Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain.
Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain.
Radiologia (Engl Ed). 2023 Mar-Apr;65(2):112-121. doi: 10.1016/j.rxeng.2023.03.002.
The primary objective of this study to determine whether infiltrating carcinoma is present in surgical specimens obtained after ultrasound-guided cryoablation from patients with HER2-negative luminal breast cancer without positive axillary lymph nodes at ultrasound. The secondary objective is to demonstrate that placing the presurgical seed-marker immediately before cryoablation does not interfere with the disappearance of tumor cells from freezing or in the surgeon's ability to locate the tumor.
We treated 20 patients diagnosed with unifocal HR-positive HER2-negative infiltrating ductal carcinoma measuring <2cm by means of ultrasound-guided cryoablation (ICEfx Galil, Boston Scientific) using a triple-phase (freezing‒passive thawing‒freezing; 10min each phase) protocol. All patients later underwent tumorectomy according to the routine operating-room agenda.
No infiltrating carcinoma cells were detected in the post-cryoablation surgical specimen in 19 patients; a focus of infiltrating carcinoma cells measuring <1mm was detected in the remaining patient.
In the near future, if confirmed in larger studies with longer follow-up, cryoablation might constitute a safe and efficacious technique for the treatment of early, low-risk infiltrating ductal carcinoma. In our series, marking with ferromagnetic seeds did not interfere with the efficacy of the procedure or of the subsequent surgical intervention.
本研究的主要目的是确定在超声引导下对无超声阳性腋窝淋巴结的 HER2 阴性 luminal 乳腺癌患者进行冷冻消融后获得的手术标本中是否存在浸润性癌。次要目的是证明在冷冻消融前立即放置术前种子标记物不会干扰肿瘤细胞的冷冻消融或外科医生定位肿瘤的能力。
我们采用超声引导下冷冻消融(ICEfx Galil,Boston Scientific)治疗了 20 例诊断为单灶 HR 阳性 HER2 阴性浸润性导管癌的患者,肿瘤大小<2cm,采用三相(冷冻-被动解冻-冷冻;每个阶段 10 分钟)方案。所有患者随后根据常规手术室日程安排进行肿瘤切除术。
19 例患者的冷冻消融后手术标本中未检测到浸润性癌细胞;另 1 例患者检测到<1mm 的浸润性癌细胞灶。
在未来,如果在具有更长随访时间的更大研究中得到证实,冷冻消融可能成为治疗早期低风险浸润性导管癌的一种安全有效的技术。在我们的系列研究中,使用铁磁种子标记不会干扰该手术的疗效或随后的手术干预。