C. Henriques

Radiofrequency Ablation as a Substitute for Surgery in Elderly Patients with Nonresected Breast Cancer: Pilot Study with Long-term Outcomes

PURPOSE To determine the efficacy and tolerance of ultrasonography (US)-guided percutaneous radiofrequency (RF) ablation with endocrine therapy in elderly patients with breast cancer who decline or are not candidates for surgery. MATERIALS AND METHODS Internal ethics committee approval was obtained, and patients gave informed written consent. Women older than 70 years with breast carcinoma, who had undergone neoadjuvant endocrine therapy within the past 6 months, underwent US-guided RF ablation while under local anesthesia and sedation. Only tumors measuring 3 cm or smaller and situated at least 1 cm from the skin, nipple, and chest wall were selected. Multitine electrodes were used. Endocrine therapy was continued for a total of 5 years, and breast irradiation was not performed. Clinical follow-up included US, mammography, and dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging every 2 months for 6 months and then every 6 months until 5 years. Primary end points were RF ablation efficacy at 1 year on the basis of DCE MR imaging follow-up and procedural tolerance. The secondary end point was delayed local efficacy at the end of endocrine therapy (5 years) on the basis of DCE MR imaging follow-up. RESULTS Twenty-one women were treated from December 2004 to April 2010 (median age, 79 years; age range, 70-88 years). Efficacy was demonstrated at 1 year, with only one patient presenting with a local relapse. No general complications were noted. Skin burn occurred in four patients, with spontaneous healing after a maximum of 2 months. Ten patients were followed up for 5 years, with three additional patients presenting with cancer recurrence outside the ablation zone at 30, 48, and 60 months-including two with lobular carcinoma. Four patients died during the full follow-up, two of breast cancer-related causes and two of unrelated causes. CONCLUSION RF ablation in elderly patients with nonresected breast cancer is well tolerated and efficient at 1-year follow-up. The technique is not recommended for lobular carcinoma.

Les prélèvements mammaires en stéréotaxie : macrobiopsies avec aspiration et biopsies chirurgicales stéréotaxiques

Resume Des techniques recentes de prelevements mammaires assistes par la stereotaxie sont utiles pour le diagnostic des images mammaires infracliniques depistees et permettent d’eviter un grand nombre de biopsies chirurgicales classiques. Les modalites techniques des macrobiopsies avec aspiration et des biopsies chirurgicales stereotaxiques sont decrites, ainsi que leurs avantages, leur fiabilite pour etablir le diagnostic histologique ou la confirmation diagnostique pretherapeutique, et les complications, limites, et inconvenients de ces methodes. Leur place dans la prise en charge des anomalies mammaires infracliniques est discutee en fonction de la classification Breast Imaging Reporting and Data System (BI-RADS) de l’ American College of Radiology .Stereotactically-guided procedures for diagnosis of breast lesions can avoid a lot of surgical biopsies. Stereotactic guidance is used for vacuum-assisted core biopsies and for stereotactic breast biopsies. Technical details of the procedures are described, and the benefits and the limits of these methods are discussed. Indications for breast sampling are proposed according to the Breast Imaging Reporting and Data System (BI-RADS) assessment categories.