeding. IRE requires general anesthesia and carries a theoretical risk of arrhythmia.
Patient Concerns:
Will minimally invasive treatment of breast lesions be painful? Answer: Minimally invasive treatments are generally less painful compared to traditional surgery because they involve smaller incisions and are performed under local anesthesia.
What is the recovery time for minimally invasive treatment? Answer: Recovery time is shorter compared to traditional surgery. Patients can typically resume normal activities shortly after treatment, but the specific time varies depending on the treatment method and individual circumstances.
Can all breast lesions be treated with minimally invasive methods? Answer: Currently, not all breast lesions are suitable for minimally invasive treatment. The decision depends on factors such as the type, size, location of the lesion, and other medical considerations.
Is the recurrence rate high after minimally invasive treatment? Answer: The recurrence rate after minimally invasive treatment is lower compared to traditional surgery. However, due to variations in lesion types and individual health conditions, regular follow-up and monitoring are essential.
How does the cost of minimally invasive treatment compare to traditional surgery? Answer: In the United States, the cost of minimally invasive treatment may be comparable to or sometimes higher than traditional surgery. However, due to shorter recovery times, the overall medical costs may be lower. Specific costs vary by region and healthcare institution.
Physician Concerns:
How to select the appropriate minimally invasive treatment method? Answer: Choosing the appropriate minimally invasive treatment method requires consideration of the specific characteristics of the lesion (such as size, location, malignancy), as well as the patient's overall health status and preferences.
How to manage patient expectations during minimally invasive treatment? Answer: Adequate communication with patients before treatment is essential to discuss potential outcomes, risks, and possible recurrence. Ensuring that patients have a proper understanding and reasonable expectations of the treatment process and expected results is crucial.
How to evaluate the effectiveness of minimally invasive treatment? Answer: Postoperative evaluation mainly relies on imaging examinations, especially MRI, which can help distinguish residual lesions from postoperative changes. Regular follow-up and imaging reviews are crucial for assessing post-minimally invasive treatment outcomes.
What are the potential risks and complications of minimally invasive treatment? Answer: Potential risks of minimally invasive treatment include local pain, infection, skin damage, and possible residual lesions. For irreversible electroporation (IRE), which requires general anesthesia, there is a theoretical risk of arrhythmia.
What are the future trends of minimally invasive treatment in breast lesion management? Answer: Future trends may include more precise imaging-guided techniques, more efficient energy delivery systems, artificial intelligence technologies supported by larger clinical datasets, and personalized treatment approaches aimed at improving treatment efficacy and reducing recurrence.