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Schwartzberg B, Lewin J, Abdelatif O, Bernard J, Bu-Ali H, Cawthorn S, Chen-Seetoo M, Feldman S, Govindarajulu S, Jones L, Juette A, Kavia S, Maganini R, Pain S, Shere M, Shriver C, Smith S, Valencia A, Whitacre E, Whitney R. Phase 2 Open-Label Trial Investigating Percutaneous Laser Ablation for Treatment of Early-Stage Breast Cancer: MRI, Pathology, and Outcome Correlations. Ann Surg Oncol 2018; 25:2958-2964. [PMID: 29987603 PMCID: PMC6208881 DOI: 10.1245/s10434-018-6623-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 12/22/2022]
Abstract
Background An institutional review board-approved, multicenter clinical trial was designed to determine the efficacy and outcome of percutaneous laser ablation (PLA) in the treatment of invasive ductal breast carcinoma (IDC). Post-ablation magnetic resonance imaging (MRI) was compared with surgical pathology in evaluation of residual post-ablation IDC and ductal carcinoma in situ. Methods Patients with a single focus of IDC 20 mm or smaller by pre-ablation MRI were treated with PLA. The patients underwent a 28-day post-ablation MRI, followed by surgical resection. Cell viability criteria were applied to pre- and post-ablation pathology specimens, which evaluated hematoxylin–eosin (H&E), cytokeratin (CK) 8/18, estrogen receptor, and Ki67 staining patterns. Results In this study, 61 patients were reported as the intention-to-treat cohort for determination of PLA efficacy. Of these 61 patients, 51 (84%) had complete tumor ablation confirmed by pathology analysis. One subject’s MRI imaging was not performed per protocol, which left 60 subjects evaluable for MRI pathology correlation. Five patients (8.3%) had residual IDC shown by both MRI and pathology. Post-ablation discordance was noted between MRI and pathology, with four patients (6.7%) false-positive and four patients (6.7%) false-negative. The negative predictive value (NPV) of MRI for all the patients was 92.2% (95% confidence interval [CI], 71.9–91.9%). Of the 47 patients (97.9%) with tumors 15 mm or smaller, 46 were completely ablated, with an MRI NPV of 97.7% (95% CI, 86.2–99.9%). Conclusions Percutaneous laser ablation is a potential alternative to surgery for treatment of early-stage IDC. Strong correlations exist between post-ablation MRI and pathologic alterations in CK8/18, ER, and Ki67 staining.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Arne Juette
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Simon Pain
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Craig Shriver
- Walter Reed National Military Medical Center, Bethesda, MD, USA
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Schwartzberg BS, Abdelatif OMA, Lewin JM, Bernard JM, Brehm JL, Bu-Ali HM, Cawthorn SJ, Chen-Seeto M, Feldman SM, Govindarajulu S, Jones LI, Juette A, Kavia S, Maganini RO, Pain SJ, Shere MH, Shriver CD, Smith SG, Valencia A, Whitacre EB, Whitney R. Abstract P3-13-03: Multicenter clinical trial of percutaneous laser ablation for early stage primary breast cancer. Results of 49 cases with radiographic and pathological correlation. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-13-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Percutaneous laser ablation of early stage primary breast cancer remains investigational. A multicenter, international clinical trial (NCT01478438) was completed to determine feasibility of this technique.
Methods: Patients with a single focus of biopsy proven infiltrating ductal carcinoma measuring 20 mm or less by pre-ablation MRI were treated by image-guided percutaneous laser ablation. A laser diode source (805 nominal nanometer wavelength) was used to perform the thermal ablation. Thermal sensors placed at the periphery of the tumor measured achievement of predefined temperature levels, indicating successful ablation. The patients were evaluated by post-ablation mammogram, ultrasound and MRI at 4 weeks post-ablation, after which they underwent surgical excision. Pathology specimens were evaluated by hematoxylin & eosin, CK 8/18, Ki-67 and estrogen receptor staining.
Results: Forty-nine of the 61 enrolled patients (ages 42-77, mean age 64 years) undergoing percutaneous laser ablation have finished protocol analysis and are reported in this series. Ablation was considered complete by the treating physician in all cases. The mean tumor size was 11.3 mm. The mean laser time was 15.7 minutes. There were no serious adverse events. Seven patients (14%) reported mild adverse events (pain, blisters, lump). Post-ablation cell viability was determined by MRI and by changes in CK 8/18, Ki67 and estrogen receptor staining. A post-ablation discordance between MRI and pathology was found in evaluation of 4 patients (8%). Three patients (6%) were considered "false negative" with a post-ablation residual tumor burden of less than 2mm which was not detected by MRI. One patient (2%) had a complete pathologic ablation but positive MRI ("false positive"). One patient (2%) had adjacent residual DCIS, visible in retrospect on the pre-ablation MRI and was considered a screening failure. Eight patients (16%) were found to have residual invasive cancer by both post-ablation MRI and pathologic analysis. Complete ablation was confirmed in 36 patients (73%) when evaluated by both post-ablation MRI and pathologic analysis.
Conclusion: Percutaneous laser ablation holds promise as an alternative to lumpectomy in the treatment of early stage breast cancer. There is a strong correlation (92%) between findings on post-ablation MRI and changes in CK 8/18, Ki67 and estrogen receptor staining in this series. Additional trials are necessary to determine the long-term curative potential of this technique.
Citation Format: Schwartzberg BS, Abdelatif OMA, Lewin JM, Bernard JM, Brehm JL, Bu-Ali HM, Cawthorn SJ, Chen-Seeto M, Feldman SM, Govindarajulu S, Jones LI, Juette A, Kavia S, Maganini RO, Pain SJ, Shere MH, Shriver CD, Smith SG, Valencia A, Whitacre EB, Whitney R. Multicenter clinical trial of percutaneous laser ablation for early stage primary breast cancer. Results of 49 cases with radiographic and pathological correlation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-13-03.
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Affiliation(s)
- BS Schwartzberg
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - OMA Abdelatif
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - JM Lewin
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - JM Bernard
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - JL Brehm
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - HM Bu-Ali
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SJ Cawthorn
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - M Chen-Seeto
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SM Feldman
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - S Govindarajulu
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - LI Jones
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - A Juette
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - S Kavia
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - RO Maganini
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SJ Pain
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - MH Shere
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - CD Shriver
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - SG Smith
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - A Valencia
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - EB Whitacre
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
| | - R Whitney
- Sarah Cannon at Rose Medical Center, Denver, CO; Carondelet St. Joseph's Hospital, Tucson, AZ; Walter Reed National Military Medical Center, Bethesda, MD; Wheaton Franciscan Health System, Wauwatosa, WI; North Bristol NHS Trust - Southmead Hospital, Bristol, United Kingdom; Columbia University Medical Center, NY, NY; Norfolk and Norwich University NHS Trust - Norfolk and Norwich University Hospital, Norwich, United Kingdom; Mid-Essex NHS Trust - Broomfield Hospital, Chelmsford, United Kingdom; Alexian Brothers Health System, Barlett, IL; Breast Center of Southern Arizona, Tuscon, AZ
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