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Dai Y, Jiang J, Liang P, Yu X, Han Z, Liu F, Tan S, Bi M, Wu C, Cai Q, Li J, Yu J. Percutaneous microwave ablation: a viable local therapy for breast cancer involving the skin/nipple-areola complex? Curr Probl Surg 2024; 61:101483. [PMID: 38823890 DOI: 10.1016/j.cpsurg.2024.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Yuqing Dai
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Jiang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - XiaoLing Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - ZhiYu Han
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuilian Tan
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingsen Bi
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chong Wu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qian Cai
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianming Li
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China.
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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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Kawamura Y, Itou H, Kida A, Sunakawa H, Kawamura K. Microwave ablation for the control of bleeding from disintegrated mammary tumours in two dogs. Vet Med Sci 2023; 9:1062-1068. [PMID: 36745474 DOI: 10.1002/vms3.1089] [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: 02/07/2023] Open
Abstract
A 16-year-old intact female Miniature Dachshund (dog 1) and a 13-year-old intact female American Cocker Spaniel (dog 2) presented with a chief complaint of bleeding from a mammary gland tumour ulceration. Dog 1 was transferred to hospital from a local hospital in a haemorrhagic shock state with uncontrolled continuous bleeding. Thoracic radiographs revealed multiple nodular shadows suspected to be pulmonary metastasis. Dog 2 presented with intermittent bleeding from a mass lesion in the right fifth mammary gland. Due to high anaesthetic risk secondary to severe mitral valve insufficiency (ASA status III), the owner declined surgical excision of the tumour. Therefore, microwave ablation (MWA) under local anaesthesia was chosen in order to achieve adequate haemostasis. Both dogs received local anaesthesia around the bleeding mass lesion, and the disintegrated site was microwave-ablated; dog 1 underwent MWA after blood transfusion to improve the haemorrhagic shock. The ablation site was protected using a non-adhesive dressing. Scarring of the ulcerated site led to complete haemostasis in both cases. Dog 1 underwent tumorectomy on the 31st hospital day to prevent rebleeding; histopathology results were consistent with mammary adenocarcinoma with the ablation site covered by a capsule structure. To the authors' knowledge, this is the first case report describing the use of MWA to stop bleeding from mammary tumours in veterinary medicine. MWA is a feasible and potentially effective palliative treatment modality to stop bleeding from disintegrated mammary tumours in dogs under local anaesthesia.
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Affiliation(s)
- Yuta Kawamura
- Kawamura Animal Hospital, Niigata, Niigata, Japan.,Department of Radiology, Division of Diagnostic Radiology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Hiroki Itou
- Kawamura Animal Hospital, Niigata, Niigata, Japan
| | - Akitomo Kida
- Kawamura Animal Hospital, Niigata, Niigata, Japan
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Li Z, Lu C, Wang F, Guo H, Wang Z, Yin H, Li J. Heat treatment-induced autophagy promotes breast cancer cell invasion and metastasis via TGF- β2-mediated epithelial-mesenchymal transitions. PeerJ 2023; 11:e14640. [PMID: 36650834 PMCID: PMC9840853 DOI: 10.7717/peerj.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023] Open
Abstract
Background Insufficient thermal ablation can accelerate malignant behaviors and metastases in some solid tumors, and epithelial-mesenchymal transition (EMT) and autophagy are involved in tumor metastasis. It has been found that TGF-β2 which belongs to the family of transforming growth factors often associated with cancer cell invasiveness and EMT. However, whether the interactions between autophagy and TGF-β2 induce EMT in breast cancer (BC) cells following insufficient microwave ablation (MWA) remains unclear. Methods BC cells were treated with sublethal heat treatment to simulate insufficient MWA, and the effects of heat treatment on the BC cell phenotypes were explored. CCK-8, colony formation, flow cytometry, Transwell, and wound healing assays were performed to evaluate the influence of sublethal heat treatment on the proliferation, apoptosis, invasion, and migration of BC cells. Western blotting, real-time quantitative PCR, immunofluorescence, and transmission electron microscopy were carried out to determine the changes in markers associated with autophagy and EMT following sublethal heat treatment. Results Results showed that heat treatment promoted the proliferation of surviving BC cells, which was accompanied by autophagy induction. Heat treatment-induced autophagy up-regulated TGF-β2/Smad2 signaling and promoted EMT phenotype, thereby enhancing BC cells' migration and invasion abilities. An increase or decrease of TGF-β2 expression resulted in the potentiation and suppression of autophagy, as well as the enhancement and abatement of EMT. Autophagy inhibitors facilitated apoptosis and repressed proliferation of BC cells in vitro, and thwarted BC cell tumor growth and pulmonary metastasis in vivo. Conclusion Heat treatment-induced autophagy promoted invasion and metastasis via TGF-β2/Smad2-mediated EMTs. Suppressing autophagy may be a suitable strategy for overcoming the progression and metastasis of residual BC cells following insufficient MWA.
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Affiliation(s)
- Zhennan Li
- Department of Breast Surgery, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Cheng Lu
- Department of Breast Surgery, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Fengliang Wang
- Department of Breast Surgery, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Haowei Guo
- Department of Breast Surgery, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Zhipeng Wang
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Hong Yin
- Department of Breast Surgery, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China
| | - Jian Li
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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5
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Dai YQ, Liang P, Wang J, Luo YC, Yu XL, Han ZY, Liu FY, Li X, Tan SL, Wang Z, Wu C, Li JM, Yu J. Microwave ablation without subsequent lumpectomy versus breast-conserving surgery for early breast cancer: a propensity score matching study. Int J Hyperthermia 2023; 40:2186325. [PMID: 36944374 DOI: 10.1080/02656736.2023.2186325] [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: 03/23/2023] Open
Abstract
PURPOSE To compare the efficacy of ultrasound-guided percutaneous microwave ablation (MWA) without subsequent lumpectomy and breast-conserving surgery (BCS) in patients with early breast cancer (BC). MATERIALS AND METHODS This retrospective cohort study enrolled 106 patients with early BC (T0/1/2 N0/1 M0) treated by MWA (n = 21) or BCS (n = 85) from October 2014 to December 2020. Propensity score matching (PSM) was performed to balance the baseline characteristics between MWA and BCS groups. The tumor progression, overall survival (OS), disease-specific survival (DSS), complications, and cosmetic results were compared. RESULTS After PSM, there were 21 patients with balanced baseline characteristics in each group. After a median follow-up of 43 months (range, 15-89 months), there was no significant difference in tumor progression (10% vs 2%, p = 0.18), OS (96% vs 99%, p = 0.36), DSS (100% vs 99%, p > 0.99), and complications (0% vs 19%, p = 0.58). The operation time of MWA was shorter (60 min vs 101 min, p < 0.001) than that of BCS. For the management of metastatic lymph nodes, five (5/21, 24%) patients with six metastatic nodes underwent ablation in the MWA group and three patients (3/21, 14%) with six metastatic nodes underwent axillary lymph node dissection in the BCS group. All the patients in the MWA group reported excellent cosmetic results, but 29% of BCS patients expressed dissatisfaction with breast asymmetry (10%) and scar formation (19%) (p < 0.001). CONCLUSION This pilot study indicated that in selected early BC patients, microwave ablation without subsequent lumpectomy had comparable tumor control effect with breast-conserving surgery and better cosmetic results at an intermediate follow-up.HighlightsMWA without subsequent lumpectomy has a comparable interim survival effect and better cosmetic results as BCS in the treatment of selected early breast cancer.MWA has the potential to be a viable and promising therapeutic option for breast cancer patients reluctant or intolerant to surgery with the advantage of minimal invasion.
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Affiliation(s)
- Yu-Qing Dai
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiandong Wang
- Department of Breast Surgery, Chinese PLA Medical College, Beijing, China
| | - Yan-Chun Luo
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Li
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shui-Lian Tan
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen Wang
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chong Wu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian-Ming Li
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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Carriero S, Lanza C, Pellegrino G, Ascenti V, Sattin C, Pizzi C, Angileri SA, Biondetti P, Ianniello AA, Piacentino F, Lavorato R, Ierardi AM, Carrafiello G. Ablative Therapies for Breast Cancer: State of Art. Technol Cancer Res Treat 2023; 22:15330338231157193. [PMID: 36916200 PMCID: PMC10017926 DOI: 10.1177/15330338231157193] [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: 03/16/2023] Open
Abstract
Breast cancer (BC) is the most frequently diagnosed malignancy among women. In the past two decades, new technologies and BC screening have led to the diagnosis of smaller and earlier-stage BC (ESBC). Therefore, percutaneous minimally invasive techniques (PMIT) were adopted to treat patients unfit for surgery, women who refuse it, or elderly patients with comorbidities that could make surgery a difficult and life-threatening treatment. The target of PMIT is small-size ESBC with the scope of obtaining similar efficacy as surgery. Minimally invasive treatments are convenient alternatives with promising effectiveness, lower morbidity, less cost, less scarring and pain, and more satisfying cosmetic results. Ablative techniques used in BC are cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound (US), and laser ablation. The aim of our study is to discuss the current status of percutaneous management of BC, evaluate the clinical outcomes of PMIT in BC, and analyze future perspectives regarding ablation therapy in BC.
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Affiliation(s)
- Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Sattin
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Pizzi
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy.,9304Università Degli Studi di Milano, Milan, Italy
| | | | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo, Varese, Italy
| | - Roberto Lavorato
- Researcher at Diagnostic and Interventional Radiology Department, 9339IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy.,9304Università Degli Studi di Milano, Milan, Italy
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7
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Percutaneous Management of Breast Cancer: a Systematic Review. Curr Oncol Rep 2022; 24:1443-1459. [PMID: 35699836 DOI: 10.1007/s11912-022-01290-4] [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: 04/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Surgical treatment of breast cancer is becoming increasingly more minimally invasive. We review the development status of percutaneous management for primary breast cancer and the evidence relating to tumor size as a fundamental determinant of treatment clinical outcome. RECENT FINDINGS It is safe and feasible for percutaneous management to treat breast cancer. For tumor size ≤ 2 cm, percutaneous management is a promising alternative modality. For tumor size ≤ 3 cm, it is controversial whether percutaneous management can achieve similar effects to surgery, especially its long-term effects. For tumor size > 3 cm, it is still in the initial exploration stage and showed the potential in the treatment of unresectable cancer by benefitting the local control of primary cancer. Percutaneous management of breast cancer is a valuable method for breast cancer treatment in selected patients. However, it will be necessary to provide the high level of evidence for widespread clinical application.
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8
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Liu G, Zhang Y, Hu E, Fan X, Wu Q, Xiong Q, Li Z. Feasibility and efficacy of microwave ablation for treating breast fibroadenoma. Int J Hyperthermia 2021; 38:471-478. [PMID: 33730973 DOI: 10.1080/02656736.2021.1895329] [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: 10/21/2022] Open
Abstract
BACKGROUND To investigate the safety, efficacy, and follow-up outcomes of microwave ablation (MWA) in patients with breast fibroadenoma. METHODS An institutional review board-approved this study of patients treated with MWA for breast fibroadenoma from October 2017 to March 2019. Clinical features of patients and breast fibroadenoma were analyzed. At follow-up all patients received physical examination and ultrasound imaging. RESULTS In total, 171 patients with 271 lesions were enrolled. The mean lesion diameter was 1.35 ± 0.47 cm. The results revealed differential lesion states, including stability, enlargement, reduction, and complete regression, at 1-6, 6-12, and >12 months of follow-up. The size was reduced in 22.14% (31/140), 26.36% (29/110), and 36.36% (16/44) of the lesions at 1-6, 6-12, and >12 months of follow-up, respectively. The proportion of lesions with complete regression was 24.29% (34/140) at 1-6 months, 45.45% (50/110) at 6-12 months, and 40.91% (18/44) at >12 months of follow up. There was no significant relationship between the curative effect and age, lesion location, and blood flow in patients with breast fibroadenoma after MWA (p > .05), but there was statistically significant relationship with lesion diameter (categorized as <1.5 cm and ≥1.5 cm) (p < .05). CONCLUSIONS The current evidence indicates that MWA is a safe and effective method for treating breast fibroadenoma. Nevertheless, further large-scale prospective trials and well-designed future studies are warranted to validate our findings.
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Affiliation(s)
- Gang Liu
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
| | - Yulu Zhang
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
| | - Erwei Hu
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
| | - Xiaoqing Fan
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
| | - Qiaosheng Wu
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
| | - Qiuyun Xiong
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
| | - Zhihua Li
- Department of Breast Surgery, The Third Hospital of Nanchang City, Key Laboratory of Breast Diseases, Nanchang, China
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Roknsharifi S, Wattamwar K, Fishman MDC, Ward RC, Ford K, Faintuch S, Joshi S, Dialani V. Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand? Radiographics 2021; 41:945-966. [PMID: 34197250 DOI: 10.1148/rg.2021200156] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Shima Roknsharifi
- 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.)
| | - Kapil Wattamwar
- 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.)
| | - Michael D C Fishman
- 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.)
| | - Robert C Ward
- 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.)
| | - Kelly Ford
- 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.)
| | - Salomao Faintuch
- 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.)
| | - Surekha Joshi
- 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.)
| | - Vandana Dialani
- 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.)
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Pan H, Qian M, Chen H, Wang H, Yu M, Zhang K, Wang S, Deng J, Xu Y, Ling L, Ding Q, Xie H, Wang S, Zhou W. Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study. Front Oncol 2021; 11:680091. [PMID: 34123849 PMCID: PMC8187871 DOI: 10.3389/fonc.2021.680091] [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: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Negative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins. Methods From 2016 to 2018, 22 women with T1/T2 invasive breast cancer were enrolled for MWA prospectively in the guidance of BCS. US-guided MWA was performed under local anesthesia, followed by BCS and sentinel lymph node biopsy (SLNB) one week after ablation. Women who underwent palpation-guided BCS directly were included as control, and propensity score matching analysis was applied. Results MWA was performed in 22 patients. Of the 21 MWA cases with effect information, the mean tumor size in US was 20.9 ± 6.2 mm (6-37 mm). Compared with control group (BCS directly), a lower rate of positive/close margins was observed in MWA guidance group (P = 0.018), and MWA caused a higher rate of accurate surgery (the largest margin ≤ 3 cm and the smallest margin ≥ 1mm, P = 0.042). Of these 21 patients treated with MWA, 18 were candidates for SLNB. And sentinel lymph nodes were successfully identified in all cases, and no recurrence was found with a mean follow-up of 23 months. Conclusion For patients with T1/T2 breast cancer, the application of preoperative MWA could guide BCS accurately without impairing SLNB. Clinical trials with long-term results are required to validate MWA in the guidance for breast cancer excision.
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Affiliation(s)
- Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengjia Qian
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Muxin Yu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.,Pancreatic Center & Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Pancreas Institute of Nanjing Medical University, Nanjing, China
| | - Siqi Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jing Deng
- Department of Ultrasonography, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiang Ding
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
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11
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Zhou W, Yu M, Pan H, Qiu W, Wang H, Qian M, Che N, Zhang K, Mao X, Li L, Wang R, Xie H, Ling L, Zhao Y, Liu X, Wang C, Ding Q, Wang S. Microwave ablation induces Th1-type immune response with activation of ICOS pathway in early-stage breast cancer. J Immunother Cancer 2021; 9:jitc-2021-002343. [PMID: 33795388 PMCID: PMC8021888 DOI: 10.1136/jitc-2021-002343] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite great advances in the treatment of breast cancer, innovative approaches are still needed to reduce metastasis. As a minimally invasive local therapy (not standard therapy for breast cancer), microwave ablation (MWA) has been attempted to treat breast cancer, but the local effect and immune response induced by MWA have seldom been reported. METHODS The clinical study was performed to determine the complete ablation rate of MWA for early-stage breast cancer. Secondary endpoints included safety and antitumor immune response. 35 subjects from this clinical study were enrolled in the current report, and the local effect was determined by pathological examinations or follow-up. To investigate MWA-induced immune response, patients treated with surgery (n=13) were enrolled as control, and blood samples were collected before and after MWA or surgery. The immune cell populations, serum cytokines, secretory immune checkpoint molecules, and T-cell receptor sequencing were analyzed. RESULTS Of 35 enrolled patients, 32 (91.4%) showed complete ablation. Compared with surgery, MWA induced significantly increased levels of inducible co-stimulator (ICOS)+ activated CD4+ T cells and serum interferon gamma, indicating a shift in the Th1/Th2 balance toward Th1. The activated ICOS pathway was involved in the MWA-induced adaptive immune response. T-cell receptor sequencing revealed MWA of primary tumor activated T lymphocytes expansion and recognized some cancer-specific antigens. Moreover, CD4+ effector memory T-cell response was induced by MWA, and the immune response still existed after surgical resection of the ablated tumor. CONCLUSIONS MWA may not only be a promising local therapy but also a trigger of antitumor immunity for breast cancer, opening new avenues for the treatment of breast cancer. Combinatorial strategy using additional agents which boost MWA-induced immune response could be considered as potential treatment for clinical study for early breast cancer therapy.
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Affiliation(s)
- Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China .,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Muxin Yu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wen Qiu
- Department of Immunology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Mengjia Qian
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Nan Che
- Department of Rheumatology and Immunology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Pancreatic Center and Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xinrui Mao
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Li Li
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ruoxi Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yi Zhao
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Cong Wang
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qiang Ding
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China .,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
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12
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Yu J, Han ZY, Li T, Feng WZ, Yu XL, Luo YC, Wu H, Jiang J, Wang JD, Liang P. Microwave Ablation Versus Nipple Sparing Mastectomy for Breast Cancer ≤5 cm: A Pilot Cohort Study. Front Oncol 2020; 10:546883. [PMID: 33117685 PMCID: PMC7576845 DOI: 10.3389/fonc.2020.546883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives Compared with nipple sparing mastectomy (NSM), microwave ablation (MWA) is one relatively new modality indicated for selected breast cancer with nipple sparing and with little of evidence-based medical research for decision-making. The objective of this study was to compare the effect of ultrasound-guided percutaneous MWA and NSM for breast cancer. Materials and Methods A retrospective cohort study was conducted in a single institution from 2014 to 2020. Women with invasive ductal carcinoma of the breast ≤ 5cm treated by MWA or NSM were enrolled. The primary end point was tumor progression and secondary end points included survival, cosmetic results, and complications. Results 21 patients in the MWA group and 43 in the NSM group were evaluated. The mean tumor size was 2.3 cm (range, 0.3-5.0 cm). Median follow-up was 26.7 months (range, 14.6-62.5 months). The mean age of MWA was 24 years older than that of the NSM group. All the patients achieved technique effectiveness. One local tumor progression and one ipsilateral breast recurrence occurred at 42 and 28 months after MWA, respectively. One ipsilateral breast recurrence and two bone metastasis occurred at 31.2, 34, and 30.5 months after NSM. Two groups had no significant difference in tumor progression (P = 0.16). No participants in both groups developed cancer related death (P > 0.99) and major complications (P > 0.99). However, MWA needed less hospitalization time (P < 0.001) and achieved better cosmetic results (P < 0.001). Conclusions MWA achieved similar short term effect for breast cancer control and better cosmetic satisfaction compared with NSM in selected patients. MWA provides appropriate option for elderly patients who are unfit for surgery.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ting Li
- Department of Ultrasound, People's Hospital of Sanya, Sanya, China
| | - Wen-Zhe Feng
- Department of Laboratory Medicine, The Fourth Hospital of Baotou City, Baotou, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Ultrasound, Qingdao Municipal Hospital, Qingdao, China
| | - Jian Jiang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jian-Dong Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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13
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Neira LM, Mays RO, Sawicki JF, Schulman A, Harter J, Wilke LG, Behdad N, Van Veen BD, Hagness SC. A Pilot Study of the Impact of Microwave Ablation on the Dielectric Properties of Breast Tissue. SENSORS 2020; 20:s20195698. [PMID: 33036268 PMCID: PMC7583923 DOI: 10.3390/s20195698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/02/2022]
Abstract
Percutaneous microwave ablation (MWA) is a promising technology for patients with breast cancer, as it may help treat individuals who have less aggressive cancers or do not respond to targeted therapies in the neoadjuvant or pre-surgical setting. In this study, we investigate changes to the microwave dielectric properties of breast tissue that are induced by MWA. While similar changes have been characterized for relatively homogeneous tissues, such as liver, those prior results are not directly translatable to breast tissue because of the extreme tissue heterogeneity present in the breast. This study was motivated, in part by the expectation that the changes in the dielectric properties of the microwave antenna’s operation environment will be impacted by tissue composition of the ablation target, which includes not only the tumor, but also its margins. Accordingly, this target comprises a heterogeneous mix of malignant, healthy glandular, and adipose tissue. Therefore, knowledge of MWA impact on breast dielectric properties is essential for the successful development of MWA systems for breast cancer. We performed ablations in 14 human ex-vivo prophylactic mastectomy specimens from surgeries that were conducted at the UW Hospital and monitored the temperature in the vicinity of the MWA antenna during ablation. After ablation we measured the dielectric properties of the tissue and analyzed the tissue samples to determine both the tissue composition and the extent of damage due to the ablation. We observed that MWA induced cell damage across all tissue compositions, and found that the microwave frequency-dependent relative permittivity and conductivity of damaged tissue are lower than those of healthy tissue, especially for tissue with high fibroglandular content. The results provide information for future developments on breast MWA systems.
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Affiliation(s)
- Luz Maria Neira
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA; (R.O.M.); (J.F.S.); (N.B.); (B.D.V.V.)
- Correspondence: (L.M.N.); (S.C.H.)
| | - R. Owen Mays
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA; (R.O.M.); (J.F.S.); (N.B.); (B.D.V.V.)
| | - James F. Sawicki
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA; (R.O.M.); (J.F.S.); (N.B.); (B.D.V.V.)
| | - Amanda Schulman
- Department of Surgery, University of Wisconsin, Madison, WI 53792, USA; (A.S.); (L.G.W.)
| | - Josephine Harter
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792, USA;
| | - Lee G. Wilke
- Department of Surgery, University of Wisconsin, Madison, WI 53792, USA; (A.S.); (L.G.W.)
| | - Nader Behdad
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA; (R.O.M.); (J.F.S.); (N.B.); (B.D.V.V.)
| | - Barry D. Van Veen
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA; (R.O.M.); (J.F.S.); (N.B.); (B.D.V.V.)
| | - Susan C. Hagness
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI 53706, USA; (R.O.M.); (J.F.S.); (N.B.); (B.D.V.V.)
- Correspondence: (L.M.N.); (S.C.H.)
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14
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Microwave ablation of primary breast cancer inhibits metastatic progression in model mice via activation of natural killer cells. Cell Mol Immunol 2020; 18:2153-2164. [PMID: 32385362 DOI: 10.1038/s41423-020-0449-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/14/2020] [Indexed: 11/08/2022] Open
Abstract
Surgery is essential for controlling the symptoms and complications of stage IV breast cancer. However, locoregional treatment of primary tumors often results in distant progression, including lung metastasis, the most common type of visceral metastasis. As a minimally invasive thermal therapy, microwave ablation (MWA) has been attempted in the treatment of breast cancer, but the innate immune response after MWA has not yet been reported. Using two murine models of stage IV breast cancer, we found that MWA of primary breast cancer inhibited the progression of lung metastasis and improved survival. NK cells were activated after MWA of the primary tumor and exhibited enhanced cytotoxic functions, and the cytotoxic pathways of NK cells were activated. Depletion experiments showed that NK cells but not CD4+ or CD8+ T cells played a pivotal role in prolonging survival. Then, we found that compared with surgery or control treatment, MWA of the primary tumor induced completely different NK-cell-related cytokine profiles. Macrophages were activated after MWA of the primary tumor and produced IL-15 that activated NK cells to inhibit the progression of metastasis. In addition, MWA of human breast cancer stimulated an autologous NK-cell response. These results demonstrate that MWA of the primary tumor in metastatic breast cancer inhibits metastatic progression via the macrophage/IL-15/NK-cell axis. MWA of the primary tumor may be a promising treatment strategy for de novo stage IV breast cancer, although further substantiation is essential for clinical testing.
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15
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Shi X, Pan H, Ge H, Li L, Xu Y, Wang C, Xie H, Liu X, Zhou W, Wang S. Subsequent cooling-circulation after radiofrequency and microwave ablation avoids secondary indirect damage induced by residual thermal energy. ACTA ACUST UNITED AC 2020; 25:291-297. [PMID: 31120427 DOI: 10.5152/dir.2019.17455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to investigate the exact role of residual thermal energy following microwave ablation (MWA) and radiofrequency ablation (RFA) at the final ablation and transition zones and determine whether residual thermal energy could be dissipated by subsequent cooling-circulation. METHODS In an ex vivo study, MWA and RFA were performed on fresh porcine liver, and central and border temperatures were compared. In an in vivo study, MWA and RFA were performed to the livers of New Zealand white rabbits. Tissue samples were stained with α-NADH-diaphorase. The coagulation zones (NADH-negative) and transition zones (lightly NADH-stained) of different groups were compared at different time points. RESULTS In the ex vivo model, the residual thermal energy after MWA and RFA could be dispersed by subsequent cooling-circulation due to the temperature decreasing rapidly. In the in vivo study, the coagulation volume in the ablation group was larger than that in the cooling-circulation group (P < 0.05) 2 days after ablation. In the ablation group, the damaged zone (the transition zone plus the coagulation zone) on α-NADH-diaphorase-stained images increased rapidly within 2 hours after ablation and slowly reached the maximum on day 2. However, the damaged zones did not change significantly at the three time points observed in the cooling-circulation group. CONCLUSION The residual thermal energy in MWA and RFA induced secondary damage beyond the direct coagulation zone, and it could be dissipated by subsequent cooling-circulation, contributing to smaller ablation and transition zones.
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Affiliation(s)
- Xinyi Shi
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Han Ge
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Li
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cong Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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16
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Zhang W, Jin ZQ, Baikpour M, Li JM, Zhang H, Liang T, Pan XM, He W. Clinical application of ultrasound-guided percutaneous microwave ablation for benign breast lesions: a prospective study. BMC Cancer 2019; 19:345. [PMID: 30975107 PMCID: PMC6458746 DOI: 10.1186/s12885-019-5523-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Background: Benign breast lesions are the most common diseases in adult women, which have been treated with minimally invasive therapies in recent years. Little is known about the feasibility of Microwave ablation (MWA) for benign breast lesion treatment. The primary aim of this prospective study was to evaluate the safety and efficiency of MWA as a potential therapeutic option for benign breast lesions in a single-center cohort study. METHODS Women with possibly benign breast lesions based on an ultrasound (US) assessment who were scheduled to undergo MWA between November 2014 to July 2018 were included in the study. The patients underwent conventional US to measure the size of the lesion, Doppler US to assess the vascularity of the lesion, elastography to evaluate the stiffness of the mass, core needle biopsy of suspicious lesions, contrast-enhanced US to help determine the treatment plan and eventually MWA of the lesion. Lesions were followed at one, three, six, twelve and eighteen months after treatment to with the same imaging modalities. RESULTS A total of 314 women aged 17 to 69 years old (mean = 36.9 ± 9.9 years) with 725 benign breast lesions (mean of maximum diameter = 10.86 ± 5.40 mm) were included. The frequency of palpable mass, pain and nipple discharge significantly decreased after treatment. Complete ablation rate was 97.8%, immediately after ablation, which increased to 100% after supplementary ablation of the 15 cases with incomplete ablation. Blood flow classification and lesion's volume also showed a significant decrease, while both volume reduction ratio and disappearance rate significantly increased following treatment. The elasticity score of the lesions showed fluctuations across different follow-up intervals. None of the patients experienced major complications and the 1% who had mild symptoms were successfully treated. CONCLUSION MWA treatment is shown to be safe and efficient and has the potential to be considered as an alternative first line treatment for benign breast lesions.
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Affiliation(s)
- Wei Zhang
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119, West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China
| | - Zhan-Qiang Jin
- Department of Ultrasound, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Masoud Baikpour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jian-Min Li
- Department of Ultrasound, The 3rd Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Zhang
- Department of Thyroid and Breast Surgery, The 3rd Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ting Liang
- Department of Ultrasound, The 3rd Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Ming Pan
- Department of Thyroid and Breast Surgery, The 3rd Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wen He
- Department of Ultrasound, Beijing Tian Tan Hospital, Capital Medical University, No. 119, West Road of South 4th Ring Road, Fengtai District, Beijing, 100160, China.
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17
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Xu J, Wu H, Han Z, Zhang J, Li Q, Dou J, An C, Qi E, Yu J, Liang P. Microwave ablation of benign breast tumors: a prospective study with minimum 12 months follow-up. Int J Hyperthermia 2018; 35:253-261. [PMID: 30130983 DOI: 10.1080/02656736.2018.1494340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/19/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE This prospective study was to evaluate clinical outcomes of microwave ablation (MWA) of benign breast tumors with minimum 12 months follow up. METHODS With approval of the institutional ethics committee and written informed consent, 56 patients with 107 biopsy-proved breast benign tumors were recruited from November, 2013 to April, 2017. MWA with ultrasound (US) guidance was performed under local anesthesia. During the procedure, pull-back technique was used for tumors larger than 1.0 cm in diameter and hydro-dissection technique was used for tumors adjacent to skin, pectoralis and areola. Clinical outcomes were followed up by physical examination and medical images including US, contrast enhanced US and MR. RESULTS The maximum diameter of these tumors was 1.6 ± 0.8 cm. MWA was successfully performed with the median 120 s of duration (ranging 20-1100 s). Technical success was achieved in all patients. At the median follow-up of 20.5 months (ranging 12-53 months), the mean volume reduction ratios (mVRRs) of tumors were 77.1 ± 8.2%, 84.3 ± 10.6%, 93.3 ± 8.2% at follow-up of 12, 18, 24 months (p < .0001), respectively. Compared with 92% of masses were palpable before ablation, mass palpabilities were 40%, 11%, 5% at follow-up of 12, 18, 24 months (p < .001), respectively. Cosmetic satisfaction was reported excellent or good in 100% of patients. CONCLUSIONS As a safe and effective minimally invasive modality for inactivating benign breast tumors in situ, MWA achieved optimistic clinical outcomes on volume reduction and cosmetic satisfaction after minimum 12 months follow-up.
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Affiliation(s)
- Jinshun Xu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Han Wu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhiyu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jing Zhang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Qinying Li
- b Department of Interventional Ultrasound , Henan Province Puyang Hospital of Tranditional Chinese Medicine , Puyang , China
| | - Jianping Dou
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Chao An
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Erpeng Qi
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
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The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9141746. [PMID: 29992167 PMCID: PMC6016148 DOI: 10.1155/2018/9141746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/14/2018] [Indexed: 12/29/2022]
Abstract
Background and Objectives Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC). Methods Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC. Results At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure. Conclusions Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.
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Li C, Li C, Ge H, Liang M, Ma G, Ling L, Pan H, Gong H, Xie H, Ding Q, Zhou W, Wang S. Technical analysis of US imaging for precise microwave ablation for benign breast tumours. Int J Hyperthermia 2018; 34:1179-1185. [PMID: 29458284 DOI: 10.1080/02656736.2018.1442589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Changwen Li
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
- Department of Breast Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China
| | - Cuiying Li
- Department of Diagnostic Ultrasound, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Han Ge
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Ge Ma
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Haiyan Gong
- Department of Diagnostic Ultrasound, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qiang Ding
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Yu J, Chen BH, Zhang J, Han ZY, Wu H, Huang Y, Mu MJ, Liang P. Ultrasound guided percutaneous microwave ablation of benign breast lesions. Oncotarget 2017; 8:79376-79386. [PMID: 29108316 PMCID: PMC5668049 DOI: 10.18632/oncotarget.18123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/12/2017] [Indexed: 01/02/2023] Open
Abstract
The benign breast lesions (BBLs) share a high incidence for women and therapy methods with minimal invasion and better cosmetic outcome are thirsted for. In this study, 122 patients with 198 biopsy-proved BBLs were enrolled. Ultrasound (US)-guided microwave ablation (MWA) was performed with local anesthesia from November, 2013 to April, 2016. The mean longest tumor size assessed was 1.6±0.7 cm (ranging 0.7-4.9 cm). MWA was successfully performed in all cases including 85 lesions adjacent to the skin, pectoralis and areola. The mean ablation time was 3.2mins (ranging 0.5-18.3 mins). 99.5% of BBLs showed complete ablation when assessed by magnetic resonance imaging and 100% of them by US. At the median 14-month follow-up, the BBLs were not palpable in 45.9 % of the cases (palpable in 90.2 % of the cases before MWA) and the mean volume reduction ratio was 78.4±33.5% for total lesions and 89.3±20.8%, 84.7±27.6% and 55.9±32.9% for ≤1.0 cm, 1.1-2.0cm and >2.0 cm lesions in 12-month follow-up, respectively. Cosmesis were reported as good or excellent in 100 % by physician and patients. No side effect was found. The MWA of the BBLs proved feasible and effective, while showing meaningful reduction in volume, palpability and cosmetic satisfying outcomes.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Bao-Hua Chen
- Department of General Surgery, The People's Liberation Army One Eight Four Hospital, Yingtan, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yan Huang
- Department of General Surgery, The People's Liberation Army One Eight Four Hospital, Yingtan, China
| | - Meng-Juan Mu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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22
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Wang B, Han ZY, Yu J, Cheng Z, Liu F, Yu XL, Chen C, Liu J, Liang P. Factors related to recurrence of the benign non-functioning thyroid nodules after percutaneous microwave ablation. Int J Hyperthermia 2017; 33:459-464. [PMID: 28081645 DOI: 10.1080/02656736.2016.1274058] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the factors affecting the recurrence of the solitary benign thyroid nodules (BTN) after microwave ablation (MWA). MATERIALS AND METHODS Between January 2013 and January 2015, a total of 110 patients with at least one solid thyroid nodule (solid component ≥ 80%) were enrolled. MWA was performed under continuous ultrasound (US) guidance. Before and during the follow-up, the thyroid nodule volume, thyroid function and cosmetic complaints were evaluated. Recurrence is defined by the new blood flow in the total ablation area or/and > 50% increase in nodule volume. RESULTS Almost all thyroid nodules were significantly decreased in size after MWA. After 12 months, the average volume of thyroid nodules was decreased from 12.6 ± 15.1 to 3.2 ± 5.7 ml. Of the total 110 patients, 16 cases had recurrence 12 months after MWA, and these patients had a larger initial volume than that of the non-recurrence patients (11.6 ± 14.9 vs. 23.9 ± 12.5, p < 0.01). The recurrence group also demonstrated more irregular blood vessels (1.8 8 ± 1.1 vs. 2.8 5 ± 1.3, p < 0.05), and a lower energy (1575.5 ± 674.3 J/ml vs. 1172.3 ± 454.2 J/ml, p < 0.01). In addition, 81.2% (13/16) of the patients in the recurrence group were adjacent to the vital structures, which is significantly higher than that of the non-recurrence group 28.7% (27/94) (p < 0.01). CONCLUSIONS The US-guided MWA results in a satisfactory long-term outcome of the patients with a benign solitary thyroid nodule. We identified three risk factors for recurrence: initial volume, vascularity and the energy per 1 ml reduction in nodular volume.
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Affiliation(s)
- Bei Wang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China.,b Department of Ultrasound , Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan , Shandong , PR China
| | - Zhi-Yu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Zhigang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Fangyi Liu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Xiao-Ling Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
| | - Chaonan Chen
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China.,d Department of Ultrasound , Beijing Friendship Hospital-Affiliate to Capital Medical University , Beijing , PR China
| | - Ju Liu
- c Medical Research Center, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan , Shandong , PR China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , PR China
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Mauri G, Sconfienza LM, Pescatori LC, Fedeli MP, Alì M, Di Leo G, Sardanelli F. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. Eur Radiol 2017; 27:3199-3210. [PMID: 28050693 DOI: 10.1007/s00330-016-4668-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. METHODS An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. RESULTS Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). CONCLUSIONS Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. KEY POINTS • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).
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Affiliation(s)
- Giovanni Mauri
- Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100, Milano, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità Operativa di Radiologia / Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milano, Italy
| | - Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Maria Paola Fedeli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Marco Alì
- Integrative Biomedical Research PhD Program, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
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Abstract
Tumour ablation is defined as the direct application of chemical or thermal therapy to eradicate or substantially destroy a tumour. Currently, minimally invasive ablation techniques are available for the local destruction of focal tumours in multiple organ sites. Microwave ablation (MWA) is premised on the biological response of solid tumours to tissue hyperthermia, and it is a relatively low-risk procedure. Due to several advantages of MWA, including higher thermal efficiency, higher capability for coagulating blood vessels, faster ablation time and the simultaneous application of multiple antennae, MWA could be a promising minimally invasive ablation technique for the treatment of solid tumours. Therefore, the use of MWA has developed rapidly in China during the last decade. Many successful studies have been performed, and widespread use has been achieved for multiple types of tumours in China, especially for liver cancer. This review will describe the state-of-the-art of MWA in China, including the development of MWA equipment and its application in the treatment of multiple types of tumours.
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Affiliation(s)
- Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
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Zhou W, Wang R, Liu X, Ling L, Liang M, Li C, Ma G, Li L, Pan H, Gong H, Ding Q, Wang S. Ultrasound-guided microwave ablation: a promising tool in management of benign breast tumours. Int J Hyperthermia 2016; 33:263-270. [PMID: 27809612 DOI: 10.1080/02656736.2016.1253876] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Ruoxi Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Cuiying Li
- Department of Diagnostic Ultrasound, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Ge Ma
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Li Li
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Haiyan Gong
- Department of Diagnostic Ultrasound, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qiang Ding
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Peek MCL, Ahmed M, Napoli A, Usiskin S, Baker R, Douek M. Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis. Int J Hyperthermia 2016; 33:191-202. [PMID: 27575566 DOI: 10.1080/02656736.2016.1230232] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Breast-conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review and meta-analysis to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer. METHODS A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded. RESULTS We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focussed ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6 ± 5.6 min) and the longest with HIFU (101.5 ± 46.6 min). CONCLUSION Minimally invasive ablative techniques are able to successfully induce coagulative necrosis in breast cancer with a low side effect profile. Adequately powered and prospectively conducted cohort trials are required to confirm complete pathological ablation in all patients.
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Affiliation(s)
- Mirjam C L Peek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| | - Muneer Ahmed
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| | - Alessandro Napoli
- b Department of Radiological Sciences , Sapienza University of Rome, School of Medicine , Roma , Italy
| | - Sasha Usiskin
- c Department of Radiology , St. Bartholomew's Hospital , London , Great Britain
| | - Rose Baker
- d School of Business, 612, Maxwell Building, University of Salford , Salford , Great Britain
| | - Michael Douek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
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Song X, Liang M, Zhou W, Ren L, Liu Z, Wang G, Wei Q, Wang S. Doxorubicin hydrochloric increases tumour coagulation and end-point survival in percutaneous microwave ablation of tumours in a VX2 rabbit tumour model. Int J Hyperthermia 2016; 32:265-71. [DOI: 10.3109/02656736.2015.1137639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ahmed M, Rubio IT, Klaase JM, Douek M. Surgical treatment of nonpalpable primary invasive and in situ breast cancer. Nat Rev Clin Oncol 2015; 12:645-63. [PMID: 26416152 DOI: 10.1038/nrclinonc.2015.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.
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Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Isabel T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands
| | - Michael Douek
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
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