van Esser S, Stapper G, van Diest P J, van den Bosch M A A J, Klaessens J H G M, Mali W P Th M, Borel Rinkes I H M, van Hillegersberg R
Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Surg Oncol. 2009 Aug;16(8):2259-63. doi: 10.1245/s10434-009-0544-z. Epub 2009 Jun 9.
The next step in breast-conserving surgery for small breast carcinomas could be local ablation. In this study, the feasibility of ultrasound-guided laser-induced thermal therapy (LITT) is evaluated.
Patients with large-core needle biopsy-proven invasive, palpable breast carcinoma (clinically <or=2 cm) underwent ultrasound-guided LITT, followed by surgical excision. Completeness of ablation was determined by both hematoxylin and eosin staining and nicotinamide adenosine diaphorase staining.
Fourteen patients completed the treatment. The mean histological tumor size was 17 mm (range, 8-37 mm); 6 of 14 tumors were histologically larger than the clinical entry threshold of 2 cm. The power applied in all patients was 7 W, and the mean treatment time was 21.4 min (range, 15-30 min). In one patient, a skin burn occurred, and one patient had a localized pneumothorax that could be treated conservatively. In 7 (50%) of 14 patients, the tumor was completely ablated, as confirmed by nicotinamide adenosine diaphorase staining. In 11 cases, extensive in-situ carcinoma was present. In one case, the in-situ carcinoma was also completely ablated. A total of seven (88%) of eight tumors <2 cm in size were completely ablated versus one (17%) of six tumors that were >or=2 cm in size (P = .026).
Successful LITT of invasive breast cancer seems to be feasible when confined to small (<2 cm) nonlobular carcinomas without surrounding extensive in-situ component and angioinvasion. However, to implement LITT in a curative setting, improvements in imaging to more reliably preoperatively assess tumor size and monitoring of fiber tip placement and treatment affect are essential.
对于小乳腺癌保乳手术的下一步可能是局部消融。在本研究中，评估了超声引导下激光诱导热疗（LITT）的可行性。
经粗针穿刺活检证实为可触及的浸润性乳腺癌（临床<或=2 cm）的患者接受超声引导下LITT，随后进行手术切除。通过苏木精和伊红染色以及烟酰胺腺嘌呤二磷酸酶染色确定消融的完整性。
14例患者完成治疗。组织学肿瘤平均大小为17 mm（范围8 - 37 mm）；14例肿瘤中有6例组织学上大于临床纳入阈值2 cm。所有患者施加的功率为7 W，平均治疗时间为21.4分钟（范围15 - 30分钟）。1例患者发生皮肤烧伤，1例患者出现局限性气胸，可保守治疗。14例患者中有7例（50%）肿瘤被完全消融，经烟酰胺腺嘌呤二磷酸酶染色证实。11例存在广泛原位癌。1例原位癌也被完全消融。8例<2 cm大小的肿瘤中有7例（88%）被完全消融，而6例>或=2 cm大小的肿瘤中有1例（17%）被完全消融（P = .026）。
对于局限于无周围广泛原位成分和血管侵犯的小（<2 cm）非小叶癌的浸润性乳腺癌，成功进行LITT似乎是可行的。然而，要在治愈性环境中实施LITT，改善成像以更可靠地术前评估肿瘤大小以及监测光纤尖端放置和治疗效果至关重要。
