MWA in Breast

MWA in Breast

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Introduction of Microwave Ablation in Breast

Breast lesions are common and occur frequently in clinical practice. They are prone to various abnormalities and disorders because mammary glands are regulated by endocrine factors [1]. Most breast lesions are benign, only 1%~2% are malignant [2].

Benign breast lesions are the outcomes of proliferation of ductal or lobular tissue that are manifested by the presence of palpable lumps or masses. lts volume will continue to increase, affecting the quality of life for women [3].

The clinical management of breast lesions mainly includes follow-up observation, lesion biopsy, and surgical intervention [1]. So far, surgical intervention, including the breast-conserving surgery(BCS), is an effective way to treat this disease. Yet, some patients are intolerant to surgery because of their poor physical condition and 10% to 40% of patients treated with BCS reported being unsatisfied with cosmetic results for the reason of scar formation and breast asymmetry [3].

In this situation, minimally invasive techniques, such as microwave ablation shows great value to treat benign breast lesions [3].


How Microwave Ablation Works

Microwave ablation refers to the use of the electromagnetic methods for inducing tumor destruction by using devices with frequencies of at least 900 MHz to produce tissue-heating effects [4]. Currently, 2450MHz is the frequency used by mainstream products worldwide.

How Effective Microwave Ablation is?

In 2018, a single center report evaluate clinical outcomes of microwave ablation (MWA) of benign breast tumors. In total, 56 patients with 107 biopsy-proved breast benign tumors were recruited from November 2013 to April 2017. Technical success was achieved in all patients [5].

In 2020,  a multi center study was reported. In total, 440 patients with 755 clinicopathologically confirmed benign breast lesions from 5 centers were prospectively enrolled from February 2014 to July 2018. The complete ablation rate reached 100%. The cosmetic and minimally invasive satisfaction rates were good or excellent in 98.4% and 94.5% of patients, respectively [6].

In 2023, a study compared the efficacy of MWA without subsequent lumpectomy and breast-conserving surgery in patients with early breast cancer.  There were 21 patients with balanced baseline characteristics in each group. MWA without subsequent lumpectomy has a comparable interim survival effect and better cosmetic results as breast-conserving surgery in the treatment of selected early breast cancer [3].

In conclusion, MWA is an effective and safe procedure for the treatment of benign breast lesions and early stage breast cancers , especially in terms of cosmetic and minimally invasive satisfaction.


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Clinical Cases

Figure 1: Imaging evaluation before and after MWA in one benign breast lesion case [7]. (A) BBL with 6.0cm * 3.5cm * 4.9cm size showing hypoechogenicity with a clear margin on US. (E) Contrast-enhanced MRI  showing a hyper-enhancement in the benign breast lesion parenchyma in the arterial phase before MWA. (H) After MWA, a hypoechoic ablation zone with a size of 5.0cm * 3.6cm * 4.5cm is shown in the tumor region by CEUS. (P) After 12 months follow-up, the ablation debris decreased gradually to a size of 1.1cm * 0.4cm * 1.2cm on T2-weighted images (yellow arrows in P). 

Advantages

Reference List

1. Zhonghua Nei Ke Za Zhi, A. E. C. (2023). Expert consensus on microwave ablation for benign breast nodules. Zhonghua nei ke za zhi, 62(4), 369-373.

2. Gruber, R., Jaromi, S., Rudas, M., Pfarl, G., Riedl, C. C., Flöry, D., ... & Helbich, T. H. (2013). Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3). European journal of radiology, 82(3), 398-403.

3. Dai, Y. Q., Liang, P., Wang, J., Luo, Y. C., Yu, X. L., Han, Z. Y., ... & Yu, J. (2023). Microwave ablation without subsequent lumpectomy versus breast-conserving surgery for early breast cancer: a propensity score matching study. International Journal of Hyperthermia, 40(1), 2186325.

4. Caroline J. Simon., Damian E. Dupuy., William W. Mayo-Smith., Microwave Ablation: Principles and Application. RadioGraphics 2005; 25:S69–S83

5. Xu, J., Wu, H., Han, Z., Zhang, J., Li, Q., Dou, J., ... & Liang, P. (2018). Microwave ablation of benign breast tumors: a prospective study with minimum 12 months follow-up. International Journal of Hyperthermia, 35(1), 253-261.

6. Yang, Q., Li, H., Chen, B. H., He, G. Z., Wu, X. P., Wang, L. X., ... & Liang, P. (2020). Ultrasound-guided percutaneous microwave ablation for 755 benign breast lesions: a prospective multicenter study. European Radiology, 30, 5029-5038.

7. Cui, R., Wu, H., Xu, J., Han, Z., Zhang, J., Li, Q., ... & Liang, P. (2021). Volume reduction for≥ 2 cm benign breast lesions after ultrasound-guided microwave ablation with a minimum 12-month follow-up. International Journal of Hyperthermia, 38(1), 341-348.


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