Apesteguía Ciriza L, Ovelar Ferrero A, Alfaro Adrián C
Departamento de Radiología, Complejo Hospitalario de Navarra, Pamplona, España.
Radiologia. 2011 May-Jun;53(3):226-35. doi: 10.1016/j.rx.2010.12.005. Epub 2011 Apr 9.
Breast imaging plays a significant role in treatment. Ultrasonography to drain fluid collections, vacuum-assisted biopsy to excise papillomas and fibroadenomas, and stereotactic excisional biopsy are a few examples of interventional procedures performed by radiologists in patients with breast disease. Moreover, there is a growing interest in the minimally invasive treatment of invasive tumors, which aims to achieve the same efficacy while minimizing morbidity and improving the esthetic outcome. Especially noteworthy are thermal ablation techniques, which involve destroying tumors with heat or cold. The most widely studied thermal ablation techniques are radiofrequency, high intensity focused ultrasound, laser therapy, microwaves, and cryoablation. After a review of the literature, we conclude that the development of these treatment approaches will depend largely on the capacity of imaging techniques to plan the destruction of the tumor. Ultrasonography and magnetic resonance imaging are the current techniques of choice for this purpose. The evidence suggests that small invasive carcinomas can be efficaciously treated with thermal ablation, especially by radiofrequency ablation; however, before this technique can be validated, phase III clinical trials must compare it with conservative surgery in terms of local progression and overall survival.
乳腺成像在治疗中起着重要作用。超声引导下抽吸液体积聚、真空辅助活检切除乳头状瘤和纤维腺瘤，以及立体定向切除活检，这些都是放射科医生对乳腺疾病患者实施的介入性操作的一些例子。此外，对浸润性肿瘤的微创治疗的兴趣日益浓厚，其目的是在将发病率降至最低并改善美观效果的同时实现相同的疗效。特别值得注意的是热消融技术，即通过加热或冷冻来破坏肿瘤。研究最为广泛的热消融技术有射频、高强度聚焦超声、激光治疗、微波和冷冻消融。在对文献进行综述后，我们得出结论，这些治疗方法的发展将在很大程度上取决于成像技术规划肿瘤破坏的能力。超声检查和磁共振成像是目前用于此目的的首选技术。有证据表明，小的浸润性癌可以通过热消融有效治疗，尤其是射频消融；然而，在该技术得到验证之前，III期临床试验必须在局部进展和总生存期方面将其与保守手术进行比较。
