Image-guided ablation in breast cancer treatment.

In the past 2 decades, new and improved imaging technologies and the use of breast cancer screening have led to the detection of smaller and earlier-stage breast cancers. Furthermore, there has been a trend toward less aggressive treatment of small breast cancers, which has led to the development of less invasive alternatives than surgery with promising effectiveness, and less morbidity. Many patients are not satisfied with the cosmetic outcome after breast-conservation therapy. Better cosmesis can be achieved with less invasive techniques. Moreover, less aggressive treatment options would be very useful in patients older than 70 years with comorbidities that make surgery a difficult and sometimes life-threatening treatment. Minimally invasive ablation techniques have been studied in early-stage small tumors with the goal of attaining efficacy similar to that of breast-conservation therapy. These techniques would have less scarring and pain, lower costs, better preservation of breast tissue, superior cosmesis, and faster recovery time. Breast lesions can be destroyed by thermal methods, that is, by heating or freezing the tissue. There are 5 types of thermal ablations that have been or currently are in research clinical trials: cryoablation, radiofrequency, laser, microwave, and high-intensity focused ultrasound ablation. The first 4 methods destroy cancers using percutaneous image-guided probe placement. High-intensity focused ultrasound is noninvasive, performed without any skin opening.