Purpose
To present the first contrast-enhanced ultrasound-guided laser ablation of a breast carcinoma. To review current literature on the feasibility of laser induced thermal therapy (LITT) for treatment of breast cancer.
Material and methods
We present a patient with a T1N0M0 intraductal breast carcinoma. Tumor borders were pre-operatively assessed using contrast-enhanced breast ultrasound with SonoVue as contrast agent. The breast tumor was treated according to a treat-and-resect protocol using LITT for tumor ablation before lumpectomy as standard surgical procedure. The success of the ablation procedure was real-time assessed with contrast-enhanced breast ultrasound. Finally, histopathologic analysis of the resected tissue was performed to assess the borders of the ablated zone and identify possible viable tumor cells. A systematic literature search on Laser Induced Thermal Therapy in the treatment of mamma carcinoma was performed.
Results
Sonovue enhanced breast ultrasound accurately assessed true tumor size and LITT enabled total ablation of the breast tumor. Current literature describes only fase II studies with large variation in the results. Completeness of ablation varies regarding the different treatment modalities. In general the technique is feasible and safe, whereas the oncologic results need further evaluation. Dynamic enhanced MRI is the best method for monitoring (77% sensitivity and 100% specificity). Cosmetic outcomes are not studied. Ultrasound (US) is especially suitable for guiding probes into the tumor, but not for monitoring the result. Our case study however, showed that contrast-enhanced breast ultrasound is a promising modality to guide and monitor the ablation process.
Conclusion
Contrast-enhanced ultrasound-guided laser ablation of small breast carcinomas seems a promising technique for minimal invasive treatment of breast cancer. However larger studies are needed to assess the accuracy of the technique in detail.