Cryoablation and its role in the treatment of breast diseases

What is cryoablation?

 

Cryoablation is a form of minimally-invasive treatment that uses extreme cold to destroy diseased tissues, including cancer cells.  Its application in the treatment of breast diseases include a) treatment of fibroadenoma and b) treatment of (selected) breast cancer.  

 

How is it performed?

 

Cryoablation can be performed under local anesthesia alone or in combination with sedation.  

 

A thin specialized needle called the cryoprobe is introduced into the breast via a 5-mm incision and guided to the target lesion with the use of an ultrasound.  Once precise placement of the cryoprobe is confirmed, extreme cold temperature is then created, which freezes and destroys the target tissue.  An ice ball is formed and its size monitored throughout the procedure.  Once the ice ball reaches the desired pre-calculated size, thawing begins.  At the end of the procedure, the needle is removed and the incision dressed.  The dead area of tissue is then rid by the body over time via natural processes.

 

Treatment of fibroadenoma

 

Fibroadenoma is a benign lump in the breast.  While many patients do not require treatment, some patients experience physical deformity or discomfort due to its size.  Cryoablation has been approved as a safe and effective therapy for treating fibroadenomas without the need for procedure to remove it.  It has also been shown that cryoablation of fibroadenoma causes minimal, if any, scar tissue in the treated area.  Because there is no ‘cutting’ involved, there is also no deformity. 

 

Treatment of breast cancer

 

Currently, the mainstay for achieving local tumour control is surgery, which is mastectomy with or without reconstruction or breast-conserving surgery with radiation therapy.  

 

Cryoablation is not currently considered as one of the mainstream treatment options for patients with breast cancer.  However, there is promising short-term data showing the usefulness and effectiveness of cryoablation in the treatment of (selected) early-stage breast cancer.  Compared to the other forms of breast cancer surgery, cryoablation is minimally invasive, causes little discomfort post procedure, and does not result in deformity. 

 

Cryoablation for breast cancer is performed in similar concept to breast-conserving surgery.  That is, the cancer and a rim of tissue surrounding it (the ‘margin’) are treated.  In surgery, the area of breast tissue is removed; with cryoablation, the area is treated with extreme cold—via the application of the cryoprobe as explained above—and left inside the body for clearance via natural processes.   Researchers believe that this allows the body’s immune system to recognise a certain type of cancer protein called the tumour antigen that is left behind post cryoablation, and to become better equipped at responding to cancer recurrence.  

 

Post procedure, patient experiences very little downtime.  The wound is essentially the size of the needle hole.  Patient will require radiation therapy to the rest of the breast, as well as receive the other appropriate adjuvant treatment for breast cancer.

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