Cryotherapy for breast fibroadenomas.

PURPOSE: To assess freezing protocols, imaging, and clinical outcomes of percutaneous ultrasonographically (US)-guided cryotherapy for breast fibroadenomas. MATERIALS AND METHODS: Institutional review board approval and patient consent were obtained. Forty-two biopsy-confirmed fibroadenomas were treated in 29 patients (mean age, 27 years) by using a 2.4-mm cryoprobe inserted into the fibroadenoma with US guidance. The first seven patients underwent conscious sedation, but the other 22 patients required only local anesthesia. US and thermocouple monitoring of the procedure were performed to evaluate freeze protocols based on tumor size. Saline injections protected the skin and/or chest wall. US follow-up was performed at 1 week and at 1, 3, 6, and 12 months. Pre- and 12-month postcryotherapy mammograms were available for seven patients who were over 30 years old. chi(2) and Student t tests were used to assess frequency and mean differences, respectively. RESULTS: The 22 patients who underwent local anesthesia reported minimal discomfort. No significant complications were noted, and patients were very pleased with the resolution of palpable mass effect and cosmetic results. The average pretreatment fibroadenoma volume of 4.2 cm(3)+/- 4.7 (standard deviation) was reduced to 0.7 cm(3)+/- 0.8 at 12-month follow-up (73% reduction, P < .001). US produced excellent ice visualization beyond tumor margins, while thermocouples confirmed cytotoxic temperatures approximately 5 mm behind the visible leading edge. Two patients elected to undergo either removal or biopsy of a residual mass, which revealed a shrunken hyaline matrix with preserved collagenous architecture. Mammograms showed comparable resolution of mass effects with mild surrounding parenchymal reaction. CONCLUSION: Cryotherapy of fibroadenomas is a safe, effective, and virtually painless clinic-based (ie, outpatient) treatment option with good cosmesis.

Office-based ultrasound-guided cryoablation of breast fibroadenomas.

BACKGROUND: Fibroadenomas commonly found by palpation and routine mammography account for approximately 20% of open surgical breast biopsies. Alternatives to open surgery include tumor removal using an automated coring device and tumor ablation using heating or cooling elements. We report our initial experience with cryoablation of biopsy-proven benign fibroadenomas. METHODS: A table-top cryoablation system employing a 2.4-mm cryoprobe was used to treat biopsy-proven benign fibroadenomas up to 4 cm in maximum diameter in a prospective nonrandomized fashion. The cryoprobe was placed under ultrasound guidance. Using a treatment algorithm based on fibroadenoma size, all tumors were subjected to two freeze cycles with an interposing thaw. Skin appearance and temperature, probe temperature, iceball size, and patient comfort were closely monitored during the procedure. Follow-up examinations including ultrasonography and photographs were scheduled for up to 12 months postablation. RESULTS: Fifty patients with 57 core biopsy-proven benign fibroadenomas were treated. Seven early cases were treated in an ambulatory surgery center setting. The remaining procedures were completely office-based using only local anesthetic. Tumor diameter varied from 7 mm to 42 mm (mean 21 mm). The iceball engulfed the target lesion in each case. Transient postoperative side effects were local swelling and ecchymosis. Postoperative discomfort rarely required medication beyond acetaminophen or ibuprofen. Lesions showed progressive shrinkage and disappearance over 3 to 12 months. No skin injury was noted and appearance remained excellent. Patient satisfaction was excellent. CONCLUSIONS: With office-based use of ultrasound-guided cryoablation for fibroadenomas there was little or no pain, target lesions were reduced in size or eliminated, scarring was minimal, cosmesis outstanding, and patient satisfaction was excellent. Cryoablation offers a useful office-based alternative to surgical excision of benign fibroadenomas.