MRI-guided treatment in the breast

Abstract

In the last decades, an increasing interest has developed towards non-invasive breast lesion treatments, which offer advantages such as the lack of surgery-related complications, better cosmetic outcomes, and less psychological distress. In addition, these treatments could be an option for patients with poor health who are not candidates for surgery. Non-surgical ablation can be performed under magnetic resonance (MR) or ultrasound (US) guidance. US is cheaper and easily available, while contrast-enhanced MR is more accurate, ensuring better safety and efficacy for the patient. Overall results of studies about MRI-guided tumor ablation reported complete ablation rates ranging between 20% and 100%. High-intensity focused ultrasound (HIFU or FUS) is the most studied ablative technique and it is already established as a valid technique for ablation of benign and malignant tumors in various organs. Ultrasound-guided FUS is very useful for young patients who refuse surgery or with multiple nodules; however, MR-guided FUS is more sensitive and allows a better evaluation of thermal accumulation within the ablated tissue or the adjacent structures. Most MR-guided FUS studies used a dedicated high-field MR scanner and complete tumor ablation was reported in 17-90% of cases. Other techniques using thermal tissue destruction are radiofrequency ablation (RFA) and laser interstitial thermal therapy (LITT). Only a few studies assessed the efficacy of these treatments, all were performed with open MR devices. RFA showed complete tumor ablation in 30-96% of patients, while LITT in 10-71%, but all the studies had a small number of patients. Cryoablation obtains tissue ablation by a rapid decrease of temperature, with a complete tumor removal reported in 18-52% of cases with MR guidance. No serious complications were reported with these techniques. Currently, breast conservative surgery replaced radical surgery when possible. Therefore, future research should focus on these treatments to shift towards an even less invasive approach to breast neoplasms. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;48:1479-1488.