Ultrasound-guided, percutaneous cryotherapy of small (≤ 15 mm) breast cancers
Ultrasound-guided, percutaneous cryotherapy of small (≤ 15 mm) breast cancers
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DOI：
10.1097/01.rli.0000166935.56971.ff
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发表时间：
2005-07-01
影响因子：
6.7
通讯作者：
Kaiser, WA
中科院分区：
文献类型：
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作者：
Pfleiderer, SOR;Marx, C;Kaiser, WA
目的：探讨超声引导下经皮冷冻治疗T1期乳腺癌的可行性、有效性和安全性。材料和方法：30例经活检证实肿瘤直径小于或等于15°(范围5~15 mm；中位数12 mm)的乳腺癌患者接受了冷冻治疗。局部麻醉后，在超声引导下将3 mm冷冻探头置入肿瘤内。所有肿瘤均接受2个冷冻周期，中间有1个解冻周期。在整个过程中，冰球的大小、它们到皮肤的距离以及探头尖端的温度都被密切监测。结果：中位最低气温达到-146℃(-117℃~-167℃)。在29例患者中，有5例在冷冻治疗后组织学上可检测到冷冻治疗后冰冻石缘以外的标本中残留的导管原位癌。24例患者均未发现存活的肿瘤细胞。未发生严重副作用。在1例患者中，由于技术问题，冷冻手术未能完全完成。讨论：经皮冷冻治疗是一种安全可行的小乳腺癌微创治疗方法。残留的导管原位癌可能归因于学习曲线的开始或介入前影像的假阴性检测。磁共振乳房X光检查可能有助于治疗计划和治疗监测，以更好地确定目标组织，并将肿瘤边缘与冰球相关联。
Rationale and Objective: The purpose of this study was to investigate the feasibility, efficacy, and safety of ultrasound-guided percutaneous cryotherapy of stage T1 breast cancers.Materials and Methods: Thirty patients with biopsy-confirmed breast cancers with tumor diameters of 15 turn or smaller (range, 5-15 mm; median, 12 mm) underwent cryotherapy. After local anesthesia, a 3-mm cryo probe was placed into the tumor under ultrasound guidance. All tumors were subjected to 2 freeze cycles with an interposing thawing cycle. The size of the iceballs, their distance to the skin, and the temperature at the tip of the probe were closely monitored during the procedure. The patients under-went surgery within 6 weeks and the specimens were evaluated histologically.Results: The median minimum temperature reached -146 degrees C (range, -117 degrees C to -167 degrees C). In 5 of 29 patients, remnant ductal carcinoma in situ was detectable histologically after cryotherapy beyond the margin of the cryosite in the specimens after open surgery. In 24 patients, no viable tumor cells were found. No severe side effects occurred. In one patient, the cryo procedure was not performed completely because of technical problems.Discussion: Percutaneous cryotherapy is a feasible and safe procedure in minimally invasive therapy for small breast cancers. Residual ductal carcinoma in situ may be attributable to the beginning of a learning curve or by false-negative detection in preinterventional imaging. Magnetic resonance mammography might aid in treatment planning and for therapy monitoring to better define target tissue and to correlate the tumor margin with the iceball.