Cryoablation Allows the Ultimate De-escalation of Surgical Therapy for Select Breast Cancer Patients

Ann Surg Oncol. 2023 Dec;30(13):8398-8403. doi: 10.1245/s10434-023-14332-3. Epub 2023 Sep 28.

Abstract

Background: Widespread use of screening mammography has allowed breast cancer to be detected at earlier stages. This allows for increased customization of treatment and less aggressive management. De-escalation of therapy plays an important role in decreasing treatment burden and improving patient quality of life. This report examines cryoablation as the next step in the surgical de-escalation of breast cancer.

Methods: Women with a diagnosis of clinically node-negative, estrogen receptor-positive (ER +), progesterone receptor-positive (PR +), human epidermal growth factor receptor 2-negative (HER2 -) infiltrating ductal carcinomas 1.5 cm or smaller underwent ultrasound-guided cryoablation. Either the Visica 2 treatment system (before 2020) or the ProSense treatment system (since 2020) was used to perform the cryoablation. Patients received mammograms and ultrasounds at a 6 months follow-up visit, and magnetic resonance images at baseline, then at 1 year follow-up intervals. Adjuvant therapy decisions and disease status were recorded.

Results: This study enrolled 32 patients who underwent 33 cryoablation procedures (1 patient had bilateral cancer). One patient had a sentinel node biopsy in addition to clinical staging of the axilla. For all the patients, adjuvant endocrine therapy was recommended, and six patients (18.75%) received adjuvant radiation. Of the 32 patients, 20 (60.6%) have been followed up for 2 years or longer, with no residual or recurrent disease at the site of ablation.

Conclusion: Cryoablation of the primary tumor foregoing sentinel node biopsy offers an oncologically safe and feasible minimally invasive office-based procedure option in lieu of surgery for patients with early-stage, low-risk breast cancer.

Keywords: Breast cancer; Cryoablation; Surgical de-escalation; Surgical resection.

MeSH terms

  • Axilla / pathology
  • Breast Neoplasms* / surgery
  • Cryosurgery* / methods
  • Early Detection of Cancer
  • Female
  • Humans
  • Mammography
  • Quality of Life
  • Sentinel Lymph Node Biopsy
  • Treatment Outcome