Background: Breast cryoablation offers multiple benefits as a treatment option for patients of high surgical risk. While lumpectomy under local anesthesia is possible, advantages of breast cryoablation in this patient population include lower cost, faster recovery time, and better cosmesis. An understanding of appropriate patient risk stratification and knowledge of helpful procedural adaptations in the aged population is critical for the radiologist performing breast cryoablations.
Learning Objectives: • Gain knowledge of breast cryoablation: rationale, usual procedure & current clinical trials • Understand inclusion criteria of current clinical trials and ideal tumor characteristics for which cryoablation can be performed • Understand risk stratification of patients with multiple comorbidities to identify those who may benefit from cryoablation • Know and prepare for common challenges encountered in performing breast cryoablation in patients with multiple comorbidities • Identify useful procedural adaptations or maneuvers to overcome the positioning challenges
Abstract Content/Results: This case-based review series will include 16 patients of high surgical risk, who were women first seen at our institution by one surgical oncologist familiar with breast cancer cryoablation, who presented this option to the patients, and consulted with the cryoablation breast radiology team. Patients were 57-94 years of age, and cryoablations were performed for all using local anesthesia. All cases were performed on an outpatient basis, by breast radiologists with multiple years of experience performing breast cryoablation. After cryoablation, patients had clinical follow up with the same referring surgical oncologist, as well as, breast imaging follow up. Through an image rich review, we will expose common challenges and pitfalls occurring when performing cryoablation in patients with multiple comorbidities (examples: positioning limitations due to advanced age, physiologic factors, pulmonary disease, limited mobility, very small or very large flaccid/pendulous breasts, and cognitive disabilities) and offer procedural adaptations to optimize safety, comfort & technical success. Follow up of both clinical and imaging outcomes will be provided.
Conclusion: Breast cryoablation offers a safe and effective alternative to treatment of breast cancer in patients with multiple comorbidities. While potentially an exigent procedure, breast cryoablation in patients of high surgical risk, can be technically successful, a rewarding radiologist experience and collaborative effort with surgery colleagues. Proper patient risk stratification, interventional ultrasound skills, and procedural adaptations, overcome common challenges in cryoablation treatment for this patient group.
