A Pilot Study of Ultrasound-Guided Cryoablation of Invasive Ductal Carcinomas up to 15 mm With MRI Follow-Up and Subsequent Surgical Resection

• Published in: American journal of roentgenology (1976) Vol. 204; no. 5; pp. 1100 - 1108
• Main Authors: Poplack, Steven P., Levine, Gary M., Henry, Lisa, Wells, Wendy A., Heinemann, F. Scott, Hanna, Cheryl M., Deneen, Daniel R., Tosteson, Tor D., Barth, Richard J.
• Format: Journal Article
• Language: English
• Published: United States 01.05.2015
• Subjects: Aged; Algorithms; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - surgery; Contrast Media; Cryosurgery - methods; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged; Neoplasm Invasiveness; Pilot Projects; Prospective Studies; Sensitivity and Specificity; Treatment Outcome; Ultrasonography, Interventional; ultrasound guidance; breast cancer; cryotherapy; minimally invasive; MRI
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.13.12325

The purpose of this study was to evaluate the effectiveness of ultrasound-guided cryoablation in treating small invasive ductal carcinoma and to assess the role of contrast-enhanced (CE) MRI in determining the outcome of cryoablation. Twenty consecutive participants with invasive ductal carcinomas up to 15 mm, with limited or no ductal carcinoma in situ (DCIS), underwent ultrasound-guided cryoablation. Preablation mammography, ultrasound, and CE-MRI were performed to assess eligibility. Clinical status was evaluated at 1 day, 7-10 days, and 2 weeks after ablation. CE-MRI was performed 25-40 days after ablation, followed by surgical resection within 5 days. Ultrasound-guided cryoablation was uniformly technically successful, and postablation clinical status was good to excellent in all participants. Cryoablation was not clinically successful in 15% (three of 20 patients). Three participants had residual cancer at the periphery of the cryoablation site. Two participants had viable nonmalignant tissue within the central zone of cryoablation-induced necrosis. Postablation CE-MRI had a sensitivity of 0% (0/3) and specificity of 88% (15/17). The predictive value of negative findings on CE-MRI was 83% (15/18). Correlations between cancer characteristics, cryoablation procedural variables, postablation CE-MRI findings, and surgical specimen features were not statistically significant. There were also no significant differences in participants with or without residual cancer. In our pilot experience, ultrasound-guided cryoablation of invasive ductal carcinomas up to 15 mm has a clinical failure rate of 15% but is technically feasible and well tolerated by patients. The majority of cryoablation failures are manifest as DCIS outside the cryoablation field. Postablation CE-MRI does not reliably predict cryoablation outcome.