非手术患者接受冷冻消融治疗早期乳腺癌的效果。
Acceptance and results of cryoablation for the treatment of early breast cancer in non-surgical patients.
机构信息
Radiology Department, Hospital Lucus Augusti Lugo, Lugo 27003, Spain.
Breast Pathology Group, Hospital Universitario Lucus Augusti-IDIS, Lugo, 27003, Spain.
出版信息
Br J Radiol. 2024 Oct 1;97(1162):1713-1723. doi: 10.1093/bjr/tqae131.
OBJECTIVES
Evaluate acceptance of percutaneous cryoablation (PCA) treatment by patients with early breast cancer (BC) who choose not to have surgery and present our experience in the use of PCA for the local control of BC in this group of patients.
METHODS
All biopsy-proven early BC diagnosed in our institution as non-surgical patients between January 2020 and December 2023 were retrospectively reviewed. We recorded if PCA was offered and if it was accepted by the patient. PCA was performed under ultrasound (US) guidance, using a liquid nitrogen-based system. Mammography and US or contrast-enhanced mammography follow-up was scheduled every 6 months for 5 years. Patient's tolerance to the procedure, adverse effects, and results regarding local control of the disease were assessed.
RESULTS
A total of 66 early BC were diagnosed in 63 patients who decided not to have surgery. Median age was 88 years (range 60-99 years). Forty-three (95.6%) of the 45 patients offered PCA accepted. Thirty-nine malignant tumours (median size 24 mm) underwent PCA. All cases were previously reviewed in a multidisciplinary tumour board. Complete tumour necrosis was achieved in 81.3% of the cases followed for ≥ 6 months. After a median follow-up of 16 months, the complete ablation rate in Luminal BC ≤ 25 mm was 100%. No major complications were seen.
CONCLUSIONS
Non-surgical patients with early BC accepted PCA when the treatment was offered. PCA is safe, effective, and well-tolerated outpatient procedure. The study outcomes suggest that PCA could be an alternative to surgery for the management of BC in this group of patients.
ADVANCES IN KNOWLEDGE
Patients with early BC who choose not to have surgery accept PCA. This percutaneous approach probably allows local control of early BC, mainly in ≤25 mm Luminal tumours.
目的
评估选择不接受手术的早期乳腺癌（BC）患者对经皮冷冻消融（PCA）治疗的接受程度，并介绍我们在该组患者中使用 PCA 进行 BC 局部控制的经验。
方法
回顾性分析 2020 年 1 月至 2023 年 12 月期间我院确诊的所有经活检证实的、选择不接受手术的非手术患者的早期 BC。记录是否向患者提供了 PCA 治疗，以及患者是否接受了 PCA 治疗。PCA 在超声（US）引导下进行，使用液氮为基础的系统。在 5 年内，每 6 个月进行一次乳腺 X 线摄影和 US 或对比增强乳腺 X 线摄影随访。评估患者对该治疗的耐受性、不良反应以及疾病局部控制的结果。
结果
63 例决定不接受手术的患者中诊断出 66 例早期 BC。中位年龄为 88 岁（范围为 60-99 岁）。45 例患者中有 43 例（95.6%）接受了 PCA 治疗。39 例恶性肿瘤（中位大小为 24mm）接受了 PCA 治疗。所有病例均在多学科肿瘤委员会中进行了预先审查。在至少随访 6 个月的病例中，81.3%的病例达到了完全肿瘤坏死。在中位随访 16 个月后，≤25mm 的 Luminal BC 的完全消融率为 100%。未出现重大并发症。
结论
当提供 PCA 治疗时，选择不接受手术的早期 BC 非手术患者接受了 PCA 治疗。PCA 是一种安全、有效且耐受良好的门诊治疗方法。研究结果表明，对于该组患者，PCA 可能是手术治疗 BC 的替代方法。
知识进展
选择不接受手术的早期 BC 患者接受了 PCA。这种经皮方法可能可以实现早期 BC 的局部控制，主要适用于≤25mm 的 Luminal 肿瘤。
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