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January 1997

Cryosurgery of Breast Cancer

Author Affiliations

From the Departments of General Surgery (Dr Staren, Sabel, Wiener, Hart, Gorski, Dowlatshahi, and Corning and Messrs Gianakakis and Haklin) and Pathology (Dr Koukoulis), Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.

Arch Surg. 1997;132(1):28-33. doi:10.1001/archsurg.1997.01430250030005

Objective:  To determine the feasibility and efficacy of cryosurgery of breast cancer.

Design:  In phase 1, carcinogen-induced mammary adenocarcinomas in 13 Sprague-Dawley rats were treated by cryosurgery and were then examined for histopathologic change. In phase 2, transplantable mammary adenocarcinomas in 50 DBA/IJ mice were treated by cryosurgery to determine the effect of varying tumor temperatures, and duration and number of freeze-thaw cycles on tumor viability. In phase 3, 2- to 3-cm ultrasound-monitored cryolesions were formed in the breasts of 4 dogs and 4 sheep. These animals were followed up for procedure-related complications; the histopathologic necrosis of the cryolesions were correlated with the ultrasound images. Based on the results of these experiments, ultrasound-guided cryosurgery of breast cancer was initiated in a human clinical trial.

Results:  In phase 1, a single, short-term (<7 minutes) freeze killed only tumors smaller than 1.5 cm in diameter, despite an apparent decrease to −40°C at the periphery of each tumor. In phase 2, varying the peripheral tumor temperature to as low as −70°C, using a single, shortterm (<7 minutes) freeze did not alter the results from phase 1. If the ice ball fully encompassed the tumor, however, maintaining it for at least 15 minutes achieved 100% tumor kill independent of tumor size. In phase 3, creation of a reproducible ultrasound-monitored cryolesion was facilitated when 2 freeze-thaw cycles were performed. No procedure-related complications were noted. In the human trial, 2 invasive lobular carcinomas from 1 patient were treated by cryosurgery and were negative for persistent tumor by core needle biopsy performed 4 and 12 weeks after a well-tolerated procedure.

Conclusions:  In situ breast cryosurgery has been proved to be feasible and efficacious in small and large animal studies and has been successfully performed in 1 patient with breast cancer. The results of this study suggest that ultrasound-guided cryosurgery of breast cancer warrants further investigation.Arch Surg. 1997;132:28-33