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Breast Ablation

Ablation Type

Cryoablation is almost exclusively used for breast tumors since it offers much greater flexibility for underlying structures, as well as the much closer overlying skin than the prior organ-based ablations. See also Protective Measures below.

Tumor Type

Nearly all primary tumors are split into benign and malignant groups:

    • Benign Breast Tumors (Fibroadenomas): As noted in the insurance section in introduction, appropriate billing codes exist for cryoablation. Since these are generally considered “leave alone lesions,” indications for treatment are generally noted by growth over time and/or focal symptoms of pain/discomfort. Cryoablation generally relieves local symptoms, but may take 6-12 months to benefit from the excellent healing of cryoablation and associated 90% volume reduction.
    • Malignant Breast Tumors: Similar to outcomes from soft tissue cryoablation of numerous tumor types, Dr. Littrup’s paper for breast cryoablation shows excellent outcomes for the silhouette group of appropriate patients. Cryoablation for breast cancer is perhaps such a potentially controversial area since standard treatment of surgical resection, frequently in combination with radiation therapy and/or chemo-hormonal therapy, has been very successful and/or curative for many patients with early breast cancer. However, many patients do not necessarily fit into, or desire, standard treatment categories and the following two groups are noted from Dr. Littrup’s paper that may help clarify some insurance and/or appeal considerations:

      • Locally Recurrent Breast Cancer: These patients frequently have few treatment options other than radical surgery and have likely already received their maximum definitive radiation therapy dose. In addition, many of these patients were elderly or not good surgical candidates and may be considered similar to our soft tissue cryoablation patient population.

        Namely, cryoablation provides excellent local control option that may include extension of the cryoablation well into the chest wall as needed. Therefore, it is entirely reasonable to consider cryoablation for potential insurance coverage or appeal since it offers a cost effective, low morbidity, local control treatment for patients with few other options, and it may significantly improve their quality of life.
      • Refuse Surgery/Standard Treatment: These patients are frequently so emphatic about their desires to avoid surgery that they may refuse treatment altogether and find it equally difficult to have a radiation oncologist treat the primary tumor alone without resection. When we first began our ablation program at Karmanos Cancer Institute many years ago, a breast surgeon coined the term “refuseniks” for this special group, but was equally enthused about using cryoablation for them since thorough ablation was far better than letting the cancer likely progress with no treatment at all.

        We therefore continue to strive for similar “good Samaritan” status in providing breast cancer cryoablation for patients who refuse standard resection option. Moreover, we encourage breast cancer patients who are eligible for the ongoing FROST trial noted below to consider participating in this nonsurgical option. For those who are NOT eligible, cryoablation for breast cancer will likely not be covered by insurance. Estimates of out of pocket expenses are currently being generated by Ascension Crittenton billing office associates.

FROST Trial: Freezing Instead of Resection Of Small Breast Tumors
A Study of Cryoablation in the Management of Early Stage Breast Cancer

  • A modification of ACOSOG Z1072 protocol
  • Cryoablation without subsequent resection, for clinical stage I, T1 (<1.5 cm), N0 M0, Luminal A phenotype breast cancers (e.g., hormone receptor positive, HER-2/neu negative, invasive ductal carcinoma), known to be the lowest risk of local regional and systemic recurrence. These women are separated into 2 groups based on relative risk or age:
    • Stratum 1 – Low Risk: Women age 70 and older, committed to taking 5 years or longer endocrine therapy.
    • Stratum 2 – Moderate Risk: Women age 50-69, committed to also receiving conventional whole breast radiotherapy and systemic therapy, including a 5 year course of endocrine therapy.

Tumor Number

Relevant to benign and malignant considerations.

  • Fibroadenomata: Multiple fibroadenomata have been treated both in single or multiple sessions. Our prior publication notes 6 tumors have been treated sequentially in a young woman who avoided mastectomy consideration.
  • Breast Cancer: Multiple tumor foci are NOT permitted in the FROST trial. Our prior publication notes multiple primary and/or recurrent foci had good outcomes.

Tumor Size

Relevant to benign and malignant considerations.

  • Fibroadenomata: Usually up to 4 cm may be safely treated without risk of encountering phylloides tumors, but may require multiple probes.
  • Breast Cancer: Up to 1.5 cm within the FROST trial. Our prior experience suggests similar requirements as soft tissue ablations, or up to 6 cm where appropriate.

Tumor Location

Relevant to benign and malignant considerations.

  • Fibroadenomata: Nearly all locations in the breast are possible with appropriate skin protection.
  • Breast Cancer: No skin involvement for both the FROST trial, as well as off-protocol consideration. Previously noted Knuckle Skin Test applies.

Protective Measures

  • Hydrodissection: Similar to soft tissue cryoablation, liberal injection of fluid immediately beneath the skin is often used in combination with warm saline bags rubbed on the overlying skin to prevent full thickness skin necrosis. Aggressive diligence with this technique allows impressive treatment close to the skin. Hydrodissection also applies to the chest wall where invasion is NOT suspected. Previous publication also noted capability of thorough ablation near breast implants.

 

Renal Ablation Hepatic Ablation Thoracic Ablation Soft Tissue Ablation Published Research