1
|
Matsumoto DRM, Facina G. Incorporating Percutaneous Laser Ablation for Early Breast Cancer Treatment: A Systematic Review. Technol Cancer Res Treat 2025; 24:15330338241300743. [PMID: 39800923 PMCID: PMC11898239 DOI: 10.1177/15330338241300743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 10/11/2024] [Accepted: 10/21/2024] [Indexed: 03/14/2025] Open
Abstract
Objectives: We conducted a systematic review to compile the findings of all published studies on the use of percutaneous laser ablation (PLA) in the treatment of early-stage breast cancer. We aimed to identify appropriate methodology as well as parameters for the selection of suitable patients to optimize outcomes with the use of PLA. Additionally, we aimed to analyze whether this method is a viable alternative to current surgical treatments employed. Methods: The PRISMA 2020 method was applied. The terms "laser ablation" AND "breast cancer" were used to select all articles published up to January 2024 on the PubMed and Embase platforms. Articles in English were included. Only original articles were considered for this systematic review. Review articles, editorials, letters, and studies ex-vivo or not performed in humans were excluded. Results: Seventeen articles, including 308 patients were analyzed. Among the studies describing the complete response rate to assess treatment success, there was no residual tumor after ablation in 74.4% of the patients. MRI was the best exam to evaluate the effectiveness of the ablative procedure with a NPV of 92% to 100%. Skin burn was the most commonly observed complication, occurring in 6% of patients. Other less frequent complications were hematoma/bleeding, pain, nodulation, erythema, seroma, and fat necrosis. Conclusions: The use of PLA remains restricted to cases with specific indications or within the context of research protocols. However, future studies may validate this promising technique for the local treatment of early-stage breast cancer. This study was registered at INPLASY (registration number: INPLASY2024100045).
Collapse
Affiliation(s)
| | - Gil Facina
- Breast surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
2
|
Fan Y, Xu L, Liu S, Li J, Xia J, Qin X, Li Y, Gao T, Tang X. The State-of-the-Art and Perspectives of Laser Ablation for Tumor Treatment. CYBORG AND BIONIC SYSTEMS 2024; 5:0062. [PMID: 38188984 PMCID: PMC10769065 DOI: 10.34133/cbsystems.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/21/2023] [Indexed: 01/09/2024] Open
Abstract
Tumors significantly impact individuals' physical well-being and quality of life. With the ongoing advancements in optical technology, information technology, robotic technology, etc., laser technology is being increasingly utilized in the field of tumor treatment, and laser ablation (LA) of tumors remains a prominent area of research interest. This paper presents an overview of the recent progress in tumor LA therapy, with a focus on the mechanisms and biological effects of LA, commonly used ablation lasers, image-guided LA, and robotic-assisted LA. Further insights and future prospects are discussed in relation to these aspects, and the paper proposed potential future directions for the development of tumor LA techniques.
Collapse
Affiliation(s)
- Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Liancheng Xu
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Shuai Liu
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jinhua Li
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jialu Xia
- School of Materials Science and Engineering, Hefei University of Technology, Hefei 230009, China
| | - Xingping Qin
- John B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Yafeng Li
- China Electronics Harvest Technology Co. Ltd., China
| | - Tianxin Gao
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Xiaoying Tang
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| |
Collapse
|
3
|
Carriero S, Lanza C, Pellegrino G, Ascenti V, Sattin C, Pizzi C, Angileri SA, Biondetti P, Ianniello AA, Piacentino F, Lavorato R, Ierardi AM, Carrafiello G. Ablative Therapies for Breast Cancer: State of Art. Technol Cancer Res Treat 2023; 22:15330338231157193. [PMID: 36916200 PMCID: PMC10017926 DOI: 10.1177/15330338231157193] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Breast cancer (BC) is the most frequently diagnosed malignancy among women. In the past two decades, new technologies and BC screening have led to the diagnosis of smaller and earlier-stage BC (ESBC). Therefore, percutaneous minimally invasive techniques (PMIT) were adopted to treat patients unfit for surgery, women who refuse it, or elderly patients with comorbidities that could make surgery a difficult and life-threatening treatment. The target of PMIT is small-size ESBC with the scope of obtaining similar efficacy as surgery. Minimally invasive treatments are convenient alternatives with promising effectiveness, lower morbidity, less cost, less scarring and pain, and more satisfying cosmetic results. Ablative techniques used in BC are cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound (US), and laser ablation. The aim of our study is to discuss the current status of percutaneous management of BC, evaluate the clinical outcomes of PMIT in BC, and analyze future perspectives regarding ablation therapy in BC.
Collapse
Affiliation(s)
- Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Sattin
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Caterina Pizzi
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy.,9304Università Degli Studi di Milano, Milan, Italy
| | | | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo, Varese, Italy
| | - Roberto Lavorato
- Researcher at Diagnostic and Interventional Radiology Department, 9339IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Policlinico di Milano Ospedale Maggiore, Via Sforza 35, 20122 Milan, Italy.,9304Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|
4
|
Geoghegan R, Zhang L, Priester A, Wu HH, Marks L, Natarajan S. Interstitial Optical Monitoring of Focal Laser Ablation. IEEE Trans Biomed Eng 2022; 69:2545-2556. [PMID: 35148260 PMCID: PMC9371599 DOI: 10.1109/tbme.2022.3150279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Focal laser ablation is a minimally invasive method of treating cancerous lesions in organs such as prostate, liver and brain. Oncologic control is achieved by inducing hyperthermia throughout the target while minimizing damage to surrounding tissue. Consequently, successful clinical outcomes are contingent upon achieving desired ablation volumes. Magnetic resonance thermometry is frequently used to monitor the formation of the induced thermal damage zone and inform the decision to terminate energy delivery. However, due to the associated cost and complexity there is growing interest in the development of alternative approaches. Here we investigate the utility of real-time interstitial interrogation of laser-tissue interaction as an inexpensive alternative monitoring modality that provides direct assessment of tissue coagulation without the need for organ specific calibration. The optical contrast mechanism was determined using a Monte Carlo model. Subsequently, four interstitial probe designs were manufactured and assessed in a tissue mimicking phantom under simultaneous magnetic resonance imaging. Finally, the optimal probe design was evaluated in ex vivo bovine muscle. It was found to be capable of providing sufficient feedback to achieve pre-defined ablation radii in the range 4-7mm with a mean absolute error of 0.3mm. This approach provides an inexpensive monitoring modality that may facilitate widespread adoption of focal laser ablation.
Collapse
|
5
|
Geoghegan R, Ter Haar G, Nightingale K, Marks L, Natarajan S. Methods of monitoring thermal ablation of soft tissue tumors - A comprehensive review. Med Phys 2022; 49:769-791. [PMID: 34965307 DOI: 10.1002/mp.15439] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/30/2020] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
Thermal ablation is a form of hyperthermia in which oncologic control can be achieved by briefly inducing elevated temperatures, typically in the range 50-80°C, within a target tissue. Ablation modalities include high intensity focused ultrasound, radiofrequency ablation, microwave ablation, and laser interstitial thermal therapy which are all capable of generating confined zones of tissue destruction, resulting in fewer complications than conventional cancer therapies. Oncologic control is contingent upon achieving predefined coagulation zones; therefore, intraoperative assessment of treatment progress is highly desirable. Consequently, there is a growing interest in the development of ablation monitoring modalities. The first section of this review presents the mechanism of action and common applications of the primary ablation modalities. The following section outlines the state-of-the-art in thermal dosimetry which includes interstitial thermal probes and radiologic imaging. Both the physical mechanism of measurement and clinical or pre-clinical performance are discussed for each ablation modality. Thermal dosimetry must be coupled with a thermal damage model as outlined in Section 4. These models estimate cell death based on temperature-time history and are inherently tissue specific. In the absence of a reliable thermal model, the utility of thermal monitoring is greatly reduced. The final section of this review paper covers technologies that have been developed to directly assess tissue conditions. These approaches include visualization of non-perfused tissue with contrast-enhanced imaging, assessment of tissue mechanical properties using ultrasound and magnetic resonance elastography, and finally interrogation of tissue optical properties with interstitial probes. In summary, monitoring thermal ablation is critical for consistent clinical success and many promising technologies are under development but an optimal solution has yet to achieve widespread adoption.
Collapse
Affiliation(s)
- Rory Geoghegan
- Department of Urology, University of California Los Angeles, Los Angeles, California, USA
| | - Gail Ter Haar
- Department of Physics, Institute of Cancer Research, University of London, Sutton, UK
| | - Kathryn Nightingale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Leonard Marks
- Department of Urology, University of California Los Angeles, Los Angeles, California, USA
| | - Shyam Natarajan
- Departments of Urology & Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
6
|
Roknsharifi S, Wattamwar K, Fishman MDC, Ward RC, Ford K, Faintuch S, Joshi S, Dialani V. Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand? Radiographics 2021; 41:945-966. [PMID: 34197250 DOI: 10.1148/rg.2021200156] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.
Collapse
Affiliation(s)
- Shima Roknsharifi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kapil Wattamwar
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Michael D C Fishman
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Robert C Ward
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kelly Ford
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Salomao Faintuch
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Surekha Joshi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Vandana Dialani
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| |
Collapse
|
7
|
van de Voort EMF, Struik GM, Birnie E, Moelker A, Verhoef C, Klem TMAL. Thermal Ablation as an Alternative for Surgical Resection of Small (≤ 2 cm) Breast Cancers: A Meta-Analysis. Clin Breast Cancer 2021; 21:e715-e730. [PMID: 33840627 DOI: 10.1016/j.clbc.2021.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 12/12/2022]
Abstract
Women with early-stage breast cancer have an excellent prognosis with current therapy, but could presumably be treated less invasively, without the need for surgery. The primary goal of this meta-analysis was to examine whether thermal ablation is an effective method to treat early-stage breast cancer. Studies reporting on complete ablation rate after thermal ablation as a treatment of small breast cancers (≤ 2 cm) were included. Methodologic quality of included studies was assessed using MINORS criteria. Complete ablation rates are given as proportions, and meta-regression and subgroup analyses were performed. The overall complete ablation rate in 1266 patients was 86% and was highest after radiofrequency ablation (RFA) (92%). Local recurrence rates varied from 0% to 3%, with a median follow-up of 15 to 61 months. Overall, complication rates were low (5%-18% across techniques) and were highest after high-intensity focused ultrasound ablation and lowest after cryoablation. Cosmetic outcome was good to excellent in at least 85% of patients but was reported infrequently and long-term results of cosmetic outcome after thermal ablation and radiotherapy are still lacking. Thermal ablation techniques treating early-stage breast cancer (≤ 2 cm) are safe and effective based on complete ablation rate and short-term local recurrence rates. Especially, RFA, microwave ablation, and cryoablation are promising techniques as an alternative to surgical resection without jeopardizing current treatment effectiveness or safety. Owing to great heterogeneity in the included studies, a formal recommendation on the best technique is not possible. These findings warrant the design of large randomized controlled trials comparing thermal ablation and breast-conserving surgery in the treatment of T1 breast cancer.
Collapse
Affiliation(s)
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Interventional Radiology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| |
Collapse
|
8
|
Perretta T, Meucci R, Pistolese CA, Manenti G, Stefano CD, Vanni G, Anemona L, Ferrari D, Lamacchia F, De Stasio V, Buonomo OC. Ultrasound-Guided Laser Ablation After Excisional Vacuum-Assisted Breast Biopsy for Small Malignant Breast Lesions: Preliminary Results. Technol Cancer Res Treat 2021; 20:1533033820980089. [PMID: 33618620 PMCID: PMC7905484 DOI: 10.1177/1533033820980089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The purpose of this preliminary study is to evaluate the
feasibility of the excisional ultrasound (US) guided
vacuum-assisted breast biopsy (VAE), followed by US-guided Laser
Interstitial Thermal Therapy (LITT) in the treatment of unifocal
ductal breast carcinomas ≤ 1 cm and estimate the ablation rate
analyzing the final histopathological results after subsequent
surgical excision. Methods: In a single session 11 female patients with unifocal less than a
centimeter breast cancer underwent 2 different minimally
invasive percutaneous US-guided techniques: a VAE breast biopsy
with an 8 G needle to remove the lesion and, immediately after,
a LITT ablation in the biopsy site. Four weeks later, all
patients underwent radiological follow-up. Afterward, a
systematic surgery was performed, the ablation rate was
calculated, and iconographic and histological features were
correlated. Results: Average maximum diameter of the lesions was 7.6 mm (5-10 mm). No
patient reported pain or discomfort during procedure. 1/11
patient (9.1%) reported an early minor complication (a small
superficial skin burn). After surgical excision, the
histopathological evaluation reported in 10/11 cases (90.9%)
complete ablation of the target lesion. In only one case (9.1%)
residual cancer was detected. The necrotic-hemorrhagic cavities
showed a mean maximum diameter of 27.3 mm (20-35 mm). Conclusions: Laser ablation performed after excisional biopsy could be
considered a valid alternative to surgical excision for the
treatment of lesions ≤ 1 cm, if carried out by expert
radiologists. The association of these minimally invasive
percutaneous methods has proven to be reliable, fast, and safe
with an ablation rate of 90.9% and excellent aesthetic results.
RM and CESM are potentially able to quantifying treatment
results and to follow-up the ablation effects.
Collapse
Affiliation(s)
- Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy.,Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Donatella Ferrari
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Vincenzo De Stasio
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| |
Collapse
|
9
|
Geoghegan R, Priester A, Zhang L, Wu H, Marks L, Natarajan S. Monitoring Focal Laser Ablation with Interstitial Fluence Probes: Monte Carlo Simulation and Phantom Validation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5272-5275. [PMID: 33019173 DOI: 10.1109/embc44109.2020.9176370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Focal laser ablation offers a minimally invasive method of treating solid organ tumors via hyperthermia. Real-time monitoring of the induced tissue damage is critical for clinical success, and is typically accomplished using thermal measurements and Arrhenius models. In this manuscript, the utility of interstitial fluence probes in assessing coagulation directly in real-time was assessed through a Monte Carlo simulation and an experimental study in tissue mimicking prostate phantoms. In the simulation results, fluence increases greater than 100% were observed inside the coagulation zone, as coagulation effectively acts as a 'light trap'. Moreover, the passing of the coagulation boundary at any given point was shown to correspond with an inflection in fluence with a mean absolute difference of 0.1mm and 0.4mm observed for the simulation and phantom respectively. These results suggest that interstitial fluence probes may be capable of providing real-time feedback during focal laser ablation.
Collapse
|
10
|
Periyasamy V, Özsoy Ç, Reiss M, Deán-Ben XL, Razansky D. In vivo optoacoustic monitoring of percutaneous laser ablation of tumors in a murine breast cancer model. OPTICS LETTERS 2020; 45:2006-2009. [PMID: 32236054 DOI: 10.1364/ol.386360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/23/2020] [Indexed: 06/11/2023]
Abstract
Laser ablation (LA) is a promising approach for minimally invasive cancer treatments. Its in vivo applicability is often impeded by the lack of efficient monitoring tools that can help to minimize collateral tissue damage and aid in determining the optimal treatment end-points. We have devised a new, to the best of our knowledge, hybrid LA approach combining simultaneous volumetric optoacoustic (OA) imaging to monitor the lesion progression accurately in real time and 3D. Time-lapse imaging of laser ablation of solid tumors was performed in a murine breast cancer model in vivo by irradiation of subcutaneous tumors with a 100 mJ short-pulsed (${\sim}{5}\;{\rm ns}$∼5ns) laser operating at 1064 nm and 100 Hz pulse repetition frequency. Local changes in the OA signal intensity ascribed to structural alterations in the tumor vasculature were clearly observed, while the OA volumetric projections recorded in vivo appeared to correlate with cross sections of the excised tumors.
Collapse
|
11
|
Dolganova IN, Shikunova IA, Katyba GM, Zotov AK, Mukhina EE, Shchedrina MA, Tuchin VV, Zaytsev KI, Kurlov VN. Optimization of sapphire capillary needles for interstitial and percutaneous laser medicine. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-7. [PMID: 31849206 PMCID: PMC7006039 DOI: 10.1117/1.jbo.24.12.128001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
Sapphire capillary needles fabricated by edge-defined film-fed growth (EFG) technique hold strong potential in laser thermotherapy and photodynamic therapy, thanks to the advanced physical properties of sapphire. These needles feature an as-grown optical quality, their length is tens of centimeters, and they contain internal capillary channels, with open or closed ends. They can serve as optically transparent bearing elements with optical fibers introduced into their capillary channels in order to deliver laser radiation to biological tissues for therapeutic and, in some cases, diagnostic purposes. A potential advantage of the EFG-grown sapphire needles is associated with an ability to form the tip of a needle with complex geometry, either as-grown or mechanically treated, aimed at controlling the output radiation pattern. In order to examine a potential of the radiation pattern shaping, we present a set of fabricated sapphire needles with different tips. We studied the radiation patterns formed at the output of these needles using a He-Ne laser as a light source, and used intralipid-based tissue phantoms to proof the concept experimentally and the Monte-Carlo modeling to proof it numerically. The observed results demonstrate a good agreement between the numerical and experimental data and reveal an ability to control within wide limits the direction of tissue exposure to light and the amount of exposed tissue by managing the sapphire needle tip geometry.
Collapse
Affiliation(s)
- Irina N. Dolganova
- Russian Academy of Sciences, Institute of Solid State Physics, Chernogolovka, Russia
- Sechenov First Moscow State Medical University, Institute for Regenerative Medicine, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | - Irina A. Shikunova
- Russian Academy of Sciences, Institute of Solid State Physics, Chernogolovka, Russia
| | - Gleb M. Katyba
- Russian Academy of Sciences, Institute of Solid State Physics, Chernogolovka, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | - Arsen K. Zotov
- Russian Academy of Sciences, Institute of Solid State Physics, Chernogolovka, Russia
| | | | - Marina A. Shchedrina
- Sechenov First Moscow State Medical University, Institute for Regenerative Medicine, Moscow, Russia
| | - Valery V. Tuchin
- Saratov State University, Saratov, Russia
- Russian Academy of Sciences, Institute of Precision Mechanics and Control, Saratov, Russia
- Tomsk State University, Tomsk, Russia
- ITMO University, St. Petersburg, Russia
| | - Kirill I. Zaytsev
- Sechenov First Moscow State Medical University, Institute for Regenerative Medicine, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
- Russian Academy of Sciences, Prokhorov General Physics Institute, Moscow, Russia
| | - Vladimir N. Kurlov
- Russian Academy of Sciences, Institute of Solid State Physics, Chernogolovka, Russia
- Sechenov First Moscow State Medical University, Institute for Regenerative Medicine, Moscow, Russia
| |
Collapse
|
12
|
The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9141746. [PMID: 29992167 PMCID: PMC6016148 DOI: 10.1155/2018/9141746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/14/2018] [Indexed: 12/29/2022]
Abstract
Background and Objectives Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC). Methods Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC. Results At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure. Conclusions Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.
Collapse
|
13
|
Laser Ablation for Cancer: Past, Present and Future. J Funct Biomater 2017; 8:jfb8020019. [PMID: 28613248 PMCID: PMC5492000 DOI: 10.3390/jfb8020019] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/27/2022] Open
Abstract
Laser ablation (LA) is gaining acceptance for the treatment of tumors as an alternative to surgical resection. This paper reviews the use of lasers for ablative and surgical applications. Also reviewed are solutions aimed at improving LA outcomes: hyperthermal treatment planning tools and thermometric techniques during LA, used to guide the surgeon in the choice and adjustment of the optimal laser settings, and the potential use of nanoparticles to allow biologic selectivity of ablative treatments. Promising technical solutions and a better knowledge of laser-tissue interaction should allow LA to be used in a safe and effective manner as a cancer treatment.
Collapse
|
14
|
Biocompatible astaxanthin as a novel marine-oriented agent for dual chemo-photothermal therapy. PLoS One 2017; 12:e0174687. [PMID: 28369126 PMCID: PMC5378353 DOI: 10.1371/journal.pone.0174687] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/12/2017] [Indexed: 12/03/2022] Open
Abstract
The photothermal effect of a marine-oriented xanthophyll carotenoid, astaxanthin (AXT), was characterized based on its potential absorption of visible laser light and conversion of optical light energy into heat for thermal treatment. As an antioxidant and anticancer agent, AXT extracted from marine material can be utilized for photothermal therapy due to its strong light absorption. The current study investigated the feasibility of the marine-based material AXT to increase the therapeutic efficacy of chemo-photothermal therapy (PTT) by assessing photothermal sessions in both cells and tumor tissues. A quasi-cw Q-switched 80 W 532 nm laser system was utilized to induce thermal necrosis in in vitro and in vivo models. An in vitro cytotoxicity study of AXT was implemented using squamous cell carcinoma (VX2) and macrophage (246.7) cell lines. In vivo PTT experiments were performed on 17 rabbits bearing VX2 tumors on their eyes that were treated with or without intratumoral injection of AXT at a dose of 100 μl (300 μg/ml) followed by laser irradiation at a low irradiance of 0.11 W/cm2. Fluorescence microscopy images revealed cellular death via apoptosis and necrosis owing to the dual chemo-photothermal effects induced by AXT. In vivo experimental results demonstrated that the AXT-assisted irradiation entailed a temperature increase by 30.4°C after tumor treatment for 4 min. The relative variations in tumor volume confirmed that the tumors treated with both AXT and laser irradiation completely disappeared 14 days after treatment, but the tumors treated under other conditions gradually grew. Due to selective light absorption, AXT-assisted laser treatment could be an effective thermal therapy for various drug-resistant cancers.
Collapse
|
15
|
|
16
|
Mauri G, Sconfienza LM, Pescatori LC, Fedeli MP, Alì M, Di Leo G, Sardanelli F. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. Eur Radiol 2017; 27:3199-3210. [PMID: 28050693 DOI: 10.1007/s00330-016-4668-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. METHODS An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. RESULTS Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). CONCLUSIONS Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. KEY POINTS • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).
Collapse
Affiliation(s)
- Giovanni Mauri
- Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100, Milano, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità Operativa di Radiologia / Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milano, Italy
| | - Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Maria Paola Fedeli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Marco Alì
- Integrative Biomedical Research PhD Program, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
17
|
|
18
|
Peek MCL, Ahmed M, Napoli A, Usiskin S, Baker R, Douek M. Minimally invasive ablative techniques in the treatment of breast cancer: a systematic review and meta-analysis. Int J Hyperthermia 2016; 33:191-202. [PMID: 27575566 DOI: 10.1080/02656736.2016.1230232] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Breast-conserving surgery is effective for breast cancer treatment but is associated with morbidity in particular high re-excision rates. We performed a systematic review and meta-analysis to assess the current evidence for clinical outcomes with minimally invasive ablative techniques in the non-surgical treatment of breast cancer. METHODS A systematic search of the literature was performed using PubMed and Medline library databases to identify all studies published between 1994 and May 2016. Studies were considered eligible for inclusion if they evaluated the role of ablative techniques in the treatment of breast cancer and included ten patients or more. Studies that failed to fulfil the inclusion criteria were excluded. RESULTS We identified 63 studies including 1608 patients whose breast tumours were treated with radiofrequency (RFA), high intensity focussed ultrasound (HIFU), cryo-, laser or microwave ablation. Fifty studies reported on the number of patients with complete ablation as found on histopathology and the highest rate of complete ablation was achieved with RFA (87.1%, 491/564) and microwave ablation (83.2%, 89/107). Short-term complications were most often reported with microwave ablation (14.6%, 21/144). Recurrence was reported in 24 patients (4.2%, 24/570) and most often with laser ablation (10.7%, 11/103). The shortest treatment times were observed with RFA (15.6 ± 5.6 min) and the longest with HIFU (101.5 ± 46.6 min). CONCLUSION Minimally invasive ablative techniques are able to successfully induce coagulative necrosis in breast cancer with a low side effect profile. Adequately powered and prospectively conducted cohort trials are required to confirm complete pathological ablation in all patients.
Collapse
Affiliation(s)
- Mirjam C L Peek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| | - Muneer Ahmed
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| | - Alessandro Napoli
- b Department of Radiological Sciences , Sapienza University of Rome, School of Medicine , Roma , Italy
| | - Sasha Usiskin
- c Department of Radiology , St. Bartholomew's Hospital , London , Great Britain
| | - Rose Baker
- d School of Business, 612, Maxwell Building, University of Salford , Salford , Great Britain
| | - Michael Douek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain
| |
Collapse
|
19
|
Zhou H, Sharma M, Berezin O, Zuckerman D, Berezin MY. Nanothermometry: From Microscopy to Thermal Treatments. Chemphyschem 2016; 17:27-36. [PMID: 26443335 PMCID: PMC7396319 DOI: 10.1002/cphc.201500753] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 01/01/2023]
Abstract
Measuring temperature in cells and tissues remotely, with sufficient sensitivity, and in real time presents a new paradigm in engineering, chemistry and biology. Traditional sensors, such as contact thermometers, thermocouples, and electrodes, are too large to measure the temperature with subcellular resolution and are too invasive to measure the temperature in deep tissue. The new challenge requires novel approaches in designing biocompatible temperature sensors-nanothermometers-and innovative techniques for their measurements. In the last two decades, a variety of nanothermometers whose response reflected the thermal environment within a physiological temperature range have been identified as potential sensors. This review covers the principles and aspects of nanothermometer design driven by two emerging areas: single-cell thermogenesis and image guided thermal treatments. The review highlights the current trends in nanothermometry illustrated with recent representative examples.
Collapse
Affiliation(s)
- Haiying Zhou
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA
| | - Monica Sharma
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA
| | | | - Darryl Zuckerman
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA
| | - Mikhail Y Berezin
- Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway, St. Louis, MO, 63110, USA.
- Institute for Materials Science and Engineering, Washington University, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| |
Collapse
|
20
|
Ahmed M, Rubio IT, Klaase JM, Douek M. Surgical treatment of nonpalpable primary invasive and in situ breast cancer. Nat Rev Clin Oncol 2015; 12:645-63. [PMID: 26416152 DOI: 10.1038/nrclinonc.2015.161] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Breast cancer is the most-common cancer among women worldwide, and over one-third of all cases diagnosed annually are nonpalpable at diagnosis. The increasingly widespread implementation of breast-screening programmes, combined with the use of advanced imaging modalities, such as magnetic resonance imaging (MRI), will further increase the numbers of patients diagnosed with this disease. The current standard management for nonpalpable breast cancer is localized surgical excision combined with axillary staging, using sentinel-lymph-node biopsy in the clinically and radiologically normal axilla. Wire-guided localization (WGL) during mammography is a method that was developed over 40 years ago to enable lesion localization preoperatively; this technique became the standard of care in the absence of a better alternative. Over the past 20 years, however, other technologies have been developed as alternatives to WGL in order to overcome the technical and outcome-related limitations of this technique. This Review discusses the techniques available for the surgical management of nonpalpable breast cancer; we describe their advantages and disadvantages, and highlight future directions for the development of new technologies.
Collapse
Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Isabel T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Paseo Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Netherlands
| | - Michael Douek
- Division of Cancer Studies, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK
| |
Collapse
|
21
|
Yang BR, Kim HJ, Shin KM, Cho SH, Jang YJ, Lee HJ, Park YM, Lee SM, Park JY, Park HY, Jung JH. Serial Ultrasound Findings After Laser Ablation for Benign Breast Lesions on Long-Term Follow-Up: Implications for Evaluation of Procedural Success. Photomed Laser Surg 2015. [DOI: 10.1089/pho.2015.3932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Bo Ra Yang
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Seung Hyeon Cho
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Yun-Jin Jang
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Hui Joong Lee
- Department of Radiology, Kyungpook National University Hospital, Daegu, Korea
| | - Young Mi Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - So Mi Lee
- Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea
| | - Ji Young Park
- Department of Pathology, Kyungpook National University Hostpital, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| |
Collapse
|
22
|
Wan T, Bloch BN, Danish S, Madabhushi A. A Learning Based Fiducial-driven Registration Scheme for Evaluating Laser Ablation Changes in Neurological Disorders. Neurocomputing 2014; 144:24-37. [PMID: 25225455 DOI: 10.1016/j.neucom.2013.11.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this work, we present a novel learning based fiducial driven registration (LeFiR) scheme which utilizes a point matching technique to identify the optimal configuration of landmarks to better recover deformation between a target and a moving image. Moreover, we employ the LeFiR scheme to model the localized nature of deformation introduced by a new treatment modality - laser induced interstitial thermal therapy (LITT) for treating neurological disorders. Magnetic resonance (MR) guided LITT has recently emerged as a minimally invasive alternative to craniotomy for local treatment of brain diseases (such as glioblastoma multiforme (GBM), epilepsy). However, LITT is currently only practised as an investigational procedure world-wide due to lack of data on longer term patient outcome following LITT. There is thus a need to quantitatively evaluate treatment related changes between post- and pre-LITT in terms of MR imaging markers. In order to validate LeFiR, we tested the scheme on a synthetic brain dataset (SBD) and in two real clinical scenarios for treating GBM and epilepsy with LITT. Four experiments under different deformation profiles simulating localized ablation effects of LITT on MRI were conducted on 286 pairs of SBD images. The training landmark configurations were obtained through 2000 iterations of registration where the points with consistently best registration performance were selected. The estimated landmarks greatly improved the quality metrics compared to a uniform grid (UniG) placement scheme, a speeded-up robust features (SURF) based method, and a scale-invariant feature transform (SIFT) based method as well as a generic free-form deformation (FFD) approach. The LeFiR method achieved average 90% improvement in recovering the local deformation compared to 82% for the uniform grid placement, 62% for the SURF based approach, and 16% for the generic FFD approach. On the real GBM and epilepsy data, the quantitative results showed that LeFiR outperformed UniG by 28% improvement in average.
Collapse
Affiliation(s)
- Tao Wan
- Department of Biomedical Engineering, Case Western Reserve University, OH 44106, USA ; School of Biological Science and Medical Engineering, BUAA, Beijing 100191, China
| | - B Nicolas Bloch
- Department of Radiology, Boston University School of Medicine, MA 02118, USA
| | - Shabbar Danish
- Department of Neurosurgery, Robert Wood Johnson Medical School, NJ 08901, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, OH 44106, USA
| |
Collapse
|
23
|
Alphandéry E. Perspectives of breast cancer thermotherapies. J Cancer 2014; 5:472-9. [PMID: 24959300 PMCID: PMC4066359 DOI: 10.7150/jca.8693] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/08/2014] [Indexed: 01/08/2023] Open
Abstract
In this article, the use of different types of thermotherapies to treat breast cancer is reviewed. While hyperthermia is most commonly used as an adjuvant in combination with radiotherapy, chemotherapy, targeted therapy or cryotherapy to enhance the therapeutic effect of these therapies, thermoablation is usually carried out alone to eradicate small breast tumors. A recently developed thermotherapy, called magnetic hyperthermia, which involves localized heating of nanoparticles under the application of an alternating magnetic field, is also presented. The advantages and drawbacks of these different thermotherapies are highlighted.
Collapse
Affiliation(s)
- Edouard Alphandéry
- 1. Nanobacterie SARL, 36 boulevard Flandrin, 75116, Paris, France. ; 2. Institut de Minéralogie et de Physique des Milieux Condensés, Université Pierre et Marie Curie, 4 Place Jussieu, 75005, Paris, France
| |
Collapse
|
24
|
Sabel MS. Nonsurgical ablation of breast cancer: future options for small breast tumors. Surg Oncol Clin N Am 2014; 23:593-608. [PMID: 24882353 DOI: 10.1016/j.soc.2014.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The surgical management of breast cancer has evolved significantly, facilitated by advancements in technology and imaging and improvements in adjuvant therapy. The changes in surgical management have been characterized by equal or improved outcomes with significantly less morbidity. The next step in this evolution is the minimally invasive or noninvasive ablation of breast cancers as an alternative to lumpectomy. In this article, the various modalities for nonsurgical breast cancer ablation and the clinical experience are reviewed, and some of the next steps necessary for their clinical implementation are outlined.
Collapse
Affiliation(s)
- Michael S Sabel
- Department of Surgery, University of Michigan, 3304 Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
25
|
Kim C, Park H, Lee H. Comparison of laser-induced damage with forward-firing and diffusing optical fiber during laser-assisted lipoplasty. Lasers Surg Med 2013; 45:437-49. [PMID: 23852719 DOI: 10.1002/lsm.22155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Laser-assisted lipoplasty is made possible by using an optical fiber that delivers light endoscopically to subcutaneous fat tissue. Most optical fibers for laser-assisted lipoplasty are designed to be irradiated in a forward direction. In this study, we compared forward-firing fiber and diffusing fiber for use in laser-assisted lipoplasty. The effective parameters of the ablation pattern which resulted from the laser-induced damage are discussed for both systems. In particular, we note the effect resulting from the different beam emission patterns and the contours of laser fluence. METHODS We used two different laser delivery systems (a forward-firing fiber and a diffusing fiber) to examine how the beam emission pattern affects the laser-assisted coagulation and damage pattern of in vitro fat tissues. A porcine liver tissue (water-rich tissue) was used as a secondary laser target to investigate how the laser-assisted coagulation pattern depends on both the type of tissue (water-rich and lipid-rich tissue) as well as the delivery system. An evaluation using a digital camera and a thermal camera was conducted for the tissue ablation processes in order to observe the generated heat transfer in fat and liver. RESULTS The overall shape of the laser-assisted coagulation zone was different from the beam emission pattern in the case where a forward-firing fiber was used within fat tissue. The center of the laser-affected zone is characterized by the formation of a reservoir of melted fat. In the thermal image analysis, there existed a discrepancy between the temperature distribution of the fat tissue and the liver tissue during the forward-firing fiber irradiation. In the liver tissue ablation process, the temperature distribution during the laser ablation also demonstrated an elongated ellipse that matches well with the laser-induced damage zone. The temperature distribution in fat tissue adhered to a more discoid pattern that corresponded to the laser-induced damage zone. CONCLUSIONS Based on our findings, we have proposed mechanisms that can explain the laser-induced damage in both tissues when a forward firing fiber is employed as the delivery system. In the case of fat tissue, the ablation mechanism can be characterized by the reservoir formation of melted lipids while the ablation is characterized as the well-known drilling effect for liver tissue.
Collapse
Affiliation(s)
- Changhwan Kim
- School of Mechanical Engineering, Kyungpook National University, Daegu, 702-701, Korea
| | | | | |
Collapse
|
26
|
Davies LB, Kiernan MN, Bishop JC, Thornton CA, Morgan G. The impact of cell culture equipment on energy loss. Lasers Med Sci 2013; 29:195-202. [DOI: 10.1007/s10103-013-1304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/05/2013] [Indexed: 10/27/2022]
|
27
|
Marqa MF, Mordon S, Betrouni N. Laser interstitial thermotherapy of small breast fibroadenomas: numerical simulations. Lasers Surg Med 2012. [PMID: 23184405 DOI: 10.1002/lsm.22097] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Laser interstitial thermotherapy (LITT) is potentially a novel method to treat small breast fibroadenoma, without the need for surgical removal. Dosimetry planning and conformation of the treated area of tumor remain major issues, especially for a moving organ such as the breast. Pre-treatment simulation planning of this therapy is an effective method to predict the final thermal damage. In this study, a mathematical model is elaborated to simulate the heat distribution and the thermal damage. METHODS The mathematical model was based on finite element method (FEM) to solve the light distribution, bioheat, and thermal damage equations. Six simulations were performed with the following powers: 5, 6, 7, 8, 9, and 10 W (λ = 980 nm), and for an irradiation time of 125 seconds, with a 50 °C iso-damage temperature. To validate these simulations, six turkey breast samples were irradiated with parameters used for simulations. Volumes of thermal damage were calculated by using formulas: spherical, Elliptical, and Carlsson volumes and compared to the simulated volumes. RESULTS Differences between volumes were from 0.01 to 1 cm3. Interpolations between volumes from ex vivo experiments with corresponding powers were established. The relationship between the volume of the thermal damage and the laser power was described by a polynomial equation (R2 = 0.99). The power estimated by the interpolation to obtain 1 cm3 of thermal damage was 7.4 W (922 J) and the maximum corresponding temperature was 90 °C. CONCLUSION In this study, a good correlation was established between simulation and ex vivo experiments of LITT for fibroadenoma breast cancer.
Collapse
|
28
|
Kosoglu MA, Hood RL, Rossmeisl JH, Grant DC, Xu Y, Robertson JL, Rylander MN, Rylander CG. Fiberoptic microneedles: novel optical diffusers for interstitial delivery of therapeutic light. Lasers Surg Med 2012; 43:914-20. [PMID: 22006734 DOI: 10.1002/lsm.21129] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Photothermal therapies have limited efficacy and application due to the poor penetration depth of light inside tissue. In earlier work, we described the development of novel fiberoptic microneedles to provide a means to mechanically penetrate dermal tissue and deliver light directly into a localized target area.This paper presents an alternate fiberoptic microneedle design with the capability of delivering more diffuse, but therapeutically useful photothermal energy. Laser lipolysis is envisioned as a future clinical application for this design. MATERIALS AND METHODS A novel fiberoptic microneedle was developed using hydrofluoric acid etching of optical fiber to permit diffuse optical delivery. Microneedles etched for 10, 30, and 50 minutes, and an optical fiber control were compared with three techniques. First, red light delivery from the microneedles was evaluated by imaging the reflectance of the light from a white paper.Second, spatial temperature distribution of the paper in response to near-IR light (1,064 nm, 1 W CW) was recorded using infrared thermography. Third, ex vivo adipose tissue response during 1,064 nm, (5 W CW)irradiation was recorded with bright field microscopy. RESULTS Acid etching exposed a 3 mm length of the fiber core, allowing circumferential delivery of light along this length. Increasing etching time decreased microneedle diameter, resulting in increased uniformity of red and 1,064 nm light delivery along the microneedle axis. For equivalent total energy delivery, thinner microneedles reduced carbonization in the adipose tissue experiments. CONCLUSIONS We developed novel microscale optical diffusers that provided a more homogeneous light distribution from their surfaces, and compared performance to a flat-cleaved fiber, a device currently utilized in clinical practice. These fiberoptic microneedles can potentially enhance clinical laser procedures by providing direct delivery of diffuse light to target chromophores, while minimizing undesirable photothermal damage in adjacent, non-target tissue.
Collapse
Affiliation(s)
- Mehmet A Kosoglu
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Kosoglu MA, Hood RL, Rossmeisl JH, Grant DC, Xu Y, Robertson JL, Rylander MN, Rylander CG. Erratum: Fiberoptic microneedles: Novel optical diffusers for interstitial delivery of therapeutic light. Lasers Surg Med 2011. [DOI: 10.1002/lsm.21163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Abstract
Minimally invasive ablative therapy techniques are being used in research protocols to treat benign and malignant tumors of the breast in select patient populations. These techniques offer the advantages of an outpatient setting, decreased pain, and improved cosmesis. These therapies, including radiofrequency ablation, cryotherapy, interstitial laser therapy, high-intensity focused ultrasonography, and focused microwave thermotherapy, are reviewed in this article.
Collapse
Affiliation(s)
- Ranjna Sharma
- Breast Care Center, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Shapiro 5, 330 Brookline Avenue, Boston, MA 02215, USA.
| | | | | |
Collapse
|
31
|
Grabau D, Ryden L, Fernö M, Ingvar C. Analysis of sentinel node biopsy - a single-institution experience supporting the use of serial sectioning and immunohistochemistry for detection of micrometastases by comparing four different histopathological laboratory protocols. Histopathology 2011; 59:129-38. [DOI: 10.1111/j.1365-2559.2011.03881.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Haraldsdóttir KH, Ivarsson K, Jansner K, Stenram U, Tranberg KG. Changes in immunocompetent cells after interstitial laser thermotherapy of breast cancer. Cancer Immunol Immunother 2011; 60:847-56. [PMID: 21400025 PMCID: PMC3098997 DOI: 10.1007/s00262-011-0992-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 02/15/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Local tumour destruction has been shown to give rise to changes in immunocompetent cells. The aim of this study was to describe the effect of interstitial laser thermotherapy (ILT) of breast carcinoma in the tumour and in regional lymph nodes. METHODS Seventeen women that underwent radical surgical excision after non-radical ILT were studied. ILT was performed at a steady-state temperature of 48°C for 30 min. Surgical excision was performed 12 (6-23) days after ILT. Six patients with breast cancer not treated with ILT before surgery served as controls. Immunohistological reactions were performed on core needle biopsies prior to treatment and on the excised specimens. RESULTS ILT resulted in more CD8 lymphocytes and CD68 macrophages within the tumour (P < 0.05 and P < 0.01, respectively) and higher counts of CD20 (P < 0.05), CD68 (P < 0.001) and CD83 (P < 0.01) at the tumour border, when compared to pre-treatment values. In the control patients not receiving ILT, CD8 cells increased within the tumour after resection (P < 0.05). With the probable exception of CD25 Foxp3 cells, the presence of cancer in a lymph node influenced the findings in lymph nodes (examined for CD1a, CD25, Foxp3 CD25, CD83 cells). Thus, comparisons between ILT and control patients were restricted to patients without lymph node metastases. In these patients, ILT and resection were followed by a decrease in CD25 Foxp3 lymphocytes (P < 0.05), when compared to surgical resection alone. CONCLUSIONS ILT induced changes in immunocompetent cells in patients with breast cancer. The stimulation of the immune system is an added feature of ILT in treatment of patients with breast cancer.
Collapse
|
33
|
Actualización en intervencionismo mamario terapéutico. RADIOLOGIA 2011; 53:226-35. [DOI: 10.1016/j.rx.2010.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/20/2010] [Accepted: 12/28/2010] [Indexed: 02/08/2023]
|
34
|
Review of interventional radiology techniques in breast disease. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
35
|
Zhao Z, Wu F. Minimally-invasive thermal ablation of early-stage breast cancer: a systemic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2010; 36:1149-55. [PMID: 20889281 DOI: 10.1016/j.ejso.2010.09.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 09/03/2010] [Accepted: 09/13/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Minimally-invasive thermal ablation techniques provide an effective approach for local destruction of solid tumor. A novel application is the use for treatment of early-stage breast carcinoma. METHODS A broad search was conducted in Pubmed, Embase and the Cochrane databases between January 1990 and December 2009. Clinical results of the relevant articles were collected and analyzed. RESULTS The analyzed studies were almost all feasibility or pilot studies using different energy sources, patients, tumor characteristics and ablation settings. They were conducted in research settings for the assessment of technical safety and feasibility, and none of those was used alone in clinical practice. Despite many methodological differences, complete tumor ablation could be achieved in 76-100% of breast cancer patients treated with radiofrequency ablation, 13-76% in laser ablation, 0-8% in microwave ablation, 36-83% in cryoablation, and 20-100% in high-intensity focused ultrasound ablation. CONCLUSION Minimally-invasive thermal ablation is a promising new tool for local destruction of small carcinomas of the breast. Large randomized control studies are required to assess the long-term advantages of minimally-invasive thermal ablation techniques compared to the current breast conserving therapies.
Collapse
Affiliation(s)
- Z Zhao
- Department of Medical Information, Chongqing Medical University, Chongqing 400016, China
| | | |
Collapse
|
36
|
Chen ZK, Lin LW, Yang YH, Cai HJ, Yang JJ, Cai MX. US-guided interstitial chemotherapy using paclitaxel temperature-responsive gel for breast cancer treatment in rat. J Cancer Res Clin Oncol 2010; 136:537-45. [PMID: 19777257 DOI: 10.1007/s00432-009-0686-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Accepted: 09/14/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study aims to investigate the therapeutic effect of paclitaxel temperature-responsive gel (PTRG) for interstitial chemotherapy on breast cancer, and to explore a new minimally invasive treatment for breast cancer. MATERIALS AND METHODS Breast cancer models were induced in rats using subcutaneous transplantation of tumor cells. The rats were then divided into control, paclitaxel injection, gel injection and paclitaxel-gel (PG) group. Following treatment, all animals were checked regularly by ultrasonography to observe changes in the tumors. Biopsy tumor tissues were processed for histopathological examination, and apoptotic index was determined by the terminal deoxynucleotidyl transferase dUTP nick end labeling method. In addition, blood cell count and liver transaminase activity were monitored, and the survival time of rats with cancer recorded. RESULTS Rats in PG group exhibited liquefaction necrosis of tumors. Ninety days after the experiment, four rats exhibited complete extinction of tumors, indicating full recovery. Pathological examination revealed that the tumor tissues in these rats were mostly necrotic, and the apoptotic index of tumor cells increased markedly compared to PI group. Also, the red blood cell, hemoglobin and white blood cell levels declined significantly in the PI group compared with PG group, while glutamic-pyruvic transaminase and glutamic-oxalacetic transaminase activities significantly increased. Meanwhile, no toxicity due to treatment was observed in PG group. CONCLUSION Interstitial chemotherapy mediated by PTRG appeared to be a safe and effective treatment for breast cancer in rats. It might have clinical applications for treating human breast cancer.
Collapse
Affiliation(s)
- Zhi-kui Chen
- Department of Ultrasonography, Affiliated Union Hospital of Fujian Medical University, Fuzhou, China
| | | | | | | | | | | |
Collapse
|
37
|
Current world literature. Curr Opin Ophthalmol 2009; 20:333-41. [PMID: 19535964 DOI: 10.1097/icu.0b013e32832e478f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|