Radiofrequency Ablation of a Stereotactically Localized Nonpalpable Breast Carcinoma

A nonpalpable breast lesion was detected in a 71-year-old woman who had returned for her annual mammogram. Stereotactic core needle biopsy revealed an infiltrating ductal carcinoma. The patient agreed to stereotactic localization and radiofrequency ablation of the lesion followed after 4 weeks by open surgical biopsy. The breast lesion was localized and the radiofrequency ablation performed under local anesthesia in the outpatient/office setting. The lesion was ablated for a total of 20 minutes at a sustained mean temperature of 75°C. After a 30-second cooldown the peripheral temperature of the four peripheral thermocouples ranged from 58°C to 70°C. A surgical clip was placed at the site of the ablated lesion. The postprocedure course was uneventful and the patient proceeded to open biopsy 4 weeks later. The open biopsy specimen, a left segmental mastectomy, underwent specimen radiography, which confirmed the surgical clip in the center of the lesion. There was extensive central necrosis and hemorrhage surrounded by fat necrosis. There was no definite viable residual tumor and the margins were clear. This is the first case in a clinical protocol designed to determine the efficacy of stereotactic localization and radiofrequency ablation of nonpalpable breast lesions. Additional ablations will be required to define the procedure but the results from this initial patient suggest that this is a promising minimally invasive curative approach for nonpalpable breast lesions.