From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.).
Radiographics. 2021 Jul-Aug;41(4):945-966. doi: 10.1148/rg.2021200156.
Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. RSNA, 2021.
治疗乳腺病变的方法已逐渐向采用微创或无创技术发展。微创治疗无需手术即可破坏局部细胞群；因此，所需麻醉剂更少，由于疤痕最小化（如果有的话），美容效果更好，恢复时间更短。这些技术包括冷冻消融、射频消融、微波消融、高强度聚焦超声、激光治疗、真空辅助切除和不可逆电穿孔。每种方式都涉及不同的机制，并且在应用时需要特定的考虑因素。迄今为止，只有冷冻消融和真空辅助切除已获得美国食品和药物管理局批准用于治疗纤维腺瘤，并已被美国乳腺外科学会纳入治疗算法。针对接受这些技术治疗的乳腺癌患者的结果，已经开展了多项关于该主题的临床研究。结果很有前景，射频消融和冷冻消融的数据比其他用于早期乳腺癌治疗的微创方法的数据更多。应根据技术的可用性，逐个病例做出临床决策。MRI 是术后随访最有效的影像学检查方法，增强模式可区分残留或复发性疾病与术后变化。RSNA，2021 年。
