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Ji Y, Zhuo Y, Li T, Lian J, Wang Z, Guo X, Kong D, Li K. MR-guided percutaneous microwave coagulation of small breast tumors. Insights Imaging 2024; 15:76. [PMID: 38499835 PMCID: PMC10948645 DOI: 10.1186/s13244-024-01645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/10/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND To evaluate the technical success and patient safety of magnetic resonance-guided percutaneous microwave coagulation (MR-guided PMC) for breast malignancies. METHODS From May 2018 to December 2019, 26 patients with breast tumors measuring 2 cm or less were recruited to participate in a prospective, single-institution clinical study. The primary endpoint of this study was the evaluation of treatment efficacy for each patient. Histochemical staining with α-nicotinamide adenine dinucleotide and reduced (NADH)-diaphorase was used to determine cell viability following and efficacy of PMC. The complications and self-reported sensations from all patients during and after ablation were also assessed. The technical success of the PMC procedure was defined when the area of the NADH-diaphorase negative region fully covered the hematoxylin-eosin (H&E) staining region in the tumor. RESULTS All patients had a complete response to ablation with no residual carcinoma on histopathological specimen. The mean energy, ablation duration, and procedure duration per tumor were 36.0 ± 4.2 kJ, 252.9 ± 30.9 S, and 104.2 ± 13.5 min, respectively. During the ablation, 14 patients underwent prolonged ablation time, and 1 patient required adjusting of the antenna position. Eleven patients had feelings of subtle heat or swelling, and 3 patients experienced slight pain. After ablation, one patient took two painkillers because of moderate pain, and no patients had postoperative oozing or other complications after PMC. Induration around the ablation area appeared in 16 patients. CONCLUSION MR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future. CRITICAL RELEVANCE STATEMENT MR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future. KEY POINTS • MR-guided PMC of small breast tumors is feasible. • PMC was successfully performed for all patients. • All patients were satisfied with the final cosmetic result.
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Affiliation(s)
- Ying Ji
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Yaoyao Zhuo
- Department of Radiology, Zhongshan Hospital, Fudan University School of Medicine, Shanghai, 200000, China
| | - Ting Li
- Department of Radiology, First People's Hospital of Changzhou, Jiangsu, 213003, China
| | - Jingge Lian
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Zilin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Xinyu Guo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Zhejiang, 310027, China
| | - Kangan Li
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China.
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Qi T, Jing Y, Deng J, Chang J, Sun W, Yang R, Liu X, Zhang Q, Wan M, Lu M. Boiling Histotripsy Using Dual-Frequency Protocol on Murine Breast Tumor Model and Promotes Immune Activation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1773-1785. [PMID: 37871099 DOI: 10.1109/tuffc.2023.3326561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Histotripsy is an ultrasound-guided, noninvasive, nonthermal ablation therapy that can mechanically lyse target tissues. There have been no reports of enhanced histotripsy for large-volume triple-negative breast cancer (TNBC). This study aims to verify the ability of a novel approach of dual-frequency mode combined with two-stage millisecond-length ultrasound pulses (DF-TS) to accelerate the treatment of murine subcutaneous 4T1 tumors and determine immune changes after treatment. A custom-designed 1.1-/2.2-MHz two-element confocal-annular array was used to treat approximately 6-mm tumors under ultrasound guidance and real-time monitoring. Two-stage millisecond-length ultrasound pulses were used to generate approximate cuboid ablation volumes (diagonal 5-6 mm) within each tumor, with a dose of 100 pulses/point. Immune effects were characterized by changes of pro-inflammatory cytokine levels and infiltration levels of immune cells. In all targeted treatment areas, bubble cloud activity was visualized by ultrasound monitoring. The novel protocol resulted in elliptical and controllable sized lesions, reducing the number of scanning points, and was generally well tolerated. After treatment, tumor growth experienced a seven-day stagnation period, the survival period of mice was prolonged, and the levels of pro-inflammatory cytokines and immune cell infiltration increased. This study demonstrates that DF-TS boiling histotripsy (BH) has a noninvasive, efficient, and precise ablation ability for TNBC and potentially enhances immune responses.
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Shibamoto Y, Takano S. Non-Surgical Definitive Treatment for Operable Breast Cancer: Current Status and Future Prospects. Cancers (Basel) 2023; 15:cancers15061864. [PMID: 36980750 PMCID: PMC10046665 DOI: 10.3390/cancers15061864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
This article reviews the results of various non-surgical curative treatments for operable breast cancer. Radiotherapy is considered the most important among such treatments, but conventional radiotherapy alone and concurrent chemoradiotherapy do not achieve high cure rates. As a radiosensitization strategy, intratumoral injection of hydrogen peroxide before radiation has been investigated, and high local control rates (75-97%) were reported. The authors treated 45 patients with whole-breast radiotherapy, followed by stereotactic or intensity-modulated radiotherapy boost, with or without a radiosensitization strategy employing either hydrogen peroxide injection or hyperthermia plus oral tegafur-gimeracil-oteracil potassium. Stages were 0-I in 23 patients, II in 19, and III in 3. Clinical and cosmetic outcomes were good, with 5-year overall, progression-free, and local recurrence-free survival rates of 97, 86, and 88%, respectively. Trials of carbon ion radiotherapy are ongoing, with promising interim results. Radiofrequency ablation, focused ultrasound, and other image-guided ablation treatments yielded complete ablation rates of 20-100% (mostly ≥70%), but long-term cure rates remain unclear. In these treatments, combination with radiotherapy seems necessary to treat the extensive intraductal components. Non-surgical treatment of breast cancer is evolving steadily, with radiotherapy playing a major role. In the future, proton therapy with the ultra-high-dose-rate FLASH mode is expected to further improve outcomes.
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Affiliation(s)
- Yuta Shibamoto
- Department of Radiation Oncology, Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi 441-8021, Japan
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita-shi 565-0871, Japan
| | - Seiya Takano
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Hussain S, Durrani F, Khan A. Frequency and Clinicopathologic Characteristics of Triple-Negative Breast Cancer Among Breast Cancer Patients Presenting to Medical Oncology Department, Hayatabad Medical Complex Peshawar, Pakistan. Cureus 2023; 15:e34581. [PMID: 36883091 PMCID: PMC9985817 DOI: 10.7759/cureus.34581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Breast cancer is one of the most common cancers affecting females. The outcomes of this study will aid future research and policy suggestions by giving a rapid local burden and clinicopathologic profile of triple-negative breast cancer (TNBC) patients. MATERIAL AND METHODS This cross-sectional study was carried out at the Department of Oncology, Hayatabad Medical Complex Peshawar, Pakistan, from April 21, 2022, to October 21, 2022. The sample size was 120 using a 95% confidence level, 18.7% proportion of TNBC frequency in patients with breast cancer, and 7% absolute precision. All patients who presented with newly diagnosed breast cancer and were between the ages of 30-60 years were included in the study. The study excluded male patients and patients with a history of surgical intervention on the breast during the previous six months. RESULTS A total of 120 patients were evaluated. Age ranged between 30-60 years with a mean age of 45 years. Thirty-four (28%) patients were in the age range of 30-45 years and 86 (72%) patients were in the age range of 46-60 years. Fifty-six (47%) patients had BMI ≤27 kg/m2 while 64 (53%) had BMI >27 kg/m2. The use of oral contraceptives was noted in 25 (21%) patients. A total of 62 (52%) patients had breast cancer on the right side while 58 (48%) had it on the left side. CONCLUSION According to the results of our study, 14% of breast cancer patients had triple-negative disease.
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Affiliation(s)
- Shah Hussain
- Medical Oncology Unit, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Fakeeda Durrani
- Medical Oncology Unit, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Asif Khan
- Department of Medicine, Khyber Teaching Hospital, Peshawar, PAK
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Adams-Tew SI, Johnson S, Odéen H, Parker DL, Payne A. Validation of a drift-corrected 3D MR temperature imaging sequence for breast MR-guided focused ultrasound treatments. Magn Reson Imaging 2023; 96:126-134. [PMID: 36496098 PMCID: PMC9810259 DOI: 10.1016/j.mri.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
Real-time temperature monitoring is critical to the success of thermally ablative therapies. This work validates a 3D thermometry sequence with k-space field drift correction designed for use in magnetic resonance-guided focused ultrasound treatments for breast cancer. Fiberoptic probes were embedded in tissue-mimicking phantoms, and temperature change measurements from the probes were compared with the magnetic resonance temperature imaging measurements following heating with focused ultrasound. Precision and accuracy of measurements were also evaluated in free-breathing healthy volunteers (N = 3) under a non-heating condition. MR temperature measurements agreed closely with those of fiberoptic probes, with a 95% confidence interval of measurement difference from -2.0 °C to 1.4 °C. Field drift-corrected measurements in vivo had a precision of 1.1 ± 0.7 °C and were accurate within 1.3 ± 0.9 °C across the three volunteers. The field drift correction method improved precision and accuracy by an average of 46 and 42%, respectively, when compared to the uncorrected data. This temperature imaging sequence can provide accurate measurements of temperature change in aqueous tissues in the breast and support the use of this sequence in clinical investigations of focused ultrasound treatments for breast cancer.
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Affiliation(s)
- Samuel I Adams-Tew
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Sara Johnson
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Henrik Odéen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Dennis L Parker
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA.
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Fang L, Huang H, Quirk JD, Zheng J, Shen D, Manion B, Mixdorf M, Karmakar P, Sudlow GP, Tang R, Achilefu S. Analysis of Stable Chelate-free Gadolinium Loaded Titanium Dioxide Nanoparticles for MRI-Guided Radionuclide Stimulated Cancer Treatment. CURR ANAL CHEM 2022; 18:826-835. [PMID: 36561765 PMCID: PMC9770661 DOI: 10.2174/1573411018666220321102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent studies demonstrate that titanium dioxide nanoparticles (TiO2 NPs) are an effective source of reactive oxygen species (ROS) for photodynamic therapy and radionuclide stimulated dynamic therapy (RaST). Unfortunately tracking the in vivo distribution of TiO2 NPs noninvasively remains elusive. Objective Given the use of gadolinium (Gd) chelates as effective contrast agents for magnetic resonance imaging (MRI), this study aims to (1) develop hybrid TiO2-Gd NPs that exhibit high relaxivity for tracking the NPs without loss of ROS generating capacity; and (2) establish a simple colorimetric assay for quantifying Gd loading and stability. Methods A chelate-free, heat-induced method was used to load Gd onto TiO2 NPs, which was coated with transferrin (Tf). A sensitive colorimetric assay and inductively coupled plasma mass spectrometry (ICP-MS) were used to determine Gd loading and stability of the TiO2-Gd-Tf NPs. Measurement of the relaxivity was performed on a 1.4 T relaxometer and a 4.7 T small animal magnetic resonance scanner to estimate the effects of magnetic field strength. ROS was quantified by activated dichlorodihydrofluorescein diacetate fluorescence. Cell uptake of the NPs and RaST were monitored by fluorescence microscopy. Both 3 T and 4.7 T scanners were used to image the in vivo distribution of intravenously injected NPs in tumor-bearing mice. Results A simple colorimetric assay accurately determined both the loading and stability of the NPs compared with the expensive and complex ICP-MS method. Coating of the TiO2-Gd NPs with Tf stabilized the nanoconstruct and minimized aggregation. The TiO2-Gd-Tf maintained ROS-generating capability without inducing cell death at a wide range of concentrations but induced significant cell death under RaST conditions in the presence of F-18 radiolabeled 2-fluorodeoxyglucose. The longitudinal (r1 = 10.43 mM-1s-1) and transverse (r2 = 13.43 mM-1s-1) relaxivity of TiO2-Gd-Tf NPs were about twice and thrice, respectively, those of clinically used Gd contrast agent (Gd-DTPA; r1 = 3.77 mM-1s-1 and r2 = 5.51 mM-1s-1) at 1.4 T. While the r1 (8.13 mM-1s-1) reduced to about twice that of Gd-DTPA (4.89 mM-1s-1) at 4.7 T, the corresponding r2 (87.15 mM-1s-1) increased by a factor 22.6 compared to Gd-DTPA (r2 = 3.85). MRI of tumor-bearing mice injected with TiO2-Gd-Tf NPs tracked the NPs distribution and accumulation in tumors. Conclusion This work demonstrates that Arsenazo III colorimetric assay can substitute ICP-MS for determining the loading and stability of Gd-doped TiO2 NPs. The new nanoconstruct enabled RaST effect in cells, exhibited high relaxivity, and enhanced MRI contrast in tumors in vivo, paving the way for in vivo MRI-guided RaST.
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Affiliation(s)
- Lei Fang
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States,Department of Biomedical Engineering, School of Engineering, Washington University in St. Louis, Saint Louis, United States
| | - Hengbo Huang
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States,Department of Biomedical Engineering, School of Engineering, Washington University in St. Louis, Saint Louis, United States
| | - James D. Quirk
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Jie Zheng
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Duanwen Shen
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Brad Manion
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Matthew Mixdorf
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Partha Karmakar
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Gail P. Sudlow
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Rui Tang
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States
| | - Samuel Achilefu
- School of Medicine, Mallinckrodt Institute of Radiology, Washington University in St. Louis, Saint Louis, United States,Department of Biomedical Engineering, School of Engineering, Washington University in St. Louis, Saint Louis, United States,Department of Biochemistry and Molecular Biophysics, School of Medicine, Washington University in St. Louis, Saint Louis, United States,Department of Biomedical Engineering, University of Texas Southwestern, Dallas, United States,Address correspondence to this author at the Department of Biomedical Engineering, School of Engineering, Washington University in St. Louis, Saint Louis, United States;
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Perretta T, Meucci R, Pistolese CA, Manenti G, Stefano CD, Vanni G, Anemona L, Ferrari D, Lamacchia F, De Stasio V, Buonomo OC. Ultrasound-Guided Laser Ablation After Excisional Vacuum-Assisted Breast Biopsy for Small Malignant Breast Lesions: Preliminary Results. Technol Cancer Res Treat 2021; 20:1533033820980089. [PMID: 33618620 PMCID: PMC7905484 DOI: 10.1177/1533033820980089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The purpose of this preliminary study is to evaluate the
feasibility of the excisional ultrasound (US) guided
vacuum-assisted breast biopsy (VAE), followed by US-guided Laser
Interstitial Thermal Therapy (LITT) in the treatment of unifocal
ductal breast carcinomas ≤ 1 cm and estimate the ablation rate
analyzing the final histopathological results after subsequent
surgical excision. Methods: In a single session 11 female patients with unifocal less than a
centimeter breast cancer underwent 2 different minimally
invasive percutaneous US-guided techniques: a VAE breast biopsy
with an 8 G needle to remove the lesion and, immediately after,
a LITT ablation in the biopsy site. Four weeks later, all
patients underwent radiological follow-up. Afterward, a
systematic surgery was performed, the ablation rate was
calculated, and iconographic and histological features were
correlated. Results: Average maximum diameter of the lesions was 7.6 mm (5-10 mm). No
patient reported pain or discomfort during procedure. 1/11
patient (9.1%) reported an early minor complication (a small
superficial skin burn). After surgical excision, the
histopathological evaluation reported in 10/11 cases (90.9%)
complete ablation of the target lesion. In only one case (9.1%)
residual cancer was detected. The necrotic-hemorrhagic cavities
showed a mean maximum diameter of 27.3 mm (20-35 mm). Conclusions: Laser ablation performed after excisional biopsy could be
considered a valid alternative to surgical excision for the
treatment of lesions ≤ 1 cm, if carried out by expert
radiologists. The association of these minimally invasive
percutaneous methods has proven to be reliable, fast, and safe
with an ablation rate of 90.9% and excellent aesthetic results.
RM and CESM are potentially able to quantifying treatment
results and to follow-up the ablation effects.
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Affiliation(s)
- Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy.,Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Donatella Ferrari
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Vincenzo De Stasio
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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Snyder KK, Van Buskirk RG, Baust JG, Baust JM. Breast Cancer Cryoablation: Assessment of the Impact of Fundamental Procedural Variables in an In Vitro Human Breast Cancer Model. Breast Cancer (Auckl) 2020; 14:1178223420972363. [PMID: 33239880 PMCID: PMC7672727 DOI: 10.1177/1178223420972363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prominent form of cancer and the second leading cause of death in women behind lung cancer. The primary modes of treatment today include surgical excision (lumpectomy, mastectomy), radiation, chemoablation, anti-HER2/neu therapy, and/or hormone therapy. The severe side effects associated with these therapies suggest a minimally invasive therapy with fewer quality of life issues would be advantageous for treatment of this pervasive disease. Cryoablation has been used in the treatment of other cancers, including prostate, skin, and cervical, for decades and has been shown to be a successful minimally invasive therapeutic option. To this end, the use of cryotherapy for the treatment of breast cancer has increased over the last several years. Although successful, one of the challenges in cryoablation is management of cancer destruction in the periphery of the ice ball as the tissue within this outer margin may not experience ablative temperatures. In breast cancer, this is of concern due to the lobular nature of the tumors. As such, in this study, we investigated the level of cell death at various temperatures associated with the margin of a cryogenic lesion as well as the impact of repetitive freezing and thawing methods on overall efficacy. METHODS Human breast cancer cells, MCF-7, were exposed to temperatures of -5°C, -10°C, -15°C, -20°C, or -25°C for 5-minute freeze intervals in a single or repeat freeze-thaw cycle. Samples were thawed with either passive or active warming for 5 or 10 minutes. Samples were assessed at 1, 2, and 3 days post-freeze to assess cell survival and recovery. In addition, the modes of cell death associated with freezing were assessed over the initial 24-hour post-thaw recovery period. RESULTS Exposure of MCF-7 cells to -5°C and -10°C resulted in minimal cell death regardless of the freeze/thaw conditions. Freezing to a temperature of -25°C resulted in complete cell death 1 day post-thaw with no cell recovery in all freeze/thaw scenarios evaluated. Exposure to a single freeze event resulted in a gradual increase in cell death at -15°C and -20°C. Application of a repeat freeze-thaw cycle (dual 5-minute freeze) resulted in an increase in cell death with complete destruction at -20°C and near complete death at -15°C (day 1 survival: single -15°C freeze/thaw = 20%; repeated -15°C freeze/thaw = 4%). Analysis of thaw interval time (5 vs 10 minute) demonstrated that the shorter 5-minute thaw interval between freezes resulted in increased cell destruction. Furthermore, investigation of thaw rate (active vs passive thawing) demonstrated that active thawing resulted in increased cell survival thereby less effective ablation compared with passive thawing (eg, -15°C 5/10/5 procedure survival, passive thaw: 4% vs active thaw: 29%). CONCLUSIONS In summary, these in vitro findings suggest that freezing to temperatures of 25°C results in a high degree of breast cancer cell destruction. Furthermore, the data demonstrate that the application of a repeat freeze procedure with a passive 5-minute or 10-minute thaw interval between freeze cycles increases the minimal lethal temperature to the -15°C to -20°C range. The data also demonstrate that the use of an active thawing procedure between freezes reduces ablation efficacy at temperatures associated with the iceball periphery. These findings may be important to improving future clinical applications of cryoablation for the treatment of breast cancer.
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Affiliation(s)
| | - Robert G Van Buskirk
- CPSI Biotech, Owego, NY, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - John G Baust
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
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Li P, Kong L, Wang Y, Lv X, Wang J, Gao H. Comparative analysis of radiofrequency ablation and resection for colorectal liver metastases in caudate lobe: a retrospective study. Acta Chir Belg 2020; 120:321-328. [PMID: 31187689 DOI: 10.1080/00015458.2019.1631614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To assess the therapeutic efficiency of radiofrequency ablation (RFA) for colorectal liver metastases (CRLM) in the caudate lobe compared with that of surgical resection.Methods: After approved by institutional review board, we retrospectively reviewed 20 patients with caudate CRLM treated by RFA or resection between 2006 and 2017. Comparative analysis was performed based on the different therapies, including patient characteristics, therapeutic outcomes, recurrences, and survivals.Results: During the median follow-up of 7 years (range, 2 -11 years), no differences in complications and recurrences were found between RFA and surgery groups (p > .05). The median overall survival (OS) of patients after RFA and resection were 41 months (95% confidence interval (CI) 23.5-70.5) and 54 months (95% CI 31.1-77.7), respectively (p = .627, hazard radio (HR) 0.7, 95% CI 0.2-2.6). However, OS of resection group was better than that of RFA group for large caudate CRLMs (>3 cm) (p = .042, HR 4.4, 95% CI 0.6-32.6).Conclusions: RFA is a feasible, safe, and effective treatment for CRLM in the caudate. Surgical resection revealed superior outcomes in the treatment of caudate CRLMs, particularly in cases with a hepatic tumor size >3 cm.
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Affiliation(s)
- Peizhe Li
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Liaocheng, Liaocheng, PR China
| | - Lingjia Kong
- Department of Digestive System, The Second People’s Hospital of Liaocheng, Liaocheng, PR China
| | - Yitong Wang
- Department of Ultrasound, The Second People’s Hospital of Liaocheng, Liaocheng, PR China
| | - Xukun Lv
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Liaocheng, Liaocheng, PR China
| | - Jinkai Wang
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Liaocheng, Liaocheng, PR China
| | - Hengling Gao
- Department of Gastrointestinal Surgery, The Second People’s Hospital of Liaocheng, Liaocheng, PR China
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Lee J, Jung JH, Kim WW, Park CS, Lee RK, Kim HJ, Kim WH, Park HY. Efficacy of breast MRI for surgical decision in patients with breast cancer: ductal carcinoma in situ versus invasive ductal carcinoma. BMC Cancer 2020; 20:934. [PMID: 32993586 PMCID: PMC7526123 DOI: 10.1186/s12885-020-07443-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 09/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background Preoperative breast magnetic resonance imaging (MRI) provides more information than mammography and ultrasonography for determining the surgical plan for patients with breast cancer. This study aimed to determine whether breast MRI is more useful for patients with ductal carcinoma in situ (DCIS) lesions than for those with invasive ductal carcinoma (IDC). Methods A total of 1113 patients with breast cancer underwent mammography, ultrasonography, and additional breast MRI before surgery. The patients were divided into 2 groups: DCIS (n = 199) and IDC (n = 914), and their clinicopathological characteristics and oncological outcomes were compared. Breast surgery was classified as follows: conventional breast-conserving surgery (Group 1), partial mastectomy with volume displacement (Group 2), partial mastectomy with volume replacement (Group 3), and total mastectomy with or without reconstruction (Group 4). The initial surgical plan (based on routine mammography and ultrasonography) and final surgical plan (after additional breast MRI) were compared between the 2 groups. The change in surgical plan was defined as group shifting between the initial and final surgical plans. Results Changes (both increasing and decreasing) in surgical plans were more common in the DCIS group than in the IDC group (P < 0.001). These changes may be attributed to the increased extent of suspicious lesions on breast MRI, detection of additional daughter nodules, multifocality or multicentricity, and suspicious findings on mammography or ultrasonography but benign findings on breast MRI. Furthermore, the positive margin incidence in frozen biopsy was not different (P = 0.138). Conclusions Preoperative breast MRI may provide more information for determining the surgical plan for patients with DCIS than for those with IDC.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chan Sub Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ryu Kyung Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. .,Department of Surgery, Joint Institute for Regenerative Medicine, School of Medicine, Kyungpook National University, Hoguk-ro 807, Buk-gu, Daegu, 41404, Republic of Korea.
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11
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Winkelmann MT, Gohla G, Kübler J, Weiß J, Clasen S, Nikolaou K, Hoffmann R. MR-Guided High-Power Microwave Ablation in Hepatic Malignancies: Initial Results in Clinical Routine. Cardiovasc Intervent Radiol 2020; 43:1631-1638. [PMID: 32699978 PMCID: PMC7591402 DOI: 10.1007/s00270-020-02584-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Evaluation of technique effectiveness, patient safety and ablation parameters of MR-guided microwave ablation in hepatic malignancies using an MR-conditional high-power microwave ablation system. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained. Patients who underwent MR-guided microwave ablation of hepatic malignancies in a 1.5T wide-bore scanner using a perfusion-cooled high-power microwave ablation system with a maximum generator power of 150 W were included. Ablation parameters comprising procedure durations, net ablation duration, applicator positions and ablation zone dimensions were recorded. Adverse events were classified according to the CIRSE classification system. Technique effectiveness was assessed after 1 month. Follow-up was conducted with contrast-enhanced MRI and ranged from 1 to 20 months (mean: 6.1 ± 5.4 months). RESULTS Twenty-one consecutive patients (age: 63.4 ± 10.5 years; 5 female) underwent 22 procedures for 28 tumours (9 hepatocellular carcinomas, 19 metastases) with a mean tumour diameter of 14.6 ± 5.4 mm (range: 6-24 mm). Technique effectiveness was achieved in all lesions. Tumours were treated using 1.7 ± 0.7 applicator positions (range: 1-3). Mean energy and ablation duration per tumour were 75.3 ± 35.4 kJ and 13.3 ± 6.2 min, respectively. Coagulation zone short- and long-axis diameters were 29.1 ± 6.4 mm and 39.9 ± 7.4 mm, respectively. Average procedure duration was 146.4 ± 26.2 min (range: 98-187 min). One minor complication was reported. Five patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed during initial follow-up. CONCLUSION MR-guided high-power microwave ablation provides safe and effective treatment of hepatic malignancies with short ablation times and within acceptable procedure durations.
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Affiliation(s)
- Moritz T Winkelmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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12
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Zaffino P, Moccia S, De Momi E, Spadea MF. A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future. Ann Biomed Eng 2020; 48:2171-2191. [PMID: 32601951 DOI: 10.1007/s10439-020-02553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
| | - Sara Moccia
- Department of Information Engineering (DII), Universitá Politecnica delle Marche, via Brecce Bianche, 12, 60131, Ancona, AN, Italy.
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, MI, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
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Kokuryo D, Kumamoto E, Kuroda K. Recent technological advancements in thermometry. Adv Drug Deliv Rev 2020; 163-164:19-39. [PMID: 33217482 DOI: 10.1016/j.addr.2020.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/25/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Thermometry is the key factor for achieving successful thermal therapy. Although invasive thermometry with a probe has been used for more than four decades, this method can only detect the local temperature within the probing volume. Noninvasive temperature imaging using a tomographic technique is ideal for monitoring hot-spot formation in the human body. Among various techniques, such as X-ray computed tomography, microwave tomography, echo sonography, and magnetic resonance (MR) imaging, the proton resonance frequency shift method of MR thermometry is the only method currently available for clinical practice because its temperature sensitivity is consistent in most aqueous tissues and can be easily observed using common clinical scanners. New techniques are being proposed to improve the robustness of this method against tissue motion. MR techniques for fat thermometry were also developed based on relaxation times. One of the latest non-MR techniques to attract attention is photoacoustic imaging.
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Affiliation(s)
- Daisuke Kokuryo
- Graduate School of System Informatics, Kobe University, Japan
| | - Etsuko Kumamoto
- Information Science and Technology Center, Kobe University, Japan
| | - Kagayaki Kuroda
- School of Information Science and Technology, Tokai University, Japan; Center for Frontier Medical Engineering, Chiba University, Japan.
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Pusceddu C, Paliogiannis P, Nigri G, Fancellu A. Cryoablation In The Management Of Breast Cancer: Evidence To Date. BREAST CANCER-TARGETS AND THERAPY 2019; 11:283-292. [PMID: 31632134 PMCID: PMC6791835 DOI: 10.2147/bctt.s197406] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Cryoablation has been successfully used to treat various type of solid tumors, including breast carcinomas. This ablation method has the advantage of being a minimally invasive procedure useful in various clinical situations, including early breast cancer and metastatic breast cancer, when co-morbidities preclude the use of surgical treatment. However, due to the small sample size of the available studies, reliable and definitive conclusions on the usefulness of cryoablation in patients with breast cancer could not be drawn. In fact, many aspects necessitate to be elucidated, regarding technical issues, indications, efficacy, imaging follow-up, and possible advantages over other percutaneous ablative methods. This review article has the aim to clarify the current evidence supporting cryoablation of breast cancer, and discuss the future perspectives, including those arising from the new studies on immunological effects related to cryoablation.
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Affiliation(s)
- Claudio Pusceddu
- Division of Interventional Radiology, Department of Oncologic Radiology, Businco Hospital, Cagliari, Italy
| | - Panagiotis Paliogiannis
- Unit of Experimental Pathology and Oncology, Department of Medical Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, Rome, Italy
| | - Alessandro Fancellu
- Unit of General Surgery 2 - Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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