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Open Access 01-07-2008 | Interventional

Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions

Authors: A. C. Schmitz, D. Gianfelice, B. L. Daniel, W. P. Th. M. Mali, M. A. A. J. van den Bosch

Published in: European Radiology | Issue 7/2008

Abstract

Image-guided focussed ultrasound (FUS) ablation is a non-invasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breast-conserving surgery remains the gold standard for breast cancer treatment.

Breast cancer. New cases and deaths from breast cancer in the United States in 2007: National Cancer Institute, Cancer Imaging Program Web site. http://www.cancer.gov/cancertopics/types/breast. Accessed July 3, 2007

Punglia RS, Morrow M, Winer EP, Harris JR (2007) Local therapy and survival in breast cancer. N Engl J Med 356:2399–2405CrossRefPubMed

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMed

Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232CrossRefPubMed

Nyström L, Andersson I, Bjurstam N, Frisell J, Nordenskjöld B, Rutqvist LE (2002) Long-term effects of mammography screening: updated overview of the Swedish randomized trials. Lancet 359:909–919CrossRefPubMed

van Esser S, van den Bosch MA, van Diest PJ, Mali WP, Borel Rinkes IH, van Hillegersberg R (2007) Minimally invasive ablative therapies for invasive breast carcinomas: An overview of the current literature. World J Surg 31(12):2284–2292CrossRefPubMed

Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT Jr, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG (2005) Society of Interventional Radiology Technology Assessment Committee; International Working Group on Image-Guided Tumour Ablation. Image-guided tumour ablation: Standardization of terminology and reporting criteria. Radiology 235:728–739

Van den Bosch MA, Daniel BL (2005) MR-guided interventions of the breast. Magn Reson Imaging Clin N Am 13:505–517CrossRefPubMed

Hynynen K, Freund WR, Cline HE, Chung AH, Watkins RD, Vetro JP, Jolesz FA (1996) A clinical, noninvasive, MR imaging-monitored ultrasound surgery method. Radiographics 16:185–195PubMed

10.

Cline HE, Hynynen K, Watkins RD, Adams WJ, Schenck JF, Ettinger RH, Freund WR, Vetro JP, Jolesz FA (1995) Focused US system for MR imaging-guided tumour ablation. Radiology 194:731–737PubMed

11.

Overgaard J, Nielsen OS (1980) The role of tissue environmental factors on kinetics and morphology of tumour cells exposed to hyperthermia. Ann NY Acad Sci 335:254–280CrossRefPubMed

12.

Sapareto SA, Dewey WC (1984) Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys 10:787–800PubMed

13.

Hokland SL, Pedersen M, Salomir R, Quesson B, Stodkilde-Jorgensen H, Moonen CT (2006) MRI-guided focused ultrasound: methodology and applications. IEEE Trans Med Imaging 25:723–731CrossRefPubMed

14.

Kennedy JE, Ter Haar GR, Cranston D (2003) High intensity focused ultrasound: surgery of the future? Br J Radiol 76:590–599CrossRefPubMed

15.

Jolesz FA, Hynynen K, McDannold N, Tempany C (2005) MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery. Magn Reson Imaging Clin N Am 13:545–560CrossRefPubMed

16.

Lynn JG, Zwemer RL, Chick AJ, Miller AE (1942) A new method for the generation and use of focused ultrasound in experimental biology. J Gen Phyciology 26:179–193CrossRef

17.

Fry WJ, Barnard JW, Fry FJ, Krumins TG, Brannan FJ (1955) Ultrasonic lesions in the mammalian central nervous system. Science 122:517–518CrossRefPubMed

18.

Gelet A, Chapelon JY, Bouvier R, Pangaud C, Lasne Y (1999) Local control of prostate cancer by transrectal high intensity focused ultrasound therapy: preliminary results. J Urol 161:156–162CrossRefPubMed

19.

Paterson RF, Barret E, Siqueira TM Jr, Gardner TA, Tavakkoli J, Rao VV, Sanghvi NT, Cheng L, Shalhav AL (2003) Laparoscopic partial kidney ablation with high intensity focused ultrasound. J Urol 169:347–351CrossRefPubMed

20.

Yang R, Sanghvi NT, Rescorla FJ, Galliani CA, Fry FJ, Griffith SL, Grosfeld JL (1992) Extracorporeal liver ablation using sonogrphy-guided high-intensity focused ultrasound. Invest Radiol 27:796–803CrossRefPubMed

21.

Wu F, ter Haag G, Chen WR (2007) High-intensity focused ultrasound ablation of breast cancer. Expert Rev Anticancer Ther 7:823–831CrossRefPubMed

22.

Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849CrossRefPubMed

23.

Hata T, Takahashi H, Watanabe K, Takahashi M, Taguchi K, Itoh T, Todo S (2004) Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 198:190–197CrossRefPubMed

24.

van Esser S, Veldhuis WB, van Hillegersberg R, van Diest PJ, Stapper G, ElOuamari M, Borel Rinkes IH, Mali WP, van den Bosch MA (2007) Accuracy of contrast-enhanced breast ultrasound for pre-operative tumour size assessment in patients diagnosed with invasive ductal carcinoma of the breast. Cancer Imaging 7:63–68CrossRefPubMed

25.

Boetes C, Mus RD, Holland R, Barentsz JO, Strijk SP, Wobbes T, Hendriks JH, Ruys SH (1995) Breast tumours: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 197:743–747PubMed

26.

Rieke V, Vigen KK, Sommer G, Daniel BL, Pauly JM, Butts K (2004) Referenceless PRF shift thermometry. Magn Reson Med 51:1223–1231CrossRefPubMed

27.

Vaezy S, Shi X, Martin RW, Chi E, Nelson PI, Bailey MR, Crum LA (2001) Real-time visualization of high-intensity focused ultrasound treatment using ultrasound imaging. Ultrasound Med Biol 27:33–42CrossRefPubMed

28.

Fornage BD, Toubas O, Morel M (1987) Clinical, mammographic, and sonographic determination of preoperative breast cancer size. Cancer 60:765–771CrossRefPubMed

29.

van der Ploeg IM, van Esser S, van den Bosch MA, Mali WP, van Diest PJ, Borel Rinkes IH, van Hillegersberg R (2007) Radiofrequency abaltion for breast cancer: a review of the literature. Eur J Surg Oncol 33:673–677PubMed

30.

Wu F, Wang Z, Cao Y, Zhu X, Zhu H, Chen W, Zou J (2007) “Wide local ablation” of localized breast cancer using high intensity focused ultrasound. J Surg Oncol 96:130–136CrossRefPubMed

31.

Wu F, Wang Z, Cao Y, Zhou Q, Zhang Y, Xu Z, Zhu X (2006) Expression of tumour antigens and heat-shock protein 70 in breast cancer cells after high-intensity focused ultrasound ablation. Ann Surg Oncol 14:1237–1242CrossRefPubMed

32.

Wu F, Wang Z, Cao Y, Xu Z, Zhou Q, Zhu H, Chen W (2006) Heat fixation of cancer cells ablated with high-intensity-focused ultrasound in patients with breast cancer. Am J Surg 192:179–184CrossRefPubMed

33.

Wu F, Wang Z, Zhu H, Chen W, Zou J, Bai J, Li K, Jin C, Xie F, Su H (2005) Extracorporeal high intensity focused ultrasound treatment for patients with breast cancer. Breast Cancer Res Treat 92:51–60CrossRefPubMed

34.

Wu F, Wang Z, Chen W, Wnag W, Gui Y, Zhang M, Zheng G, Zhou Y, Xu G, Li M, Zhang C, Ye H, Feng R (2004) Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview. Ultrason Sonochem 11:149–154CrossRefPubMed

35.

Wu F, Wang Z, Chen W, Zou J, Bai J, Zhu H, Li K, Xie F, Jin C, Su H, Gao G (2004) Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: early chinese clinical experience. Ultrasound Med Biol 30:245–260CrossRefPubMed

36.

Wu F, Wang Z, Cao Y, Chen W, Bai J, Zou J, Zhu H (2003) A randomised clinical trial of high-intensity focused ultrasound ablation for the treatment of patients with localised breast cancer. Br J Cancer 89:2227–2233CrossRefPubMed

37.

Wu F, Wang Z, Cao Y, Chen W, Zou J, Bai J, Zhu H, Li K, Jin C, Xie F, Su H, Gao G (2003) Changes in biologic characteristics of breast cancer treated with high-intensity focused ultrasound. Ultrasound Med Biol 29:1587–1492

38.

Wu F, Chen W, Bai J, Zou J, Wang Z, Zhu H, Wang Z (2001) Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound. Ultrasound Med Biol 27:1099–1106CrossRefPubMed

39.

Hynynen K, Pomeroy O, Smith DN, Huber PE, McDannold NJ, Kettenbach J, Baum J, Singer S, Jolesz FA (2001) MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology 219:176–185PubMed

40.

Huber PE, Jenne JW, Rastert R, Simiantonakonis I, Sinn H, Strittmatter H, von Fournier D, Wannenmacher MF, Debus J (2001) A new noninvasive approach in breast cancer therapy using magnetic resonance imaging-guided focused ultrasound surgery. Cancer Res 61:8441–9447PubMed

41.

Gianfelice D, Khiat A, Amara M, Belblidia A, Boulanger Y (2003) MR imaging-guided focused US ablation of breast cancer: histopathologic assessment of effectiveness– initial experience. Radiology 227:849–855CrossRefPubMed

42.

Gianfelice D, Khiat A, Amara M, Belblidia A, Boulanger Y (2003) MR imaging-guided focused ultrasound surgery of breast cancer: correlation of dynamic contrast-enhanced MRI with histopathological findings. Breast Cancer Res Treat 82:93–101CrossRefPubMed

43.

Zippel DB, Papa MZ (2005) The use of MR imaging guided focused ultrasound in breast cancer patients; a preliminary phase one study and review. Breast Cancer 12:32–38CrossRefPubMed

44.

Khiat A, Gianfelice D, Amara M, Boulanger Y (2006) Influence of post-treatment delay on the evaluation of the response to focused ultrasound surgery of breast cancer by dynamic contrast enhanced MRI. Br J Radiol 79:308–314CrossRefPubMed

45.

Furusawa H, Namba K, Thomsen S, Akiyama F, Bendet A, Tanaka C, Yasuda Y, Nakahara H (2006) Magnetic resonance-guided focused ultrasound surgery of breast cancer: reliability and effectiveness. J Am Coll Surg 203:54–63CrossRefPubMed

46.

Gianfelice D, Khait A, Boulanger Y, Amara M, Beblidia A (2003) Feasibility of magnetic resonance imaging-guided focused ultrasound surgery as an adjunct to tamoxifen therapy in high-risk surgical patients with breast carcinoma. J Vasc Interv Radiol 14:1275–1282PubMed

47.

Furusawa H, Namba K, Nakahara H, Tanaka C, Yasuda Y, Hirabara E, Imahariyama M, Komaki K (2007) The evolving non-surgical ablation of breast cancer: MR guided focused ultrasound (MRgFUS). Breast Cancer 14:55–58CrossRefPubMed

48.

Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, Silver B, Hetelekidis S, Abner A, Harris JR, Schnitt SJ (2000) Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 18:1668–1675PubMed

49.

Singletary SE (2002) Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 184:383–393CrossRefPubMed

50.

Tartter PI, Kaplan J, Bleiweiss I, Gajdos C, Kong A, Ahmed S, Zapetti D (2000) Lumpectomy margins, reexcision, and local recurrence of breast cancer. Am J Surg 179:81–85CrossRefPubMed

51.

Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, Gamagami P, Colburn WJ (1999) The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 340:1455–1461CrossRefPubMed

52.

Kunos C, Latson L, Overmoyer B, Silverman P, Shenk R, Kinsella T, Lyons J (2006) Breast conservation surgery achieving ≥2 mm tumour-free margins results in decreased local-regional recurrence rates. Breast J 12:28–36CrossRefPubMed

53.

Fornage BD, Sneige N, Ross MI, Mirza AN, Kuerer HM, Edeiken BS, Ames FC, Newman LA, Babiera GV, Singletary SE (2004) Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study. Radiology 231:215–524CrossRefPubMed

54.

Kuhl CK, Schrading S, Bieling HB, Wardelmann E, Leutner CC, Koenig R, Kuhn W, Schild HH (2007) MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 370:485–492CrossRefPubMed

55.

Shiraishi A, Kurosaki Y, Maehara T, Suzuki M, Kurosumi M (2003) Extension of ductal carcinoma in situ: histopathological association with MR imaging and mammography. Magn Reson Med Sci 31:2159–2163

56.

Kim do Y, Moon WK, Cho N, Ko ES, Yang SK, Park JS, Kim SM, Park IA, Cha JH, Lee EH (2007) MRI of the breast for the detection and assessment of the size of ductal carcinoma in situ. Korean J Radiol 8:32–39PubMedCrossRef

57.

Schouten van der Velden AP, Boetes C, Bult P, Wobbes T (2006) The value of magnetic resonance imaging in diagnosis and size assessment of in situ and small invasive breast carcinoma. Am J Surg 192:172–178CrossRefPubMed

58.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Robertson C, Maisonneuve P, Renne G, De Cicco C, De Lucia F, Gennari R (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553CrossRefPubMed

59.

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, Intra M, Veronesi P, Maisonneuve P, Gatti G, Mazzarol G, De Cicco C, Manfredi G, Fernández JR (2006) Sentinel-lymph-node biopsy as a staging procedure in breast cancer: update of a randomised controlled study. Lancet Oncol 7:983–990CrossRefPubMed

60.

Vargas HI, Dooley WC, Gardner RA, Gonzalez KD, Heywang-Köbrunner SH, Fenn AJ (2003) Success of sentinel lymph node mapping after breast cancer ablation with focused microwave phased array thermotherapy. Am J Surg 186:330–332CrossRefPubMed

61.

Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, Feldman S, Kusminsky R, Gadd M, Kuhn J, Harlow S, Beitsch P (1998) The sentinel node in breast cancer–a multicentre validation study. N Engl J Med 339:941–946CrossRefPubMed

62.

Hu Z, Yang XY, Liu Y, Sankin GN, Pua EC, Morse MA, Lyerly HK, Clay TM, Zhong P (2007) Investigation of HIFU-induced anti-tumour immunity in a murine tumour model. J Trans Med 5:34CrossRef

63.

Rome C, Couillaud F, Moonen CTW (2007) Gene expression and gene therapy imaging. Eur Radiol 17:305–19CrossRefPubMed

64.

Moonen CTW (2007) Spatio-temporal control of gene expression and cancer treatment using magnetic resonance imaging-guided focused ultrasound. Clin Cancer Res 13:3482–3489CrossRefPubMed

65.

Plathow C, Lohr F, Divkovic G, Rademaker G, Farhan N, Peschke P, Zuna I, Debus J, Claussen CD, Kauczor HU, Li CY, Jenne J, Huber P (2005) Focal gene induction in the liver of rats by a heat-inducible promoter using focused ultrasound hyperthermia. Inv Radiology 40:729–735CrossRef

66.

Allen TM (1997) Liposomes: opportunities in drug delivery. Drugs 54(suppl 4):8–14PubMed

67.

Kong G, Braun RD, Dewhirst MW (2001) Characterization of the effect of hyperthermia on nanoparticle extravasation from tumour vasculature. Cancer Res 61:3021–3032

68.

Dittmar KM, Xie J, Hunter F, Trimble C, Bur M, Frenkel V, Li KC (2005) Pulsed high-intensity focused ultrasound enhances systemic administration of naked DNA in squamous cell carcinoma model: initial experience. Radiology 235:541–546CrossRefPubMed

69.

Frenkel V, Etherington A, Greene M, Quijano J, Xie J, Hunter F, Dromi S, Li KCP (2006) Delivery of liposomal doxorubicin (Doxil) in a breast cancer tumour model: investigation of potential enhancement by pulsed-high intensity focused ultrasound exposure. Acad Radiol 13:469–479CrossRefPubMed

Title: Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions
Authors: A. C. Schmitz
D. Gianfelice
B. L. Daniel
W. P. Th. M. Mali
M. A. A. J. van den Bosch
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 7/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-0906-0

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Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions

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