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Small (2-cm) Breast Cancer Treated with US-guided Radiofrequency Ablation: Feasibility Study¹

¹ From the Depts of Diagnostic Radiology (B.D.F., B.S.E.), Pathology (N.S.), and Surgical Oncology (B.D.F., M.I.R., A.N.M., H.M.K., F.C.A., L.A.N., G.V.B., S.E.S.), Univ of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030. From the 2002 RSNA Scientific Assembly. Received Apr 24, 2003; revision requested Jun 11; revision received Sep 10; accepted Oct 13. Supported by a grant from RITA Medical Systems, Mountain View, Calif. Address correspondence to B.D.F. (e-mail: fornage@swbell.net or bfornage@di.mdacc.tmc.edu).

View larger version (91K): [in a new window]   Figure 1. Photograph of the tip of the RITA Starburst XL needle electrode with the prongs deployed over a distance of 3 cm.

View larger version (156K): [in a new window]   Figure 2. Longitudinal sonogram shows 1.1-cm invasive ductal carcinoma (outlined by calipers) with margins that are well demarcated from the surrounding fat. Note the internal calcification.

View larger version (131K): [in a new window]   Figure 3. Longitudinal sonogram shows measurements of the 1.2-cm distance between the skin and the anterior aspect of the tumor (between the two "+" cursors) and the 2.4-cm distance between the posterior aspect of the tumor and the anterior aspect of the pectoralis major muscle (between the two "x" cursors).

View larger version (126K): [in a new window]   Figure 4. Intraoperative photograph shows the lateral compression applied to the breast during the entire RF ablation procedure to ensure a safe distance between the tumor and the skin anteriorly and between the tumor and the chest wall posteriorly.

View larger version (128K): [in a new window]   Figure 5. Intraoperative photograph shows insertion of the needle electrode into the lesion, with the needle electrode as parallel to the chest wall as possible. This technique is similar to the needle insertion technique used to perform core-needle biopsy.

View larger version (182K): [in a new window]   Figure 6a. US monitoring to ensure accurate placement of the RF device in the geometric center of the tumor to be ablated. (a) Predeployment longitudinal sonogram shows the tip of the needle electrode (arrows) in contact with the tumor. (b) Postdeployment longitudinal sonogram shows two echogenic prongs (arrows) traversing the central portion of the tumor. (c) Postdeployment transverse sonogram shows the echogenic cross sections of the deployed prongs (arrows) in the center of the lesion, confirming the accurate three-dimensional placement of the RF device.

View larger version (179K): [in a new window]   Figure 6b. US monitoring to ensure accurate placement of the RF device in the geometric center of the tumor to be ablated. (a) Predeployment longitudinal sonogram shows the tip of the needle electrode (arrows) in contact with the tumor. (b) Postdeployment longitudinal sonogram shows two echogenic prongs (arrows) traversing the central portion of the tumor. (c) Postdeployment transverse sonogram shows the echogenic cross sections of the deployed prongs (arrows) in the center of the lesion, confirming the accurate three-dimensional placement of the RF device.

View larger version (178K): [in a new window]   Figure 6c. US monitoring to ensure accurate placement of the RF device in the geometric center of the tumor to be ablated. (a) Predeployment longitudinal sonogram shows the tip of the needle electrode (arrows) in contact with the tumor. (b) Postdeployment longitudinal sonogram shows two echogenic prongs (arrows) traversing the central portion of the tumor. (c) Postdeployment transverse sonogram shows the echogenic cross sections of the deployed prongs (arrows) in the center of the lesion, confirming the accurate three-dimensional placement of the RF device.

View larger version (42K): [in a new window]   Figure 7. Drawing illustrates the RF ablation device correctly placed so as to produce a thermal lesion volume (black outline) that is concentric to the tumor and that encompasses the tumor and a sufficient margin of noncancerous tissue.

View larger version (130K): [in a new window]   Figure 8a. Monitoring of temperatures at the tip of the RF device prongs. (a) Control panel of the RF generator. The target temperature of 95°C has been reached; the specific temperatures at the tip of the five thermocouple-equipped prongs are 94°C, 94°C, 96°C, 96°C, and 97°C. The temperatures at the tip of the prongs, the power output, and the tissue impedance are displayed in real time on the screen of the laptop computer on top of the generator. (b) After RF ablation, laptop monitor screen shows graphs of the temperatures recorded at the tips of the five prongs over time (top) and of the impedance of the tissues and the power output of the generator (bottom).

View larger version (63K): [in a new window]   Figure 8b. Monitoring of temperatures at the tip of the RF device prongs. (a) Control panel of the RF generator. The target temperature of 95°C has been reached; the specific temperatures at the tip of the five thermocouple-equipped prongs are 94°C, 94°C, 96°C, 96°C, and 97°C. The temperatures at the tip of the prongs, the power output, and the tissue impedance are displayed in real time on the screen of the laptop computer on top of the generator. (b) After RF ablation, laptop monitor screen shows graphs of the temperatures recorded at the tips of the five prongs over time (top) and of the impedance of the tissues and the power output of the generator (bottom).

View larger version (167K): [in a new window]   Figure 9a. Longitudinal sonograms show decreasing visibility of the target lesion during RF ablation. (a) Sonogram obtained before RF ablation shows irregularly shaped invasive ductal carcinoma with margins (arrows) that are clearly demarcated from the surrounding fat. (b) Sonogram obtained at the beginning of RF ablation shows the hypoechoic tumor (arrows) traversed by the deployed prongs of the RF device. (c) Sonogram obtained at the end of RF ablation shows the tumor obscured by an echogenic area (arrows) associated with some shadowing. Arrowheads point to the shaft of the RF needle.

View larger version (169K): [in a new window]   Figure 9b. Longitudinal sonograms show decreasing visibility of the target lesion during RF ablation. (a) Sonogram obtained before RF ablation shows irregularly shaped invasive ductal carcinoma with margins (arrows) that are clearly demarcated from the surrounding fat. (b) Sonogram obtained at the beginning of RF ablation shows the hypoechoic tumor (arrows) traversed by the deployed prongs of the RF device. (c) Sonogram obtained at the end of RF ablation shows the tumor obscured by an echogenic area (arrows) associated with some shadowing. Arrowheads point to the shaft of the RF needle.

View larger version (174K): [in a new window]   Figure 9c. Longitudinal sonograms show decreasing visibility of the target lesion during RF ablation. (a) Sonogram obtained before RF ablation shows irregularly shaped invasive ductal carcinoma with margins (arrows) that are clearly demarcated from the surrounding fat. (b) Sonogram obtained at the beginning of RF ablation shows the hypoechoic tumor (arrows) traversed by the deployed prongs of the RF device. (c) Sonogram obtained at the end of RF ablation shows the tumor obscured by an echogenic area (arrows) associated with some shadowing. Arrowheads point to the shaft of the RF needle.

View larger version (145K): [in a new window]   Figure 10a. Photographs of gross breast tissue specimens resected after RF ablation. (a) Mastectomy specimen has a reddish hyperemic ring (arrows) that defines the extent of the ablation zone. (b) Close-up view of the specimen in a shows the well-defined tumor (arrows) in the center of the ablation zone.

View larger version (130K): [in a new window]   Figure 10b. Photographs of gross breast tissue specimens resected after RF ablation. (a) Mastectomy specimen has a reddish hyperemic ring (arrows) that defines the extent of the ablation zone. (b) Close-up view of the specimen in a shows the well-defined tumor (arrows) in the center of the ablation zone.

View larger version (151K): [in a new window]   Figure 11. Photomicrograph of tissue section from invasive carcinoma shows a moderate thermal effect characterized by cytoplasmic eosinophilia and dark pyknotic nuclear chromatin. (Hematoxylin-eosin stain; original magnification, x250.)

View larger version (142K): [in a new window]   Figure 12a. Photomicrographs of tissue stained with NADH-diaphorase to confirm the efficacy of the RF ablation. (a) Section of ablated invasive ductal carcinoma tissue (original magnification, x100) shows a negative reaction to NADH-diaphorase stain, which confirmed the absence of viable tumor cells after RF ablation. (b) Tissue section (original magnification, x200) obtained at the periphery of the ablation zone shows the sharp vertical demarcation between the NADH-diaphorase-negative ablated tissue (right) and the NADH-diaphorase-positive (ie, blue-stained) viable surrounding fat (left), which represents the margin of the ablation zone.

View larger version (133K): [in a new window]   Figure 12b. Photomicrographs of tissue stained with NADH-diaphorase to confirm the efficacy of the RF ablation. (a) Section of ablated invasive ductal carcinoma tissue (original magnification, x100) shows a negative reaction to NADH-diaphorase stain, which confirmed the absence of viable tumor cells after RF ablation. (b) Tissue section (original magnification, x200) obtained at the periphery of the ablation zone shows the sharp vertical demarcation between the NADH-diaphorase-negative ablated tissue (right) and the NADH-diaphorase-positive (ie, blue-stained) viable surrounding fat (left), which represents the margin of the ablation zone.