Interventional Oncology for Breast Cancer: A Patient's Guide to Minimally Invasive Treatments

Table of Contents

• Key Points
• Introduction: What This Article Covers
• Background: Breast Cancer and the Shift Toward Gentler Treatments
• Percutaneous Treatments for Early-Stage Breast Cancer
• Cryoablation: Freezing the Tumor
• Radiofrequency Ablation (RFA): Heating the Tumor
• Microwave Ablation (MWA): Faster, Hotter, and More Powerful
• Laser Ablation: Using Light to Destroy Cancer
• High-Intensity Focused Ultrasound (HIFU): No Needles Required
• When Breast Cancer Spreads to the Liver (BCLM)
• Percutaneous Ablation for Liver Metastases
• Intra-Arterial Therapies: Delivering Treatment Through the Blood Supply
• Transarterial Chemoembolization (TACE)
• Transarterial Radioembolization (TARE)
• Clinical Implications: What This Means for Patients
• Limitations: What the Research Can't Yet Tell Us
• Recommendations for Patients
• Frequently Asked Questions
• Source Information

Key Points

• Interventional oncology uses image-guided techniques like cryoablation, radiofrequency, microwave, laser, and high-intensity focused ultrasound to treat breast tumors without surgery.
• In a meta-analysis of 397 breast cancers up to 2 cm, cryoablation achieved complete ablation in 85% of cases and had the fewest complications among thermal ablation methods.
• For breast cancer liver metastases, percutaneous ablation can achieve local control with a mortality of 0.15%, compared with up to 5.8% for surgical resection.
• Intra-arterial therapies such as TACE and TARE may provide survival benefits for liver metastases, especially in patients who respond to treatment.
• There is no high-level evidence or specific guidelines for local therapies in metastatic breast cancer; decisions should be made by a multidisciplinary team board.

Introduction: What This Article Covers

This article is based on a peer-reviewed medical review written by Dr. Franco Orsi at the European Institute of Oncology in Milan, Italy, published in the Journal of Medical Imaging and Radiation Oncology in 2023. It explores the growing role of interventional oncology (IO) in breast cancer treatment.

Interventional oncology uses minimally invasive, image-guided procedures to diagnose and treat cancer. Instead of making large incisions, doctors use needles, probes, or catheters guided by imaging tools like ultrasound, CT, or MRI to target tumors directly. The review covers two main areas: treating the primary breast tumor itself without surgery, and treating breast cancer that has spread to the liver (breast cancer liver metastases, or BCLM).

Background: Breast Cancer and the Shift Toward Gentler Treatments

Breast cancer is the most common cancer worldwide among women and one of the most important causes of death in this group. The incidence varies across European countries, but overall, the lifetime risk of developing breast cancer is about 10% for women. Over the past few decades, survival has improved significantly, thanks largely to breast screening programs available in most European countries and easier access to diagnostic services for women with breast symptoms. These advances allow breast cancer to be detected at earlier stages and treated more promptly.

Treatment of breast cancer itself has evolved dramatically. Surgery has moved from radical mastectomy (complete removal of the breast) to breast-conserving surgery, which removes only the tumor and a small margin of surrounding tissue. This shift was made possible by earlier imaging detection, which allows less radical surgery, and by advances in biology and molecular classification of different breast cancer subtypes. Personalized cancer care and new standardization of surgical margins in breast-conserving surgery are creating both opportunities and challenges.

Despite these improvements, metastatic disease remains a serious problem. Approximately 3.5–7% of breast cancer patients initially present with distant metastases (meaning the cancer has already spread at the time of diagnosis, classified as Stage IV). Additionally, nearly 30–40% of women initially diagnosed with early-stage disease will eventually develop metastatic lesions, months or even years later.

The most common sites where breast cancer spreads are:

• Bone (51% of metastatic cases)
• Lung
• Brain
• Liver

For Stage IV breast cancer, systemic therapy is the standard of care. This includes chemotherapy, endocrine therapy (hormone therapy), or HER2-targeted therapy, depending on whether the tumor has oestrogen/progesterone receptors and HER2 status. Even with these treatments, the median overall survival for Stage IV patients is 2–3 years, and the 5-year survival rate is only about 25%.

Local treatments — such as surgery, radiation therapy, and more recently interventional oncology procedures — are sometimes added to systemic therapy. Recent evidence shows that these local approaches can benefit patients with oligo-metastatic disease (a limited number of metastases) or oligo-progressive liver disease, improving survival compared with systemic treatment alone. Local treatments can also help relieve symptoms, which improves patients' treatment adherence, satisfaction, and overall well-being.

It is important to note that there is currently no high-level evidence confirming the effectiveness of local therapies in metastatic breast cancer, and no specific guidelines are available. However, within the "Recommendation Statements" from the European School of Oncology (ESO)–MBC Task Force, local treatment of a "solitary metastatic lesion" is an accepted indication. The Task Force also emphasizes the need for a multidisciplinary team board (MDTB) discussion to define a tailored treatment plan for each metastatic breast cancer patient. For these reasons, a breast cancer treatment center must have access to interventional oncology expertise.

Percutaneous Treatments for Early-Stage Breast Cancer

Women with newly diagnosed breast cancer typically undergo breast-conserving surgery, the standard treatment for early-stage disease. This procedure involves local tumor excision with clear margins plus sentinel lymph node biopsy for invasive cancers. For both invasive and in situ (non-invasive) breast carcinoma, the status of the surgical margins is one of the main factors affecting the risk of local recurrence.

Current guidelines support a negative margin defined as "no ink on tumor" to minimize local recurrence risk in invasive breast cancer. For women with ductal carcinoma in situ (DCIS) treated with lumpectomy plus radiation therapy, a minimum margin of 2 mm is required, and larger margins do not provide added benefit.

Although surgery remains the standard of care, some patients cannot undergo resection due to:

• Comorbidities (other health conditions that make surgery risky)
• Advanced age
• Patient refusal

These patients may be considered for percutaneous ablation, a procedure in which a needle or probe is inserted through the skin directly into the tumor. Percutaneous thermal ablation (TA) techniques include cryoablation (CA), radiofrequency ablation (RFA), laser ablation (LA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU).

The advantages of percutaneous therapy are significant:

• Outpatient treatment (no hospital stay required)
• Low rate of complications
• Minimal scarring
• Rapid recovery

The main drawback is that the tumor is not removed, so it cannot be examined under a microscope afterward. Because core biopsies cannot assess whether tumor-free margins have been achieved, doctors must oversize the ablation area to avoid recurrence. A margin of 5 mm beyond the visible tumor is considered necessary for thermal ablation. Heat-based techniques can be painful and generally require local anesthesia plus intravenous sedation.

Cryoablation: Freezing the Tumor

Cryoablation is an emerging therapeutic technique that uses extremely low temperatures to destroy cancer cells. Under image guidance — most commonly ultrasound, which easily visualizes the "ice ball" forming during the procedure — the doctor places a small cryoprobe through the skin into the tumor. One of the key advantages of cryoablation is the ability to clearly see the area being treated in real time on ultrasound images, which helps ensure the entire tumor is frozen while minimizing damage to surrounding healthy tissue.

The technique was first described in 1985 and, thanks to recent technical improvements, can now be performed using small, easy-to-handle cryoprobes powered by argon gas or liquid nitrogen.

Cryoablation offers several important benefits compared with heat-based techniques:

• It is essentially painless — cold temperatures have an analgesic (pain-relieving) effect, unlike heat-based methods
• It can be performed safely without sedation — only local anesthesia is needed for the probe insertion
• It offers better cosmetic outcomes — minimal scarring
• It has a low complication rate
• It is low cost

A recent meta-analysis studied 397 breast cancers up to 2 cm in size treated with cryoablation and reported complete ablation in 339 cases — a success rate of 85% (95% confidence interval 82–89%). The analysis also found that cryoablation is the thermal ablation technique with the fewest associated complications compared to heat-based methods.

Two ongoing clinical trials are currently studying cryoablation as a replacement for surgery:

• ICE3 (Cryoablation of Low Risk Small Breast Cancer) — A prospective study in women aged 50 or over with early-stage hormone receptor-positive, HER2-negative breast cancer. The interim analysis reported an ipsilateral breast tumor recurrence (IBTR) rate of only 2% at a mean follow-up of 34.83 months after cryoablation without surgery.
• FROST (Freezing instead of Removal Of Small Tumours) — Studying cryoablation without surgery and its impact on local or distant recurrence at 5 years.

These trials will help determine whether cryoablation can be a definitive treatment for small, low-risk breast cancers in appropriate patients.

Radiofrequency Ablation (RFA): Heating the Tumor

Radiofrequency ablation is one of the most extensively studied thermal ablation techniques for breast cancer. In a meta-analysis of all thermal ablation techniques for breast cancer, more than half of the lesions in 1,156 patients were ablated using RFA — specifically, 577 lesions (50%).

RFA works by passing an alternating electrical current between the needle tip placed in the tumor and a skin electrode pad. The friction of ions adjacent to the needle converts electrical energy into heat, which destroys the cancer cells.

Several studies have shown promising rates of complete ablation with an excellent safety profile. Most patients in these studies underwent surgical excision after RFA, and pathological examination confirmed complete ablation of the target lesion.

A randomized trial compared breast cancer treatment using RFA followed by lumpectomy versus lumpectomy alone (considered the standard treatment). The study compared margin status, cosmetic results, adverse events, and local recurrences between the two groups. The results showed:

• Clear tumor margins were more frequent when RFA was used before lumpectomy
• However, RFA had a higher complication rate, mainly local breast inflammation and local infection, especially when combined with partial irradiation of the breast

In a prospective study in which patients did not undergo surgical resection after RFA, imaging was the only method used to assess the success of the ablation. Results showed that relapses were delayed — occurring at 30, 48, and 60 months — and were located outside the ablation zone, suggesting that RFA successfully destroyed the targeted tumor tissue.

Microwave Ablation (MWA): Faster, Hotter, and More Powerful

Microwave ablation was more recently proposed for treating breast tumors. Compared with RFA, MWA offers several technical advantages:

• Consistently higher temperatures
• Larger tumor ablation volumes
• Faster treatment times

MWA works by generating an oscillating electromagnetic field from an antenna (needle) placed in the tumor. This field induces heat in the adjacent tissue through the kinetic energy of water molecules (dipoles) within the cells, essentially cooking the tumor from the inside out.

An "ablate and resect" study of ultrasound-guided MWA for small breast cancers demonstrated results similar to RFA: complete tumor coagulation was achieved in 95% of cases (36 out of 38 tumors). However, treatments in this study were performed under general anesthesia, and complications included thermal injuries to the skin and the pectoralis major muscle (the chest muscle beneath the breast). These side effects highlight the importance of careful technique and patient selection.

Laser Ablation: Using Light to Destroy Cancer

Laser ablation destroys tumors by converting light into thermal (heat) energy, which heats and kills the cancer cells. Among thermal ablation techniques, interstitial laser photocoagulation was one of the first to be reported for treating breast tumors, dating back to the 1990s.

An open-label phase 2 multicentre clinical trial evaluated laser ablation followed by surgical removal of the treated area. The study compared 28-day post-ablation MRI images with the surgical pathology to determine whether any residual tumor remained after ablation. Here are the key results from this trial:

• 61 patients were enrolled in the study
• 51 patients (84%) had complete tumor ablation confirmed by pathology analysis
• 4 patients (6.7%) had false-positive MRI results (MRI suggested residual tumor, but none was found)
• 4 patients (6.7%) had false-negative MRI results (MRI showed no residual tumor, but pathology found some)
• The overall negative predictive value (NPV) of MRI — meaning the probability that a negative MRI truly means no residual tumor — was 92.2%

Even better results were obtained for tumors up to 15 mm in size, where the MRI negative predictive value rose to 97.7%. Adverse events were minimal, and the majority of patients — 96.6% — reported good to excellent satisfaction 28 days after the procedure.

This means that for small tumors, MRI is quite reliable at confirming successful ablation, though it is not perfect.

High-Intensity Focused Ultrasound (HIFU): No Needles Required

High-intensity focused ultrasound is unique among the ablation techniques because it requires no needle insertion at all. Instead, focused mechanical ultrasound waves are delivered into the body to a predefined target. The patient lies on their stomach (prone position), and the therapeutic transducer (the device that emits the ultrasound waves) is placed below or to the side of the breast.

HIFU can be guided by either ultrasound (USgHIFU) or magnetic resonance imaging (MRgHIFU). MRI guidance offers advantages because it allows precise treatment planning and real-time temperature monitoring through special thermometry sequences, so the doctor can see exactly how hot the tissue is getting during treatment.

Here is how the technology works: a beam of ultrasound waves is concentrated into a focal point within a small volume of tissue using a spherically curved phased-array transducer. At that focal spot, the absorption of energy creates a highly localized temperature increase, leading to protein coagulation (the proteins in cells clump together and stop functioning) and cell death. The temperature rise depends mainly on how much energy the tissue absorbs, and it can be reduced by attenuation from the tissues the waves must pass through on their way to the target.

MRgHIFU has been tested on breast tumors since the 2000s, but studies are still scarce, with most conducted as pilot feasibility and safety studies. The efficacy results are mixed and variable, with complete tumor ablation success rates ranging from 20% to 100% across different studies. This wide variation is largely due to differences in MRgHIFU systems, imaging techniques, ablation protocols, and patient selection criteria used in the published studies.

In one series of breast cancer patients treated with ultrasound-guided HIFU followed by modified radical mastectomy (surgical removal of the breast), complete ablation was demonstrated in 100% of cases. However, the technology has some important limitations at present:

• Cost — especially for MRI-guided systems
• Long treatment times — typically 35 to 150 minutes per session
• Risk of target lesion motion — the tumor may shift during treatment (for example, with breathing), which can affect accuracy

The technology is promising but requires further development before it can be widely adopted.

When Breast Cancer Spreads to the Liver (BCLM)

Breast cancer liver metastases (BCLM) represent a complex oncological situation in which systemic therapy plays the crucial therapeutic role in improving both the quality and quantity of life. The primary goal of any local therapy in metastatic breast cancer is to achieve local disease control that translates into a clinical benefit — ideally, longer survival or better symptom control.

The aim of local tumor treatment depends on the stage of the disease and the extent of liver involvement:

• Patients with extensive extrahepatic disease (cancer spread beyond the liver): Their survival is primarily driven by the overall tumor burden, so it may not be desirable to ablate every single liver metastasis.
• Patients whose metastatic involvement is confined to the liver: Complete ablation is preferable if it can be achieved safely.

Two clinical scenarios where local minimally invasive therapies are increasingly indicated are:

1. Oligo-metastatic disease — defined as the presence of ≤5 metastatic deposits. In this situation, a radical (curative) outcome is reasonably achievable, and percutaneous ablations are mainly indicated.
2. Oligo-progressive metastatic disease — a newer disease concept with no consensus definition yet. In clinical practice, there is a growing number of metastatic breast cancer patients in whom systemic therapy remains effective long-term, but one or a few deposits stop responding. Rather than changing the systemic treatment (which may be working well elsewhere), treating only the non-responsive lesions locally may allow the effective systemic therapy to continue.

Locoregional and local therapies — such as percutaneous ablations and intra-arterial techniques — may only benefit very well-selected patients. According to the very few data available in the literature (mostly from small retrospective studies), a multidisciplinary team board (MDTB) discussion is mandatory for defining the indications for interventional oncology treatments outside of clinical trials. As BCLM is a complex condition with no standard established therapy, the MDTB is considered crucial for planning a personalized treatment strategy.

Among the available options for local therapy in liver disease, percutaneous ablation and liver-directed arterial treatments are the most commonly used approaches in BCLM.

Percutaneous Ablation for Liver Metastases

Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most common ablation techniques used in clinical practice for treating liver metastases. They can be performed percutaneously (through the skin), laparoscopically (through small keyhole incisions), or during open surgery. The image-guided percutaneous approach — most commonly using ultrasound and CT — is the preferred method for BCLM, where laparoscopy and open surgery are considered unacceptably invasive.

While clinical indications for liver ablation in BCLM are still not well-defined, the technical indications are well-established and relate mainly to:

• Tumor size — acceptable size criteria range from 3 to 5 cm in largest diameter, depending on the technique and device used
• Tumor shape
• Tumor site — location within the liver matters for safe probe placement

It is well-known that local recurrence and treatment failure are higher with larger lesions, due to incomplete ablation at the periphery of the tumor. Therefore, achieving an adequate margin of healthy tissue around the tumor is critical.

Only a few retrospective studies are available on percutaneous thermal ablation of BCLM, but the results are encouraging:

• Local success with up to 92% of tumor necrosis (cell death) was reported with RFA ablation — though in that series, up to 58% of patients developed new liver metastases during follow-up, highlighting the systemic nature of the disease.
• A local tumor progression rate of 11.6% was reported in a study of 69 patients with 135 lesions.
• Another study reported a median overall survival of 26 months after RFA, with 1-year, 3-year, and 5-year survival rates of 81.8%, 25.3%, and 11.0%, respectively.
• A recent study of percutaneous RFA for 64 liver lesions up to 8.5 cm in 26 drug-resistant patients reported a complete local response rate of 92.2% and an estimated overall survival of 29.3 months.

These results compare favorably with surgical series, where complete resection of liver metastases is achieved in 62–96% of cases, but with overall mortality rates of up to 5.8%. By comparison, mortality after percutaneous RFA of liver tumors is just 0.15%. This dramatic difference in safety profile makes percutaneous ablation an appealing option, especially for patients who are not good surgical candidates.

Intra-Arterial Therapies: Delivering Treatment Through the Blood Supply

Indications for intra-arterial (IA) therapies are usually less restrictive than for percutaneous ablation, and the aim is more often local tumor control rather than radical (curative) treatment. Patients with BCLM who are considered for IA therapies are typically in a more advanced stage, often with extrahepatic disease and having already received multiple lines of chemotherapy. They frequently have long clinical histories, significant treatment side effects, and may be mentally and emotionally distressed.

The rationale behind arterial treatment is anatomical: liver tumors — both primary and metastatic — are supplied mainly, if not exclusively, by arterial blood flow. This means that by delivering treatment directly through the hepatic artery, it is possible to achieve higher local concentrations of chemotherapy within the liver metastases while exposing the rest of the body to less of the drug, compared with systemic therapy.

Cytotoxic drugs can be delivered in two main ways:

1. Selective intra-arterial chemotherapy infusion — drugs are infused directly into the artery feeding the tumor
2. Chemoembolization — drugs are injected along with embolic agents that slow down the arterial flow, increasing the contact time between the chemotherapy and the cancer cells

The arterial route is also used for radioembolization, which takes advantage of the fact that breast cancer cells are sensitive to radiation.

Unlike thermal ablation, liver-directed intra-arterial therapies are not limited by tumor size. The main indications are usually local tumor control in patients with:

• Unresectable liver-only metastases (tumors that cannot be surgically removed)
• BCLM with extrahepatic disease

The main contraindications include:

• Large tumor burden — more than 50% of the liver involved by tumor
• Liver failure — the liver is not functioning adequately

Transarterial Chemoembolization (TACE)

Transarterial chemoembolization (TACE) combines local chemotherapy delivery with blockage of the blood supply to the tumor. Mitomycin C and gemcitabine are the most common chemotherapy drugs reported in the literature for this purpose, with no clear evidence that one is superior to the other in terms of effectiveness.

The role of TACE in unresectable BCLM has been evaluated in a few retrospective studies based on small patient groups. The results show meaningful benefits for patients who respond to treatment:

• A median overall survival of 24 months was reported in responder patients, who received a median of 4 sessions of TACE
• This compares with a median survival of only 7 months in non-responders — a striking difference that underscores the importance of patient selection
• A prospective phase II study evaluated gemcitabine-based TACE in 43 patients with inoperable BCLM and reported an estimated median overall survival of 10.2 months

Post-embolization syndrome (PES) is the most common side effect after TACE. It typically includes symptoms such as fever, nausea, vomiting, and abdominal pain. The severity of PES is related to the amount of liver tissue treated during the procedure — the more liver parenchyma (functional liver tissue) that is involved, the more pronounced the symptoms tend to be.

Transarterial Radioembolization (TARE)

Radiation-based tumor treatment has a well-established rationale: radiation has a tumoricidal (tumor-killing) effect, and this effect does not depend on whether the tumor is sensitive to chemotherapy. For breast cancer, this is particularly relevant since breast cancer cells are known to be sensitive to radiation.

Transarterial radioembolization (TARE) was initially developed as a liver-directed therapy for primary liver cancer and colorectal liver metastases. The treatment uses microscopic spheres (microspheres) loaded with yttrium-90 (90Y), a radioactive isotope that emits beta radiation. These microspheres are administered directly into the arterial blood supply of the liver tumors.

Selective administration of the radioactive beads is essential for achieving good oncological results while protecting healthy liver tissue. By delivering radiation directly into the tumor's blood supply, TARE can deliver a high radiation dose to the cancer while sparing the rest of the body.

While the review notes that TARE has been less extensively studied in breast cancer liver metastases specifically, the biological rationale is sound: because breast cancer is radiosensitive, liver tumors from breast cancer should respond to targeted radiation delivery through this approach.

Clinical Implications: What This Means for Patients

This review has several important messages for patients facing breast cancer treatment decisions.

First, if you have early-stage breast cancer and cannot undergo surgery — whether due to other health problems, advanced age, or personal choice — interventional oncology techniques offer viable alternatives. Cryoablation, in particular, has demonstrated an 85% complete ablation rate for tumors up to 2 cm, with the fewest complications among thermal ablation methods and excellent cosmetic results. Ongoing clinical trials like ICE3 and FROST are working to confirm these benefits in larger patient populations.

Second, if you have breast cancer that has spread to the liver, local treatments can play an important role in specific situations. For patients with only a few liver metastases (five or fewer), percutaneous ablation can achieve local control with a very low risk of serious complications — mortality of just 0.15% compared with up to 5.8% for surgical resection. For patients with more extensive liver involvement, intra-arterial therapies like TACE and TARE can provide meaningful survival benefits, particularly for those who respond to treatment.

Third, the concept of "oligo-progressive" disease is a promising development. If you are on a systemic therapy that is working well overall, but one or two liver lesions are growing, local treatment of those specific lesions might allow you to stay on your effective systemic therapy longer, rather than switching to a new treatment.

However, the review emphasizes that patient selection is everything. The benefits of these local treatments are most pronounced in well-selected patients, and the decision should always be made within a multidisciplinary team board (MDTB) that includes medical oncologists, surgeons, radiologists, and interventional oncology specialists.

Limitations: What the Research Can't Yet Tell Us

It is essential to understand the limitations of the evidence supporting interventional oncology in breast cancer. This review is honest about these gaps:

• No high-level evidence — There are no large randomized controlled trials confirming the effectiveness of local therapies in metastatic breast cancer. Most data come from retrospective studies with small patient cohorts.
• No specific guidelines — Unlike surgery or systemic therapy, there are no formal clinical guidelines establishing when interventional oncology procedures should be used in breast cancer patients.
• No histological confirmation — Percutaneous ablation destroys the tumor in place, so it cannot be examined under a microscope to confirm complete removal. This is why a 5 mm safety margin is needed, and why imaging follow-up is critical.
• Variable results across techniques — For HIFU, for example, complete ablation success rates ranged from 20% to 100% in published studies, reflecting differences in equipment, protocols, and patient selection.
• Mixed imaging reliability — MRI after laser ablation showed a 92.2% negative predictive value overall, but this was not perfect; 6.7% of patients had false negatives, meaning MRI missed residual disease.
• Higher failure with larger tumors — Local recurrence and treatment failure rates are higher for larger lesions due to incomplete ablation at the periphery.
• Ongoing risk of new metastases — Even after successful ablation, many patients develop new liver lesions elsewhere, reflecting the systemic nature of metastatic breast cancer.

These limitations are not reasons to avoid these treatments, but they are reasons to approach them with appropriate expectations and to ensure that decisions are made collaboratively with a fully informed care team.

Recommendations for Patients

Based on the findings of this review, here are practical steps patients can consider when discussing interventional oncology options with their care team:

1. Ask about a multidisciplinary team board (MDTB) discussion. The European School of Oncology recommends that every metastatic breast cancer patient have a tailored treatment plan developed by a multidisciplinary team. Ask your oncologist whether your case has been or will be discussed at an MDTB meeting.
2. Inquire about interventional oncology expertise. A breast cancer treatment center should have access to interventional radiology specialists. If your center does not, ask for a referral.
3. If you have small, early-stage breast cancer and surgery is not an option for you, ask your doctor whether cryoablation or another thermal ablation technique could be appropriate. Current data show an 85% success rate for tumors up to 2 cm, with a very low complication profile.
4. If you have liver metastases from breast cancer, ask whether local treatments like percutaneous ablation, TACE, or TARE should be considered in addition to your systemic therapy. This is especially relevant if you have only a few liver lesions (≤5, known as oligo-metastatic disease) or if you have one or a few lesions that are growing while your overall disease is otherwise well controlled (oligo-progressive disease).
5. Consider clinical trials. Ongoing studies like ICE3 and FROST are evaluating the role of cryoablation without surgery in early-stage breast cancer. Enrolling in a clinical trial can give you access to cutting-edge treatments while contributing to medical knowledge.
6. Understand the follow-up requirements. Because ablated tumors are not removed for examination, imaging follow-up (ultrasound, MRI, or CT) is essential after these procedures. Make sure you understand the follow-up schedule and adhere to it.

Important note: Every patient's situation is unique. Interventional oncology procedures are not appropriate for everyone, and the decision to pursue them should always be made in close consultation with your entire medical team, taking into account your specific cancer type, stage, overall health, and personal preferences.

Frequently Asked Questions

I have early-stage breast cancer but cannot have surgery. What minimally invasive options might be available?

If surgery is not possible due to other health conditions, advanced age, or personal choice, percutaneous ablation may be considered. Techniques include cryoablation, radiofrequency ablation, microwave ablation, laser ablation, and high-intensity focused ultrasound. These are outpatient procedures with low complication rates, minimal scarring, and rapid recovery. A multidisciplinary team discussion is needed to decide if one is appropriate for you.

What is cryoablation and how successful is it for small breast tumors?

Cryoablation uses extreme cold to destroy cancer cells. A small probe is placed into the tumor under ultrasound guidance, and the ice ball is visible in real time. A meta-analysis of 397 breast cancers up to 2 cm found complete ablation in 339 cases, an 85% success rate. It is essentially painless, needs only local anesthesia, and has the fewest complications among thermal ablation methods.

What are the risks or side effects of thermal ablation for breast cancer?

Heat-based techniques can be painful and usually require local anesthesia plus intravenous sedation. In one randomized trial, radiofrequency ablation before lumpectomy had a higher complication rate, mainly local breast inflammation and infection, especially when combined with partial breast irradiation. Microwave ablation under general anesthesia caused thermal injuries to skin and chest muscle in some cases. Cryoablation has the fewest complications among thermal ablation methods.

If I have breast cancer that has spread to the liver, can ablation or other local treatments help?

For a limited number of liver metastases (five or fewer), percutaneous ablation can achieve local control with a very low risk of serious complications. Mortality after percutaneous radiofrequency ablation of liver tumors is 0.15%, compared with up to 5.8% for surgical resection. For more extensive liver involvement, intra-arterial therapies like TACE or TARE may provide survival benefits, especially in patients who respond to treatment.

What does it mean if I have 'oligo-progressive' disease?

Oligo-progressive disease means that while your systemic therapy is working well overall, one or a few liver lesions are growing. Instead of switching the systemic treatment, which may still be effective elsewhere, treating only those non-responsive lesions locally might allow you to continue the effective systemic therapy longer. This approach is still being studied and requires discussion within a multidisciplinary team.

Why is imaging follow-up needed after ablation instead of examining the tumor?

Percutaneous ablation destroys the tumor in place, so it cannot be removed and examined under a microscope to confirm complete removal. Doctors therefore oversize the ablation area, aiming for a 5 mm margin beyond the visible tumor. Imaging follow-up with ultrasound, MRI, or CT is essential to check for any residual or recurrent disease. Make sure you understand and adhere to the follow-up schedule.

Are there clinical trials testing cryoablation without surgery for early breast cancer?

Yes. The ICE3 trial is studying cryoablation in women aged 50 or over with early-stage hormone receptor-positive, HER2-negative breast cancer. Its interim analysis reported an ipsilateral breast tumor recurrence rate of only 2% at a mean follow-up of 34.83 months. The FROST trial is evaluating cryoablation without surgery and its impact on local or distant recurrence at 5 years. Enrolling in a trial can give access to treatments under study.

If I have early-stage breast cancer and cannot have surgery, or breast cancer that has spread to the liver, when should I seek a second opinion?

Seek a second opinion when surgery is not possible for early-stage disease due to comorbidities, advanced age, or personal choice, and you want to know whether cryoablation or another thermal ablation technique is appropriate; cryoablation achieved complete ablation in 85% of tumors up to 2 cm. Also seek one if breast cancer has spread to the liver and you have five or fewer lesions, or one or a few lesions growing while systemic therapy otherwise works, to review percutaneous ablation, TACE, or TARE. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

This patient-friendly article is based on peer-reviewed research.

• Original article title: J Med Imag Rad Onc - 2023 - Orsi - Interventional oncology in breast cancer