Cryoablation Without Excision for Low-Risk Early-Stage Breast Cancer: 3-Year Interim Analysis of Ipsilateral Breast Tumor Recurrence in the ICE3 Trial.

BACKGROUND: The ICE3 trial is designed to evaluate the safety and efficacy of breast cryoablation, enabling women older than 60 years with low-risk early-stage breast cancers to benefit from a nonsurgical treatment and to avoid the associated surgical risks. METHODS: The ICE3 trial is a prospective, multi-center, single-arm, non-randomized trial including women age 60 years or older with unifocal, ultrasound-visible invasive ductal carcinoma size 1.5 cm or smaller and classified as low to intermediate grade, hormone receptor (HR)-positive, and human epidermal growth factor receptor 2 (HER2)-negative. Ipsilateral breast tumor recurrence (IBTR) at 5 years was the primary outcome. A 3-year interim analysis of IBTR was performed, and the IBTR probability was estimated using the Kaplan-Meier method. RESULTS: Full eligibility for the study was met by 194 patients, who received successful cryoablation per protocol. The mean age was 75 years (range, 55-94 years). The mean tumor length was 8.1 mm (range, 8-14.9 mm), and the mean tumor width was 7.4 mm (range, 2.8-14 mm). During a mean follow-up period of 34.83 months, the IBTR rate was 2.06% (4/194 patients). Device-related adverse events were reported as mild in 18.4% and moderate in 2.4% of the patients. No severe device-related adverse events were reported. More than 95% of the patients and 98% of the physicians reported satisfaction with the cosmetic results at the clinical follow-up evaluation. CONCLUSIONS: Breast cryoablation presents a promising alternative to surgery while offering the benefits of a minimally invasive procedure with minimal risks. Further study within a clinical trial or registry is needed to confirm cryoablation as a viable alternative to surgical excision for appropriately selected low-risk patients.

Is radial scar on core needle biopsy a risk factor for malignancy? A single-center retrospective review and implications for management.

INTRODUCTION: Reported upgrade rate to malignancy of radial scars (RS) ranges widely (0%-40%) making management controversial. METHODS: A retrospective chart review was performed on patients with RS on core needle biopsy (CNB). Upgrade rates to malignancy and atypia on surgical excision were evaluated. RESULTS: Of 127 patients with RS on CNB, 53 were excluded due to malignancy or missing records. Of 74 patients reviewed, 52 (70.3%) had surgical excision with four (7.7%) upgraded to malignancy. Eight patients (10.8%) had atypia with RS on CNB with two (25%) upgraded to malignancy. When isolated RS was on CNB, 2 of 44 (4.5%) upgraded to malignancy while 15 of 44 (34%) had atypia on excision. Of 22 patients (29.7%) who did not have excision, zero developed cancer. CONCLUSION: We found higher than expected upgrade rates of isolated RS to atypia which can alter management. Additionally, 25% of RS with atypia upgraded to malignancy suggesting these patients are at higher risk.

Cryoablation Therapy for Early-Stage Breast Cancer: Evidence and Rationale.

Recent advances in breast cancer research and treatment propel a paradigm shift toward less aggressive and less invasive treatment for some early-stage breast cancer. Select patients with small, low-risk tumors may benefit from a less aggressive approach with de-escalated local therapy. Cryoablation of breast cancer is an emerging nonsurgical treatment alternative to breast-conserving surgery. Advantages of cryoablation over surgery include the use of local anesthesia, faster recovery, improved cosmesis, and cost savings. Proper patient selection and meticulous technique are keys to achieving successful clinical outcomes. The best candidates for cryoablation have unifocal invasive ductal carcinoma tumors that are low grade, hormone receptor positive, and ≤1.5 cm in size. In this review, we outline the current evidence, patient selection criteria, procedural technique, pre- and postablation imaging, and the advantages and limitations of cryoablation therapy.

Inflammatory pseudotumor: the great mimicker.

OBJECTIVE: The purpose of this review is to describe the pathophysiologic findings, differential diagnosis, imaging features, and management of inflammatory pseudotumor in various locations throughout the body. CONCLUSION: Inflammatory pseudotumor is a rare benign process mimicking malignant processes and has been found in almost every organ system. Radiologists should be familiar with this entity as a diagnostic consideration to avoid unnecessary surgery.

Serial electron beam CT measurements of coronary artery calcium: Has your patient's calcium score actually changed?

OBJECTIVE: The objective of our study was to develop a model for determining the smallest statistically significant change in the coronary artery calcium score (CAC) between serial measurements in a given subject. MATERIALS AND METHODS: We assembled a convenience sample of 2,217 pairs of repeated electron beam CT coronary calcium scans acquired in quick succession. Each scan consisted of forty 100-msec, 3-mm sections obtained at 60% of the ECG R-R interval. A single observer quantified calcium in each scan independent of knowledge of calcium quantity in the repeated scan. We then modeled a relationship between the variation of the differences between repeated measurements of calcium and the magnitude of the calcium score and formulated 95% repeatability coefficient equations for the Agatston and volumetric CAC score. The equations allow determining the smallest statistically significant interval change in the calcium score between two serial measurements in a given subject. RESULTS: In a subject with measurable CAC at baseline, the smallest statistically significant interval change is +/- (4.930 x square root of baseline Agatston CAC score) or +/- (3.445 x square root of baseline volumetric CAC score). In a subject with no measurable CAC at baseline, a follow-up CAC score exceeding 11.6 Agatston units or 9.5 mm3 qualifies for statistically significant progression. The results were similar in men and women. CONCLUSION: By examining repeatability of quantitative electron beam CT measurements of coronary calcium as a function of the magnitude of the calcium score, we developed a model to determine the smallest statistically significant change between serial measurements in a given subject.