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Pigg N, Ward RC. Cryoablation for the Treatment of Breast Cancer: A Review of the Current Landscape and Future Possibilities. Acad Radiol 2023; 30:3086-3100. [PMID: 37596141 DOI: 10.1016/j.acra.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 08/20/2023]
Abstract
Breast cancer is one of the most common malignancies worldwide. Traditional treatment options for breast cancer include surgery, radiation therapy, and chemotherapy. However, cryoablation, a minimally invasive technique, has emerged as a promising alternative for the treatment of early-stage breast cancer. This article aims to provide an overview of cryoablation, focusing on incorporation into practice, patient selection, procedural technique, imaging follow-up, post-treatment radiopathological findings, and current and ongoing research in the field. The current evidence suggests that cryoablation offers a safe and effective treatment option for selected patients, providing comparable oncological outcomes to traditional treatments while minimizing invasiveness and preserving breast aesthetics.
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Affiliation(s)
- Nicholas Pigg
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Women & Infants Hospital, Providence, Rhode Island.
| | - Robert C Ward
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Women & Infants Hospital, Providence, Rhode Island
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Holmes D, Iyengar G. Breast Cancer Cryoablation in the Multidisciplinary Setting: Practical Guidelines for Patients and Physicians. Life (Basel) 2023; 13:1756. [PMID: 37629613 PMCID: PMC10456083 DOI: 10.3390/life13081756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Breast cancer cryoablation has emerged as a minimally invasive alternative to lumpectomy for treating early-stage breast cancer. However, no consensus exists on what should be considered the standard of care for the multidisciplinary management of patients treated with breast cancer cryoablation. In lieu of national guidelines, this review of the literature provides a multidisciplinary framework and an evidence-based discussion of the integration of "standard of care practices" in the comprehensive management of breast cancer cryoablation patients.
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Affiliation(s)
- Dennis Holmes
- Adventist Health Glendale, 1505 Wilson Terrace, Suite 370, Glendale, CA 91206, USA
| | - Geeta Iyengar
- Medical Imaging Center of Southern California, 8727 Beverly Blvd., Beverly Hills, CA 90048, USA
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Roca Navarro MJ, Garrido Alonso D, Navarro Monforte Y, García Martínez F, Díaz de Bustamante Durbán T, Córdoba Chicote MV, Oliver Goldaracena JM. Efficacy of ultrasound-guided cryoablation in treating low-risk breast cancer. RADIOLOGIA 2023; 65:112-121. [PMID: 37059577 DOI: 10.1016/j.rxeng.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 04/16/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- M J Roca Navarro
- Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain.
| | - D Garrido Alonso
- Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain
| | - Y Navarro Monforte
- Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain
| | - F García Martínez
- Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain
| | | | - M V Córdoba Chicote
- Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain
| | - J M Oliver Goldaracena
- Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain
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Milgrom ZZ, Milgrom DP, Han Y, Hui SL, Haggstrom DA, Fisher CS, Mendonca EA. Breast Cancer Screening, Diagnosis, and Surgery during the Pre- and Peri-pandemic: Experience of Patients in a Statewide Health Information Exchange. Ann Surg Oncol 2023; 30:2883-2894. [PMID: 36749504 PMCID: PMC9904246 DOI: 10.1245/s10434-023-13119-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/04/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Measures taken to address the COVID-19 pandemic interrupted routine diagnosis and care for breast cancer. The aim of this study was to characterize the effects of the pandemic on breast cancer care in a statewide cohort. PATIENTS AND METHODS Using data from a large health information exchange, we retrospectively analyzed the timing of breast cancer screening, and identified a cohort of newly diagnosed patients with any stage of breast cancer to further access the information available about their surgical treatments. We compared data for four subgroups: pre-lockdown (preLD) 25 March to 16 June 2019; lockdown (LD) 23 March to 3 May 2020; reopening (RO) 4 May to 14 June 2020; and post-lockdown (postLD) 22 March to 13 June 2021. RESULTS During LD and RO, screening mammograms in the cohort decreased by 96.3% and 36.2%, respectively. The overall breast cancer diagnosis and surgery volumes decreased up to 38.7%, and the median time to surgery was prolonged from 1.5 months to 2.4 for LD and 1.8 months for RO. Interestingly, higher mean DCIS diagnosis (5.0 per week vs. 3.1 per week, p < 0.05) and surgery volume (14.8 vs. 10.5, p < 0.05) were found for postLD compared with preLD, while median time to surgery was shorter (1.2 months vs. 1.5 months, p < 0.0001). However, the postLD average weekly screening and diagnostic mammogram did not fully recover to preLD levels (2055.3 vs. 2326.2, p < 0.05; 574.2 vs. 624.1, p < 0.05). CONCLUSIONS Breast cancer diagnosis and treatment patterns were interrupted during the lockdown and still altered 1 year after. Screening in primary care should be expanded to mitigate possible longer-term effects of these interruptions.
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Affiliation(s)
- Zheng Z. Milgrom
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN USA
| | | | - Yan Han
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN USA
| | - Siu L. Hui
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN USA ,Regenstrief Institute, Indianapolis, IN USA
| | - David A. Haggstrom
- Regenstrief Institute, Indianapolis, IN USA ,Richard L. Roudebush VA Medical Center, Indianapolis, IN USA ,Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | - Carla S. Fisher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN USA
| | - Eneida A. Mendonca
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
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Roca Navarro M, Garrido Alonso D, Navarro Monforte Y, García Martínez F, Díaz de Bustamante Durbán T, Córdoba Chicote M, Oliver Goldaracena J. Eficacia de la crioablación guiada con ecografía en el tratamiento del cáncer de mama de bajo riesgo. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hasnain M, Pasha MF, Ghani I, Jeong SR. Emerging technologies and their roles during the COVID-19 pandemic and safety challenges of frontline medical staff: a rapid review. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC8335463 DOI: 10.1007/s42600-021-00167-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose The coronavirus 2019 (COVID-19) pandemic has rapidly spread worldwide, with an ever-increasing number of confirmed positive cases and mortality rate. Moreover, frontline medical staff fighting with the COVID-19 infection have been infected and show psychological effects of the pandemic. This study presents an overview of the emerging literature on the safety challenges of frontline medical staff and how technology is being used to control the COVID-19 pandemic. Methods This study conducts a rapid review of available studies by following the “preferred reporting items for systematic reviews and meta-analyses” (PRISMA) guidelines. Sixty-three articles were selected for this rapid review paper from three popular digital data repositories. Results The majority of the studies chosen focused on the discussion of COVID-19 with regard to China, Singapore, Italy, and the USA. A previously proposed framework is used to synthesize the findings of this study. The results throw light on the several challenges faced by medical staff during the COVID-19 pandemic. Eleven major technologies have been identified in this paper. Conclusion This work concludes that technology helps in the prevention and detection of the COVID-19 infection, where it specifically helps in reducing the safety challenges of frontline medical staff and monitoring the COVID-19 patients.
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Affiliation(s)
- Muhammad Hasnain
- School of IT, Monash University, Ridzuan Condominium, Block C-309, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
| | - Muhammad Fermi Pasha
- School of IT, Monash University, Ridzuan Condominium, Block C-309, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
| | - Imran Ghani
- Virginia Military Institute, Lexington, VA USA
| | - Seung Ryul Jeong
- Graduate School of Business IT, Kookmin University, Seoul, Korea
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Alkhalifa H, Mohammed F, Taurin S, Greish K, Taha S, Fredericks S. Inhibition of aquaporins as a potential adjunct to breast cancer cryotherapy. Oncol Lett 2021; 21:458. [PMID: 33907568 PMCID: PMC8063341 DOI: 10.3892/ol.2021.12719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/02/2021] [Indexed: 12/20/2022] Open
Abstract
Cryoablation is an emerging type of treatment for cancer. The sensitization of tumors using cryosensitizing agents prior to treatment enhances ablation efficiency and may improve clinical outcomes. Water efflux, which is regulated by aquaporin channels, contributes to cancer cell damage achieved through cryoablation. An increase in aquaporin (AQP) 3 is cryoprotective, whereas its inhibition augments cryodamage. The present study aimed to investigate aquaporin (AQP1, AQP3 and AQP5) gene expression and cellular localization in response to cryoinjury. Cultured breast cancer cells (MDA-MB-231 and MCF-7) were exposed to freezing to induce cryoinjury. RNA and protein extracts were then analyzed using reverse transcription-quantitative PCR and western blotting, respectively. Localization of aquaporins was studied using immunocytochemistry. Additionally, cells were transfected with small interfering RNA to silence aquaporin gene expression and cell viability was assessed using the Sulforhodamine B assay. Cryoinjury did not influence gene expression of AQPs, except for a 4-fold increase of AQP1 expression in MDA-MD-231 cells. There were no clear differences in AQP protein expression for either cell lines upon exposure to frozen and non-frozen temperatures, with the exception of fainter AQP5 bands for non-frozen MCF-7 cells. The exposure of cancer cells to freezing temperatures altered the localization of AQP1 and AQP3 proteins in both MCF-7 and MDA-MD-231 cells. The silencing of AQP1, AQP3 and AQP5 exacerbated MDA-MD-231 cell damage associated with freezing compared with control siRNA. This was also observed with AQP3 and AQP5 silencing in MCF-7 cells. Inhibition of aquaporins may potentially enhance cryoinjury. This cryosensitizing process may be used as an adjunct to breast cancer cryotherapy, especially in the border area targeted by cryoablation where freezing temperatures are not cold enough to induce cellular damage.
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Affiliation(s)
- Haifa Alkhalifa
- Department of Basic Medical Sciences, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya 15503, Kingdom of Bahrain
- Department of Science, New York University Abu Dhabi, Abu Dhabi 129188, United Arab Emirates
| | - Fatima Mohammed
- Department of Basic Medical Sciences, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya 15503, Kingdom of Bahrain
| | - Sebastien Taurin
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Segaya, Manama 328, Kingdom of Bahrain
| | - Khaled Greish
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Segaya, Manama 328, Kingdom of Bahrain
| | - Safa Taha
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Princess Al-Jawhara Centre for Molecular Medicine, Arabian Gulf University, Segaya, Manama 328, Kingdom of Bahrain
| | - Salim Fredericks
- Department of Basic Medical Sciences, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya 15503, Kingdom of Bahrain
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Pellini F, Di Filippo G, Mirandola S, Deguidi G, Filippi E, Pollini GP. Effects of Lean Thinking and Emerging Technologies on Breast Cancer Patients' Therapeutic Process During COVID-19 Pandemic: A Case-Control Matched Study. Front Surg 2021; 8:582980. [PMID: 33791333 PMCID: PMC8006315 DOI: 10.3389/fsurg.2021.582980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: The advent of the COVID-19 pandemic has led to the sudden disruption of routine medical care, and the subsequent reorganization of hospital structures and therapeutic algorithms, aiming at protecting patients and health professionals. This was inevitably bound to affect our Breast Unit, dilating both pre- and post-operative times. The aim of this study was to evaluate the effect on patients' flow of organizational and logistic changes (key interventions) based on lean thinking implemented after the COVID-19 outbreak. Materials and Methods: Clinical and demographic data were retrospectively collected from patients undergoing sentinel lymph node biopsy for breast cancer at the Verona University Hospital from January 2018 to June 2020. Patients enrolled (n = 341) were divided into two groups according to date of admission: before (Group A; n = 294) and after (Group B; n = 47) the implementation of key interventions. Each case in Group B was subsequently matched 1:1 by means of case-control matching with cases from Group A for age, comorbidities, and type of surgery (Subgroup A1; N = 47). Pre-admission time (T0) and length of stay (T1) were compared between the three groups. Results: Median T0 was 312 h, whereas median T1 was 24 h. Patients in Group B had a higher frequency of comorbidities (57.4 vs. 25.2%, p = 0.001) and underwent mastectomy more often than patients in Group A (61.7 vs. 36.7%, p = 0.001). Both median T0 and T1 were higher in group B than in group A (384 vs. 300 h, p = 0.001, 48 vs. 24 h, p = 0.001, respectively). Median T0 and T1 did not significantly differ between Group B and Subgroup A1 (all p > 0.05). Conclusions: Lean thinking and new technologies could prove useful to the optimization of preoperative and postoperative times during the current pandemic, minimizing healthcare personnel and patients' exposure to SARS-CoV-2, and promoting a rational use of limited resources, while complying with oncological principles.
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Affiliation(s)
- Francesca Pellini
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy
| | - Giacomo Di Filippo
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy
| | - Sara Mirandola
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy
| | - Giulia Deguidi
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy
| | - Elisa Filippi
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy
| | - Giovanni Paolo Pollini
- Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy
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Habrawi Z, Melkus MW, Khan S, Henderson J, Brandi L, Chu V, Layeequr Rahman R. Cryoablation: A promising non-operative therapy for low-risk breast cancer. Am J Surg 2020; 221:127-133. [PMID: 32788081 DOI: 10.1016/j.amjsurg.2020.07.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of cryoablation for early-stage low-risk breast cancer without tumor resection. METHODS Women diagnosed with ER+, PR+, and HER2-infiltrating ductal carcinomas ≤1.5 cm were treated with cryoablation. The non-surgical procedure used a Visica® 2 Treatment System with ultrasound guidance for ablation of the tumor with a 1 cm margin. Patients were monitored at 6-month intervals by MRI, mammogram, and ultrasound. RESULTS Twelve patients with unifocal breast cancer were treated with cryoablation for local control without follow-up tumor resection. All patients received adjuvant endocrine therapy, and none had radiation. The median follow-up was 28.5 (range = 4-41) months with 11 patients having at least one six-month follow-up. All imaging modalities showed complete ablation of target zone 11/11 (100%). Four patients (33.3%) have been followed up for ≥ 2 years with no local failure or residual disease. CONCLUSION Cryoablation of early-stage low-risk (ER+, PR+, and HER2-) breast cancer is a safe alternative to surgery.
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Affiliation(s)
- Zaina Habrawi
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Michael W Melkus
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Sonia Khan
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - James Henderson
- Texas Tech University Health Sciences Center, Breast Center of Excellence, Lubbock, TX, 79430, USA
| | - Luis Brandi
- Department of Pathology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Victoria Chu
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Rakhshanda Layeequr Rahman
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA; Texas Tech University Health Sciences Center, Breast Center of Excellence, Lubbock, TX, 79430, USA.
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