Division of Breast Surgery, Chiba Cancer Center, 666-2 Nitona-Cho, Chuo-Ku, Chiba, Japan.
Breast Cancer. 2011 Jan;18(1):3-9. doi: 10.1007/s12282-010-0197-6. Epub 2010 Mar 4.
There is increasing demand for minimally invasive treatments for small breast cancer mainly because of the desire for better cosmetic results. Although radiofrequency ablation (RFA) is an attractive approach as a local control method for small breast cancer, the problems of histological effectiveness and safety management remain.
A total of 29 patients including one patient with bilateral breast cancer were enrolled in this study. The mean tumor size of 30 breasts was 12.8 mm (range 5-19 mm). Under general anesthesia, RFA was performed with a Cool-tip RF system (Valleylab, Boulder, CO, USA) after sentinel lymph node biopsy. Postoperative evaluation with magnetic resonance imaging (MRI) and vacuum-assisted core needle biopsy was done 3-4 weeks after RFA before radiotherapy. Ablated tumors were evaluated with hematoxylin-eosin (H&E) and nicotinamide adenine dinucleotide (NADH)-diaphorase staining. If needed, adjuvant chemo and/or endocrine therapy was performed.
All patients except one completed one session of RFA. The mean temperature near the center of the tumors was 89.6°C (range 78-100°C). Postoperative MRI showed the ablated zone clearly in all patients. MRI revealed no hypervascularity of the tumors in the ablated zone. Evaluation with H&E staining of the tumors showed remarkable degenerative changes in only three patients. NADH-diaphorase staining showed no viable tumor tissue in 24 patients out of 26 examined. Three patients received small diameter grade 3 skin burns, two on the outside of the thigh from the grounding pad and one on the breast skin. One patient had a breast lesion like a chronic granulomatous mastitis resulting from overreaction of the ablated zone.
RFA therapy appeared relevant and applicable for patients with small breast cancer. Because small skin burns were observed as adverse events, close attention should be paid in the course of the RFA procedure.
由于对更好美容效果的渴望，对小乳腺癌微创治疗的需求日益增加。虽然射频消融（RFA）作为小乳腺癌局部控制方法具有吸引力，但仍存在组织学有效性和安全管理方面的问题。
本研究共纳入 29 例患者，其中 1 例为双侧乳腺癌患者。30 个乳房的平均肿瘤大小为 12.8mm（范围 5-19mm）。在全身麻醉下，在进行前哨淋巴结活检后，使用 Cool-tip RF 系统（美国科罗拉多州博尔德的 Valleylab）进行 RFA。在 RFA 后 3-4 周进行磁共振成像（MRI）和真空辅助核心针活检的术后评估，然后进行放疗。使用苏木精-伊红（H&E）和烟酰胺腺嘌呤二核苷酸（NADH）-黄递酶染色评估消融的肿瘤。如果需要，进行辅助化疗和/或内分泌治疗。
除 1 例患者外，所有患者均完成了 1 次 RFA 治疗。肿瘤中心附近的平均温度为 89.6°C（范围 78-100°C）。所有患者术后 MRI 均清晰显示消融区。MRI 显示消融区肿瘤无血管过度增生。对 H&E 染色肿瘤的评估显示，仅 3 例患者有明显退行性变化。在 26 例检查的患者中，24 例 NADH-黄递酶染色未见存活的肿瘤组织。3 例患者出现小面积 3 级皮肤灼伤，2 例位于大腿接地垫外侧，1 例位于乳房皮肤。1 例患者因消融区过度反应出现类似慢性肉芽肿性乳腺炎的乳房病变。
RFA 治疗似乎适用于小乳腺癌患者。由于观察到小面积皮肤灼伤等不良事件，在 RFA 过程中应密切关注。
