Pre-surgical cryoablation in ≤ 2 cm ER + /HER2-tumors. Prognostic factors for the presence of residual invasive carcinoma.

BACKGROUND: Breast cancer remains the most commonly diagnosed cancer in women. Breast-conserving surgery (BCS) is the standard approach for small low-risk tumors. If the efficacy of cryoablation is demonstrated, it could provide a minimally invasive alternative to surgery. PURPOSE: To determine the success of ultrasound-guided cryoablation in achieving the absence of Residual Invasive Cancer (RIC) for patients with ER + /HER2- tumors ≤ 2cm and sonographically negative axillary nodes. MATERIALS AND METHODS: This prospective study was carried out from April 2021 to June 2023, and involved 60 preoperative cryoablation procedures on ultrasound-visible, node-negative (cN0) infiltrating ductal carcinomas (IDC). Standard diagnostic imaging included mammography and tomosynthesis, supplemented by ultrasound-guided biopsy. MRI was performed in patients with associated intraductal carcinoma (DCIS) and an invasive component on core needle biopsy (18 out of 22 cases). All tumors were tagged with ferromagnetic seeds. A triple-phase protocol (freezing-thawing-freezing) with Argon was used, with an average procedure duration of 40 min. A logistic regression model was applied to determine significant correlation between RIC and the study variables. RESULTS: Fifty-nine women (mean age 63 ± 8 years) with sixty low-risk unifocal IDC underwent cryoablation prior to surgery. Pathological examination of lumpectomy specimens post-cryoablation revealed RIC in only one of 38 patients with pure IDC and in 4 of 22 mixed IDC/DCIS cases. All treated tumors had clear surgical margins, with no significant procedural complications. CONCLUSIONS: Cryoablation was effective in eradicating 97% of pure infiltrating ER + /HER2-tumors ≤ 2cm, demonstrating its potential as a surgical alternative in selected patients.

Near-infrared hyperspectral imaging and robust statistics for in vivo non-melanoma skin cancer and actinic keratosis characterisation.

One of the most common forms of cancer in fair skinned populations is Non-Melanoma Skin Cancer (NMSC), which primarily consists of Basal Cell Carcinoma (BCC), and cutaneous Squamous Cell Carcinoma (SCC). Detecting NMSC early can significantly improve treatment outcomes and reduce medical costs. Similarly, Actinic Keratosis (AK) is a common skin condition that, if left untreated, can develop into more serious conditions, such as SCC. Hyperspectral imagery is at the forefront of research to develop non-invasive techniques for the study and characterisation of skin lesions. This study aims to investigate the potential of near-infrared hyperspectral imagery in the study and identification of BCC, SCC and AK samples in comparison with healthy skin. Here we use a pushbroom hyperspectral camera with a spectral range of ≈ 900 to 1600 nm for the study of these lesions. For this purpose, an ad hoc platform was developed to facilitate image acquisition. This study employed robust statistical methods for the identification of an optimal spectral window where the different samples could be differentiated. To examine these datasets, we first tested for the homogeneity of sample distributions. Depending on these results, either traditional or robust descriptive metrics were used. This was then followed by tests concerning the homoscedasticity, and finally multivariate comparisons of sample variance. The analysis revealed that the spectral regions between 900.66-1085.38 nm, 1109.06-1208.53 nm, 1236.95-1322.21 nm, and 1383.79-1454.83 nm showed the highest differences in this regard, with <1% probability of these observations being a Type I statistical error. Our findings demonstrate that hyperspectral imagery in the near-infrared spectrum is a valuable tool for analyzing, diagnosing, and evaluating non-melanoma skin lesions, contributing significantly to skin cancer research.

Tratamiento percutáneo del cáncer infiltrante de mama en estado clínico I/II mediante crioablación en pacientes sin indicación de cirugía axilar / Percutaneous cryoablation of clinical stage I/II breast cancer in patients without indication for axillary surgery

Objetivo: revisar la eficacia del tratamiento percutáneo del cáncer infiltrante de mama (CM) mediante crioablación guiada con ecografía en pacientes con estadio clínico I/II en las que se desestima la cirugía axilar. Métodos: se recogieron de nuestros archivos las pacientes con CM en estadio clínico I/II que fueron tratadas mediante crioablación guiada con ecografía en las que se desestimó la cirugía axilar. Se seleccionaron las pacientes que tuvieron un seguimiento mínimo de 12 meses. Las revisiones fueron ecográficas: la primera entre 1 y 2 meses (para valorar lesiones residuales por tratamiento incompleto) y posteriormente semestrales (para valorar las recidivas). Las lesiones residuales y las recidivas se confirmaron con BAG y en todos los casos se valoró el tratamiento con nueva crioablación (de rescate). Se analizó la eficacia del procedimiento en función del control local en la mama. Resultados: desde marzo de 2019 hasta septiembre de 2022 fueron tratadas mediante crioablación guiada con ecografía 84 pacientes con 92 CM en estadio clínico I/II en las que la cirugía axilar fue desestimada. Se estudiaron retrospectivamente las 43 pacientes (58-96 años, media 83, DE ±7,64) con 48 CM (entre 5 y 60 mm, media 17, DE ±13,75) que tuvieron un seguimiento mínimo de 12 meses (entre 12 y 40 meses, media 20). Hubo 2 pacientes con tratamiento incompleto en la primera ecografía y 5 pacientes recidivaron (entre 9 y 27 meses, media 17). Todas se trataron con crioablaciones de rescate. El control local a los 12 meses fue del 90,5% (probabilidad 0,905 error estándar 0,045) y en el 95% de las pacientes (41/43) se consiguió controlar localmente el CM. Fallecieron 6 pacientes, 3 por evolución del CM y 3 por otras causas. Todos los procedimientos fueron bien tolerados y no hubo complicaciones graves. (AU)

Objective: To review the efficacy of percutaneous treatment of infiltrating breast cancer (BC) by ultrasound-guided cryoablation in patients with clinical stage I/II without indication for axillary surgery Methods: Patients with clinical stage I/II BC who were treated by ultrasound-guided cryoablation in whom axillary surgery was ruled out were collected from our files. Patients who had a minimum follow-up of 12 months were selected. The ultrasound follow up were: the first between 1-2 months (to assess residual lesions due to incomplete treatment) and subsequently every six months (to assess recurrences). Residual lesions and recurrences were confirmed with CNB and in all cases treatment with new (salvage) cryoablation was considered. The efficacy of the procedure was assessed on local control in the breast. Results: Between March 2019 and September 2022, 84 patients with 92 BC in clinical stage I/II were treated with ultrasound-guided cryoablation without indication for axillary surgery. The inclusion criteria of the retrospective study were met by 43 patients (58-96 years, mean 83, SD ±7,64) with 48 BC (between 5-60mm, mean 17, SD ±13,75) who were reviewed during a mean period of 20 months (between 12-40 months). There were two patients with incomplete treatment at the first ultrasound and five patients relapsed (between 9-27 months, mean 17). All were treated with salvage cryoablation. Local control at 12 months was 90.5% (probability 0.905 standard error 0.045) and in 95% of patients (41/43) the BC was locally controlled. Six patients died, three due to progression of the BC and three due to other causes. All procedures were well tolerated and there were no serious complications. (AU)

Efficacy of ultrasound-guided cryoablation in treating low-risk breast cancer.

OBJECTIVES: The primary objective of this study to determine whether infiltrating carcinoma is present in surgical specimens obtained after ultrasound-guided cryoablation from patients with HER2-negative luminal breast cancer without positive axillary lymph nodes at ultrasound. The secondary objective is to demonstrate that placing the presurgical seed-marker immediately before cryoablation does not interfere with the disappearance of tumor cells from freezing or in the surgeon's ability to locate the tumor. METHODS: We treated 20 patients diagnosed with unifocal HR-positive HER2-negative infiltrating ductal carcinoma measuring <2cm by means of ultrasound-guided cryoablation (ICEfx Galil, Boston Scientific) using a triple-phase (freezing‒passive thawing‒freezing; 10min each phase) protocol. All patients later underwent tumorectomy according to the routine operating-room agenda. RESULTS: No infiltrating carcinoma cells were detected in the post-cryoablation surgical specimen in 19 patients; a focus of infiltrating carcinoma cells measuring <1mm was detected in the remaining patient. CONCLUSION: In the near future, if confirmed in larger studies with longer follow-up, cryoablation might constitute a safe and efficacious technique for the treatment of early, low-risk infiltrating ductal carcinoma. In our series, marking with ferromagnetic seeds did not interfere with the efficacy of the procedure or of the subsequent surgical intervention.

Eficacia de la crioablación guiada con ecografía en el tratamiento del cáncer de mama de bajo riesgo / Efficacy of ultrasound-guided cryoablation in treating low-risk breast cancer

Objetivos El objetivo principal del estudio es evaluar si en pacientes con tumores luminales Her2– menores de 1,5cm y axila ecográficamente negativa, tras la realización de crioablación guiada con ecografía, hay ausencia de carcinoma infiltrante en la pieza quirúrgica. El objetivo secundario es demostrar que la colocación de semilla prequirúrgica en el instante anterior a realizar la crioablación no interfiere posteriormente en la desaparición de las células tumorales por congelación ni en la adecuada localización del tumor por parte del cirujano. Métodos Veinte pacientes diagnosticadas de carcinoma ductal infiltrante (CDI), unifocal, receptores hormonales + Her2– menores de 2cm fueron tratadas con crioablación. Se usó, mediante guía ecográfica, el sistema de crioablación ICEfx Galil Boston Scientific con protocolo triple fase, congelación-descongelación pasiva-congelación, de 10min de duración cada una. Las pacientes se sometieron a tumorectomía posterior según agenda de quirófano habitual. Resultados De 20 pacientes con CDI de bajo riesgo, en 19 de ellas no se identificaron células de carcinoma infiltrante en el examen de la pieza quirúrgica poscrioablación y solo en una paciente quedó un foco menor de 1mm. Conclusión En un futuro cercano, a falta de estudios con mayor número de casos y seguimiento posterior, la crioablación en pacientes seleccionadas podría constituir una técnica percutánea eficaz y segura en el tratamiento del CDI precoz de bajo riesgo. En nuestra serie, el marcaje con semilla ferromagnética no interfirió en la eficacia del procedimiento ni en la posterior intervención quirúrgica (AU)

Objective The primary objective of this study to determine whether infiltrating carcinoma is present in surgical specimens obtained after ultrasound-guided cryoablation from patients with HER2-negative luminal breast cancer without positive axillary lymph nodes at ultrasound. The secondary objective is to demonstrate that placing the presurgical seed-marker immediately before cryoablation does not interfere with the disappearance of tumor cells from freezing or in the surgeon's ability to locate the tumor. Methods e treated 20 patients diagnosed with unifocal HR-positive HER2-negative infiltrating ductal carcinoma measuring < 2cm by means of ultrasound-guided cryoablation (ICEfx Galil, Boston Scientific) using a triple-phase (freezing?passive thawing?freezing; 10min each phase) protocol. All patients later underwent tumorectomy according to the routine operating-room agenda. Results No infiltrating carcinoma cells were detected in the post-cryoablation surgical specimen in 19 patients; a focus of infiltrating carcinoma cells measuring < 1mm was detected in the remaining patient. Conclusion In the near future, if confirmed in larger studies with longer follow-up, cryoablation might constitute a safe and efficacious technique for the treatment of early, low-risk infiltrating ductal carcinoma. In our series, marking with ferromagnetic seeds did not interfere with the efficacy of the procedure or of the subsequent surgical intervention (AU)