Pathologic Evaluation of Cryoprobe-Assisted Lumpectomy for Breast Cancer
Cryoprobe-assisted lumpectomy is a relatively new technique that converts nonpalpable carcinomas into well-defined, palpable ones by creating an ice ball under ultrasonographic guidance, thus eliminating the need for preoperative needle localization. We evaluated the effect of cryoprobe-induced freezing on tumor tissue, peritumoral tissue, and margin status in 6 cases of cryoprobe-assisted lumpectomy performed for infiltrating ductal carcinoma. Immunohistochemical stains for estrogen and progesterone receptors and the proliferation marker Ki-67 were performed on 4 cases and results compared with those of the pretreatment biopsy specimens. Although it was possible to recognize the tumor as infiltrating carcinoma in all cases, the alteration in tumor morphology interfered with tumor grading, distinguishing in situ and invasive components, and assessment of mitoses and lymphovascular invasion. The expression of estrogen and progesterone receptors was greatly reduced, whereas the Ki-67 staining was not significantly different when compared with pretreatment biopsy specimens. The "cryoprobe effect" did not interfere with evaluation of the margins and surrounding breast tissue.
New ablative methods have been used instead of standard surgical excision to treat benign breast lesions. Cryoablation is an ablative technique that uses extreme cold to treat benign and malignant breast tumors. The advantages of this technique for the treatment of benign tumors are that it can be used as an office-based procedure with minimal discomfort, no need for systemic anesthesia, and with little or no scarring. Cryoprobe-assisted lumpectomy is a modification of the cryoablation technique in which a cryoprobe is introduced to the center of a lesion to generate an ice ball by using liquid nitrogen or argon gas. The ice ball is created and monitored under real-time ultrasound to encompass the tumor and a margin of normal tissue to be excised. The main purpose of cryoprobe- assisted lumpectomy is to assist surgical excision of nonpalpable, sonographically detected carcinomas by making them palpable, therefore avoiding preoperative wire localization. In addition, the freezing process acts as an anesthetic so the procedure is less painful for the patient and potentially can be performed in an office-based, fully equipped treatment room under local anesthesia. It has also been shown in a pilot study that by freezing 6 mm or more of breast tissue beyond the sonographic limits of the tumor, the incidence of positive or close margins was reduced to 5.6%.
Studies evaluating the effects of this procedure on the histologic characteristics of the tumor are few. The purpose of this study was to evaluate the effect of cryoprobe-induced freezing on tumor tissue, peritumoral tissue, and margin status in cryoprobe-assisted lumpectomy specimens from procedures performed for nonpalpable infiltrating carcinomas at our institution. In this study, we also evaluated the extent of cellular alteration and its effects on antigenicity of tumor and nontumor tissue in cryoprobe-assisted lumpectomy specimens.
Cryoprobe-assisted lumpectomy is a relatively new technique that converts nonpalpable carcinomas into well-defined, palpable ones by creating an ice ball under ultrasonographic guidance, thus eliminating the need for preoperative needle localization. We evaluated the effect of cryoprobe-induced freezing on tumor tissue, peritumoral tissue, and margin status in 6 cases of cryoprobe-assisted lumpectomy performed for infiltrating ductal carcinoma. Immunohistochemical stains for estrogen and progesterone receptors and the proliferation marker Ki-67 were performed on 4 cases and results compared with those of the pretreatment biopsy specimens. Although it was possible to recognize the tumor as infiltrating carcinoma in all cases, the alteration in tumor morphology interfered with tumor grading, distinguishing in situ and invasive components, and assessment of mitoses and lymphovascular invasion. The expression of estrogen and progesterone receptors was greatly reduced, whereas the Ki-67 staining was not significantly different when compared with pretreatment biopsy specimens. The "cryoprobe effect" did not interfere with evaluation of the margins and surrounding breast tissue.
New ablative methods have been used instead of standard surgical excision to treat benign breast lesions. Cryoablation is an ablative technique that uses extreme cold to treat benign and malignant breast tumors. The advantages of this technique for the treatment of benign tumors are that it can be used as an office-based procedure with minimal discomfort, no need for systemic anesthesia, and with little or no scarring. Cryoprobe-assisted lumpectomy is a modification of the cryoablation technique in which a cryoprobe is introduced to the center of a lesion to generate an ice ball by using liquid nitrogen or argon gas. The ice ball is created and monitored under real-time ultrasound to encompass the tumor and a margin of normal tissue to be excised. The main purpose of cryoprobe- assisted lumpectomy is to assist surgical excision of nonpalpable, sonographically detected carcinomas by making them palpable, therefore avoiding preoperative wire localization. In addition, the freezing process acts as an anesthetic so the procedure is less painful for the patient and potentially can be performed in an office-based, fully equipped treatment room under local anesthesia. It has also been shown in a pilot study that by freezing 6 mm or more of breast tissue beyond the sonographic limits of the tumor, the incidence of positive or close margins was reduced to 5.6%.
Studies evaluating the effects of this procedure on the histologic characteristics of the tumor are few. The purpose of this study was to evaluate the effect of cryoprobe-induced freezing on tumor tissue, peritumoral tissue, and margin status in cryoprobe-assisted lumpectomy specimens from procedures performed for nonpalpable infiltrating carcinomas at our institution. In this study, we also evaluated the extent of cellular alteration and its effects on antigenicity of tumor and nontumor tissue in cryoprobe-assisted lumpectomy specimens.
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