Furusawa Hidemi, Namba Kiyoshi, Thomsen Sharon, Akiyama Futoshi, Bendet Achiude, Tanaka Chiaki, Yasuda Yukiko, Nakahara Hiroshi
Department of Breast Diseases, Breastopia Namba Hospital, Miyazaki, Japan.
J Am Coll Surg. 2006 Jul;203(1):54-63. doi: 10.1016/j.jamcollsurg.2006.04.002.
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive technique that has been shown to coagulate benign and malignant tumors. The purpose of this study was to evaluate MRgFUS safety and effectiveness for the ablation of breast carcinomas.
Thirty women with biopsy-proved breast cancer underwent MRgFUS treatment. Gadolinium-enhanced MR images were used for treatment planning and posttreatment radiologic assessment of treated tissue, and temperature-sensitive MR images provided real-time treatment monitoring. After MRgFUS, all 30 women underwent wide excision or mastectomy. The extent of thermal ablation was assessed with tumor histology.
Treatment was well tolerated, with a minimum of adverse effects, especially when performed under local anesthesia. On pathologic examination, mean (+/-SD) necrosis of the targeted breast tumors was 96.9 +/- 4% (median 100%, range 78% to 100%) of tumor volume. Fifteen (53.5%) of 28 evaluable patients had 100% necrosis of the ablated tumor; only 3 patients (10.7%) had less than 95% necrosis. In 28 (93.3%) patients, 100% of the malignancy was within the treatment field, and 98% and 95% of tumor lay within the treatment field in 2 remaining patients. Retrospective analysis in two patients with residual tumor showed treatment was not delivered to the full recommended area, reaffirming the need for precise localization and the value of contrast-enhanced images for treatment planning.
MRgFUS has great potential to become a viable noninvasive replacement for lumpectomy. Additional studies focusing on posttreatment image-based evaluation are needed.
磁共振引导聚焦超声手术（MRgFUS）是一种已被证明可使良性和恶性肿瘤凝固的非侵入性技术。本研究的目的是评估MRgFUS消融乳腺癌的安全性和有效性。
30名经活检证实患有乳腺癌的女性接受了MRgFUS治疗。钆增强磁共振图像用于治疗规划和对治疗组织的治疗后放射学评估，温度敏感磁共振图像提供实时治疗监测。MRgFUS治疗后，所有30名女性均接受了广泛切除或乳房切除术。通过肿瘤组织学评估热消融的范围。
治疗耐受性良好，不良反应最少，尤其是在局部麻醉下进行时。病理检查显示，目标乳腺肿瘤的平均（±标准差）坏死率为肿瘤体积的96.9±4%（中位数100%，范围78%至100%）。28名可评估患者中有15名（53.5%）消融肿瘤坏死率达100%；只有3名患者（10.7%）坏死率低于95%。28名（93.3%）患者的全部恶性肿瘤位于治疗区域内，其余2名患者中98%和95%的肿瘤位于治疗区域内。对两名有残留肿瘤患者的回顾性分析显示，治疗未覆盖到全部推荐区域，再次证实了精确定位的必要性以及对比增强图像在治疗规划中的价值。
MRgFUS极有可能成为一种可行的保乳手术非侵入性替代方法。需要开展更多聚焦于基于图像的治疗后评估的研究。
