Ablative Techniques in the Treatment of Benign and Malignant Breast Disease

Ablative treatments for benign and malignant breast disease are image-guided percutaneous techniques, including radiofrequency ablation (RFA), microwave, laser ablation, electromagnetic waves, cryoablation, and high-intensity focused ultrasound (HIFU). Ablative techniques use different types of energy instead of, or in addition to, immediate or delayed surgical excision. Ablative treatment is being investigated for small (T1) breast tumors (=2 cm) located 1 cm from the skin and pectoralis major, less than 25% carcinoma component in situ, and, most important, tumors must be visible using imaging modalities. The goal is to reduce complications, decrease morbidity, shorten hospitalization, and improve the cosmetic outcome and quality of life while not increasing recurrence rates. Complete ablation rates vary among ablative techniques and are highest in patients undergoing RFA (87.1%) and lowest in patients undergoing HIFU (47.6%). Several studies showed small recurrences rates (0 to 10.7%) among all ablative techniques. Excellent cosmetic outcome has been reported for all techniques. Complications occur in about 10% of patients, most commonly skin burns followed by pectoralis major muscle damage. Current problems are the lack of a predictive tool for assessing complete tumor ablation. Larger multicenter randomized controlled trials are required to confirm the efficacy of ablation compared with resection.