Stereotactically guided laser therapy of occult breast tumors -: Work-in-progress report
Stereotactically guided laser therapy of occult breast tumors -: Work-in-progress report
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DOI：
10.1001/archsurg.135.11.1345
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发表时间：
2000-11-01
影响因子：
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通讯作者：
Ali, A
中科院分区：
文献类型：
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作者：
Dowlatshahi, K;Fan, M;Ali, A
假设：乳腺X线检查发现的乳腺肿瘤可以完全消融与laser energy.Design：Nonrandomized control trial.Setting：A university hospital ambulatory care center.Patients：36例乳腺X线检查发现明确乳腺肿瘤的患者被选中。患者在立体定向手术台上接受治疗，使用16- 18号激光探针，光纤传输预定量的激光能量。将多传感器热探头插入激光探头附近的乳房中以监测治疗。后10例患者在激光治疗前后用彩色多普勒超声造影评估肿瘤血流。激光治疗后1 ~ 8周，手术切除肿瘤，连续切片。主要结果测量：66%的肿瘤完全坏死。结果：当给予2500 J/mL的肿瘤或热传感器记录60 degreesC时，观察到肿瘤完全消融，边缘阴性。1周时的显微镜检查显示恶性细胞崩解，伴有外周急性炎症反应，4至8周时出现广泛纤维化。对比增强彩色多普勒超声显示治疗后肿瘤循环丧失，正电子发射断层扫描与组织学检查结果相关性良好。无全身不良反应。两名患者持续3 × 4-mm皮肤烧伤周围的激光needle.Conclusion：立体定向引导微创技术可能是有效的乳腺癌钼靶摄影检测的治疗。
Hypothesis: Mammographically detected breast tumors can be completely ablated with laser energy.Design: Nonrandomized control trial.Setting: A university hospital ambulatory care center.Patients: Thirty-six patients with mammographically detected well-defined breast tumors were selected.Interventions: The diagnosis of malignant neoplasms and determination of prognostic factors were established by image-guided needle-core biopsy. Patients were treated on a stereotactic table, using a 16- to 18-gauge laser probe, with an optic fiber transmitting a predetermined amount of laser energy. A multisensor thermal probe was inserted into the breast adjacent to the laser probe to monitor treatment. In the last 10 patients, the tumor blood flow was evaluated before and after laser therapy with contrast-enhanced color Doppler ultrasound. One to 8 weeks after laser therapy, the tumors were surgically removed and serially sectioned.Main Outcome Measure: Complete necrosis in 66% of tumors.Results: Total tumor ablation with negative margins was observed whenever 2500 J/mL of tumor was given or the thermal sensors recorded 60 degreesC. Microscopic examination at 1 week showed disintegration of malignant cells, with peripheral acute inflammatory response and at 4 to 8 weeks extensive fibrosis. Contrast-enhanced color Doppler ultrasound revealed loss of tumor circulation after therapy, and positron emission tomography scan correlated well with histologic findings. There were no systemic adverse effects. Two patients sustained 3 x 4-mm skin burns around the laser needle.Conclusion: A stereotactically guided minimally invasive technique may be effective for the treatment of mammographically detected breast cancer.