Magnetic resonance-guided focused ultrasound surgery of breast cancer: Reliability and effectiveness
Magnetic resonance-guided focused ultrasound surgery of breast cancer: Reliability and effectiveness
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DOI：
10.1016/j.jamcollsurg.2006.04.002
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发表时间：
2006-07-01
影响因子：
5.2
通讯作者：
Nakahara, H
中科院分区：
文献类型：
--
作者：
Furusawa, H;Namba, K;Nakahara, H
背景技术：磁共振引导聚焦超声手术（MRgFUS）是一种非侵入性技术，已被证明可以凝固良性和恶性肿瘤。本研究的目的是评估MRgFUS消融乳腺癌的安全性和有效性。研究设计：30例经活检证实的乳腺癌患者接受了MRgFUS治疗。钆增强MR图像用于治疗计划和治疗后放射学评估的治疗组织，和温度敏感的MR图像提供实时治疗监测。在MRgFUS后，所有30名女性均接受了广泛切除或乳房切除术。热消融的程度进行了评估，肿瘤histologic.Results：治疗耐受性良好，最小的不良反应，特别是在局部麻醉下进行。在病理学检查中，靶乳腺肿瘤的平均（+/- SD）坏死为肿瘤体积的96.9 +/- 4%（中位数100%，范围78%-100%）。28例可评价患者中有15例（53.5%）消融肿瘤100%坏死;仅3例患者（10.7%）坏死小于95%。在28例（93.3%）患者中，100%的恶性肿瘤位于治疗野内，其余2例患者中98%和95%的肿瘤位于治疗野内。回顾性分析显示，在两个残留肿瘤患者的治疗没有提供到全部推荐的区域，重申需要精确定位和对比增强图像的治疗planning.CONCLUSIONS的价值：MRgFUS有很大的潜力，成为一个可行的非侵入性替代乳房肿瘤切除术。需要更多的研究，重点是治疗后基于图像的评价。
BACKGROUND: Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive technique that has been shown to coagulate benign and malignant tumors. The purpose of this study was to evaluate MRgFUS safety and effectiveness for the ablation of breast carcinomas.STUDY DESIGN: Thirty women with biopsy-proved breast cancer underwent MRgFUS treatment. Gadolinium-enhanced MR images were used for treatment planning and posttreatment radiologic assessment of treated tissue, and temperature-sensitive MR images provided real-time treatment monitoring. After MRgFUS, all 30 women underwent wide excision or mastectomy. The extent of thermal ablation was assessed with tumor histology.RESULTS: Treatment was well tolerated, with a minimum of adverse effects, especially when performed under local anesthesia. On pathologic examination, mean ( +/- SD) necrosis of the targeted breast tumors was 96.9 +/- 4% (median 100%, range 78% to 100%) of tumor volume. Fifteen (53.5%) of 28 evaluable patients had 100% necrosis of the ablated tumor; only 3 patients (10.7%) had less than 95% necrosis. In 28 (93.3%) patients, 100% of the malignancy was within the treatment field, and 98% and 95% of tumor lay within the treatment field in 2 remaining patients. Retrospective analysis in two patients with residual tumor showed treatment was not delivered to the full recommended area, reaffirming the need for precise localization and the value of contrast-enhanced images for treatment planning.CONCLUSIONS: MRgFUS has great potential to become a viable noninvasive replacement for lumpectomy. Additional studies focusing on posttreatment image-based evaluation are needed.