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Small (<2.0-cm) Breast Cancers: Mammographic and US Findings at US-guided Cryoablation—Initial Experience¹

¹ From the Departments of Radiology (M.A.R., J.E.B., K.A.K., M.A.H.), Surgery (M.S.S.), and Pathology (C.G.K.), University of Michigan Comprehensive Cancer Center, 1500 E Medical Center Dr, Room 2910H, Ann Arbor, MI 48109-0326. From the 2003 RSNA scientific assembly. Received October 29, 2003; revision requested January 16, 2004; revision received March 23; accepted April 1. Address correspondence to M.A.R.

View larger version (158K): [in a new window]   Figure 1a. Longitudinal US images relative to transducer show placement of cryoprobe in tumor (arrows). (a) Invasive cancer. (b) Cryoprobe placed through tumor with US guidance. Procedure is similar to US-guided core-needle biopsy. Tip (arrowhead) of probe was advanced 1.0-1.5 cm beyond distal aspect of tumor and allowed ice ball to engulf entire tumor.

View larger version (155K): [in a new window]   Figure 1b. Longitudinal US images relative to transducer show placement of cryoprobe in tumor (arrows). (a) Invasive cancer. (b) Cryoprobe placed through tumor with US guidance. Procedure is similar to US-guided core-needle biopsy. Tip (arrowhead) of probe was advanced 1.0-1.5 cm beyond distal aspect of tumor and allowed ice ball to engulf entire tumor.

View larger version (80K): [in a new window]   Figure 2a. US images depict ice ball formation. At maximum size, ice ball is an oval mass with echogenic anterior surface and dense posterior acoustic shadowing. Distance between margin of ice ball and skin (arrowheads) was greater on b because of injection of sterile saline, which was intermittently instilled between ice ball and skin to maintain an ice ball-to-skin distance of at least 5 mm to prevent hypothermic injury to skin. (a) Longitudinal and (b) transverse orientation of US transducer relative to ice ball.

View larger version (101K): [in a new window]   Figure 2b. US images depict ice ball formation. At maximum size, ice ball is an oval mass with echogenic anterior surface and dense posterior acoustic shadowing. Distance between margin of ice ball and skin (arrowheads) was greater on b because of injection of sterile saline, which was intermittently instilled between ice ball and skin to maintain an ice ball-to-skin distance of at least 5 mm to prevent hypothermic injury to skin. (a) Longitudinal and (b) transverse orientation of US transducer relative to ice ball.

View larger version (136K): [in a new window]   Figure 3a.  Color Doppler US images of ice ball show twinkling artifact (arrows), which is a US artifact that occurs at highly reflective objects. Twinkling artifact appears as rapidly alternating red and blue color Doppler signal, which gives the appearance of movement, at surface of ice ball. No definite vascular flow was identified anterior to ice ball with color Doppler imaging. Amount of signal varies from (a) small or (b) moderate to (c) large.

View larger version (136K): [in a new window]   Figure 3b.  Color Doppler US images of ice ball show twinkling artifact (arrows), which is a US artifact that occurs at highly reflective objects. Twinkling artifact appears as rapidly alternating red and blue color Doppler signal, which gives the appearance of movement, at surface of ice ball. No definite vascular flow was identified anterior to ice ball with color Doppler imaging. Amount of signal varies from (a) small or (b) moderate to (c) large.

View larger version (141K): [in a new window]   Figure 3c.  Color Doppler US images of ice ball show twinkling artifact (arrows), which is a US artifact that occurs at highly reflective objects. Twinkling artifact appears as rapidly alternating red and blue color Doppler signal, which gives the appearance of movement, at surface of ice ball. No definite vascular flow was identified anterior to ice ball with color Doppler imaging. Amount of signal varies from (a) small or (b) moderate to (c) large.

View larger version (79K): [in a new window]   Figure 4. Mammograms show appearance of invasive ductal cancer after cryoablation. This cancer originally manifested as a circumscribed slightly lobulated mass (arrow) surrounded by only fat. After cryoablation, a new halo of density (arrowheads) surrounded the mass. Patient had no residual carcinoma after cryoablation. A, B, Craniocaudal views. C, D, Mediolateral oblique views. A, C, Before cryoablation. B, C, At wire localization 24 days after cryoablation. Images show a change in mammographic appearance. E, Radiograph of specimen shows in greater detail that the mass and adjacent fatty tissue were surrounded by halo of density (arrowheads).

View larger version (205K): [in a new window]   Figure 5a. US images of invasive cancer (arrow). (a) Before cryoablation, hypoechoic mass was observed with spiculated margins. (b) After cryoablation, mass was visible but more ill-defined, with a larger region of hyperechogenicitiy surrounding it.

View larger version (188K): [in a new window]   Figure 5b. US images of invasive cancer (arrow). (a) Before cryoablation, hypoechoic mass was observed with spiculated margins. (b) After cryoablation, mass was visible but more ill-defined, with a larger region of hyperechogenicitiy surrounding it.

View larger version (160K): [in a new window]   Figure 6. Image shows histopathologic specimen of breast tissue obtained after cryoablation and lumpectomy. Extensive areas of coagulative necrosis (thick arrow) were observed, as well as high eosinophilic staining (pink) of tissue (thin arrow), which was amorphous and demonstrated areas of hemorrhage without visible carcinoma. (Hematoxylin-eosin stain; original magnification, x2.)

View larger version (151K): [in a new window]   Figure 7. Image shows histopathologic specimen of breast tumor tissue in patient with residual invasive ductal carcinoma next to resection margin obtained after cryoablation and lumpectomy. Residual tubules and single cells with slight pleomorphism, which represent residual invasive ductal carcinoma (arrows), were observed. (Hematoxylin-eosin stain; original magnification, x20.)