High-intensity focused ultrasound in breast pathology: non-invasive treatment of benign and malignant lesions

Abstract

Breast neoplasms are one of the leading causes of morbidity and mortality in women. Even if surgery is the treatment of choice, other forms of less invasive radical treatment are desirable. High-intensity focused ultrasound is already established as a valid non-invasive technique that ensures tumor ablation in various organs. The use of ultrasound or magnetic resonance guidance allows having some advantages such as the capability to treat tumors in moving organs or the possibility to have a real-time monitoring of the temperature increase. The aim of this paper is to report the use of high-intensity focused ultrasound technique with ultrasound and magnetic resonance guidance for the ablation of breast tumors, including both benign and malignant lesions.

Keywords:

• breast diseases
• fibroadenoma
• high-intensity focused ultrasound ablation
• invasive ductal carcinoma
• magnetic resonance imaging

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• High-intensity focused ultrasound (HIFU) is a valid noninvasive technique that ensures tissue ablation in various organs. The use of an extra-corporeal transducer makes this technique less invasive compared to other percutaneous procedures.

• The ultrasound guidance allows the capability to treat breast fibroadenomas during free breathing of the patient. Moreover, it allows performing the treatment with the patient standing in a comfortable position.

• Even if ultrasound-guided HIFU was performed without the use of contrast agent, the changes in the echogenicity ensured the presence of thermal damage and consequent coagulation necrosis inside the nodule.

• Preliminary results obtained at 3 months after HIFU treatment demonstrate a 50% reduction of the maximum diameter of the treated fibroadenomas.

• Magnetic resonance guidance represents an added value in order to better visualize the margins and the dimensions of the area to be treated, allowing an accurate planning of the procedure.

• The use of dedicated sequences allows having a real-time monitoring of the temperature increase within breast target tissue. Moreover, the capability to have a real-time temperature monitoring increases the safety of the procedure, avoiding thermal damage to the surrounding anatomical structures.

• The use of Gd-enhanced sequences allows having a quick assessment of the treatment efficacy, immediately at the end of the procedure.

• Results obtained in patients with invasive ductal carcinoma of the breast show the absence of residual neoplastic cells in 60% of treated cases.

Notes