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Stereotactically Guided Laser Therapy of Occult Breast Tumors
Work-in-Progress Report
Kambiz Dowlatshahi, MD;
Ming Fan, MD;
Victor E. Gould, MD;
Kenneth J. Bloom, MD;
Amjad Ali, MBBS
Arch Surg. 2000;135:1345-1352.
Hypothesis Mammographically detected breast tumors can be completely ablated with laser energy.
Design Nonrandomized control trial.
Setting A university hospital ambulatory care center.
Patients Thirty-six patients with mammographically detected well-defined breast tumors were selected.
Interventions The diagnosis of malignant neoplasms and determination of prognostic factors were established by image-guided needle-core biopsy. Patients were treated on a stereotactic table, using a 16- to 18-gauge laser probe, with an optic fiber transmitting a predetermined amount of laser energy. A multisensor thermal probe was inserted into the breast adjacent to the laser probe to monitor treatment. In the last 10 patients, the tumor blood flow was evaluated before and after laser therapy with contrast-enhanced color Doppler ultrasound. One to 8 weeks after laser therapy, the tumors were surgically removed and serially sectioned.
Main Outcome Measure Complete necrosis in 66% of tumors.
Results Total tumor ablation with negative margins was observed whenever 2500 J/mL of tumor was given or the thermal sensors recorded 60°C. Microscopic examination at 1 week showed disintegration of malignant cells, with peripheral acute inflammatory response and at 4 to 8 weeks extensive fibrosis. Contrast-enhanced color Doppler ultrasound revealed loss of tumor circulation after therapy, and positron emission tomography scan correlated well with histologic findings. There were no systemic adverse effects. Two patients sustained 3 x 4-mm skin burns around the laser needle.
Conclusion A stereotactically guided minimally invasive technique may be effective for the treatment of mammographically detected breast cancer.
From the Departments of General Surgery (Drs Dowlatshahi and Fan), Pathology (Drs Gould and Bloom), and Nuclear Medicine (Dr Ali), Rush-Presbyterian St Luke's Medical Center, Chicago, Ill.
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