Ultrasound-guided percutaneous microwave ablation of central intraductal papilloma: a prospective pilot study

Figures & data

Figure 1. Imaging before microwave ablation (MWA) in a 63-year-old woman with left central intraductal papilloma (IDP). (A) Ultrasound (US) scan before MWA shows the dilated duct with hypoechoic IDP (yellow arrow) connected to the nipple (red arrow). The dilated duct is in the middle of nipple (green arrow). (B) Contrast-enhanced US before MWA shows both the dilated duct and lesion hypo-enhancement with a size 2.0 × 0.3 × 0.4 cm. (C) Sagittal contrast-enhanced magnetic resonance imaging (MRI) shows hyperintense duct (arrow) in the left breast before MWA in the arterial phase.

Figure 2. US imaging during MWA in the patient. (A) US shows 16 G core needle biopsy (arrow) of the hypoechoic lesion. (B) US showing the 22 G fine needle (yellow arrow) at the depth of the nipple for saline infusion (red arrow). (C) US showing the 16 G MWA needle (arrow) ablating the dilated duct and intraductal papilloma with the hyperechoic zone.

Table 1. The clinical features of patients and masses.

No.	Age (years)	Max lesion size (mm)	Lesion volume (ml)	Lesion location (L/R breast)	Lesion location in quadrant	Ablation reason	Palpable	Score for the probability of malignancy^a	Ablation time (mins)	Applicator insertion
1	42	18	0.9	L	Lower outer	Yellow discharge for 3 months	Yes	3.7	1.3	1
2	67	11	0.4	L	Upper outer	Yellow discharge for 1 month	No	0	5.8	1
3	61	13	0.7	L	Upper outer	Blood discharge for 3 months	No	3.4	5.7	1
4	78	16	1.4	L	Upper inner	Yellow discharge for 9 months	Yes	1.8	10.3	1
5	27	11	0.2	L	Upper inner	Painful	No	0	1.2	1
6	63	20	0.1	L	Upper inner	Psychological stress	Yes	3.7	5.1	1
7	50	18	1.7	R	Upper outer	Psychological stress	Yes	3.7	1.7	1
8	34	12	0.5	L	Upper inner	Yellow discharge for 2 months	No	0	1.4	1
9	46	13	0.1	L	Upper outer	Psychological stress	No	0	1.4	1
10	45	7	0.1	R	Lower outer	Psychological stress	No	0	0.7	1
11	38	9	0.1	L	Upper outer	Psychological stress	No	0	1.0	2
12	42	9	0.2	L	Upper outer	Psychological stress	Yes	1.5	1.3	1
13	63	17	0.7	L	Upper	Blood discharge for 2 months	Yes	3.4	10.1	3

^a Referring to Ref. [16].

Figure 3. Image after MWA in the patient. (A) After MWA, only a pinhole-sized scar is visible on the skin (yellow arrow); around the ablation zone, skin flushing (red arrow) can be seen, which resolved in 1 week after 3-day antibiotic treatment. (B) US showing the heterogeneous ablation zone (measure markers) adjacent to the nipple (arrow) with a size 1.7 × 1.3 cm at 6 months after MWA. (C) Contrast-enhanced MRI image showing hypointense MWA treatment zone (arrow) in the arterial phase.

Table 2. The effect of IDPs volume reduction after MWA.

Variable	Baseline	3 months after MWA	p-value (95%CI)	6 months after MWA	p-value (95%CI)	12 months after MWA	p-value (95%CI)
Max lesion size (mm)	13.5 ± 4.1	9.7 ± 3.1	.03^# (0.5, 6.9)	7.3 ± 2.9	.001^# (3.0, 9.3) .07* (−0.2, 5.1)	4.5 ± 3.4	.001^^ (2.3,8.1) .06^& (−0.1, 5.6)
Lesion volume (ml)	0.4 (0.1–1.4)	0.2 (0.04–0.5)	.07^# (−0.02, 0.7)	0.06 (0.01–0.3)	.01^# (0.1, 0.8) .06* (−0.003, 0.3)	0.02 (0–0.1)	.003^^ (0.08, 0.3) .03^& (0.008, 0.1)
VRR (%)		52.3 ± 18.2		72.6 ± 23.1	.008* (−0.4, −0.1)	92.9 ± 7.5	.001^^ (−0.5, −0.3) .005^& (−0.3, −0.6)

Unless otherwise indicated, data are means ± standard deviation.

Data in parentheses are ranges.

*p value was obtained by comparing variable of 3 months and that of 6 months.

^# p value was obtained by comparing variable of baseline and that of 3 months and 6 months, respectively.

^{^} p value was obtained by comparing variable of 3 months and 12 months.

^& p value was obtained by comparing variable of 6 months and 12 months.

Ahn SK, Han W, Moon HG, et al. Management of benign papilloma without atypia diagnosed at ultrasound-guided core needle biopsy: scoring system for predicting malignancy. Eur J Surg Oncol. 2018;44:53–58.

 PubMed Web of Science ®Google Scholar