Perfusion volume correlates, percentage of involution, and clinical efficacy at diverse follow-up survey times after MR-guided focused ultrasound surgery in uterine fibroids: first report in a Mexican mestizo population.

OBJECTIVES: To evaluate the clinical efficacy of magnetic resonance-guided focused ultrasound surgery in a Mexican mestizo population. METHODS: This retrospective study included 159 women (mean age 37 ± 6.4 years, range 22-53 years) from 2008 to 2010. Two hundred sixty-eight symptomatic uterine fibroids were treated using MR-guided focused ultrasound surgery. Parameters included initial perfused volume, final perfused volume, non-perfused volume (NPV), and treated volume ratio (TVR). Follow-up up to 15 months assessed treatment efficacy and symptomatic relief. Non-parametric statistics and the Kaplan-Meier method were performed. RESULTS: T2-weighted hypointense fibroids showed a frequency of 93.6%; isointense and hyperintense fibroids had frequencies of 5.60 and 1.1%. There was a negative correlation between NPV and age (r = -0.083, p = 0.307) and treatment time (r = -0.253, p = 0.001). Median TVR was 96.0% in small fibroids and 76.5% in large fibroids. Involution of 50% and 80% was achieved at months 6-7 and month 11, respectively. Relief of symptoms was significant (p < 0.05). CONCLUSIONS: Our data show that higher TVR attained immediately post-treatment of MRgFUS favours higher involution percentages at follow-up; however, careful patient selection and use of pretreatment imaging are important components for predicting success using MR-guided focused ultrasound surgery. KEY POINTS: • Type 1 fibroids were the most common (93.2%). • Age and treated volume were not correlated (r s = -0.215, p = 0.165). • Small fibroids achieved a higher treated volume than large (96.0% vs. 76.5%). • A 50% involution was achieved at 6-month follow-up for type-1 fibroid. • A decrease of 80% was reached at 11 months for type-1 fibroids.

[Principles and technique of magnetic resonance guided focused ultrasound surgery (MRgFUS) in the treatment of uterine fibroids]. / Principios y técnica de la cirugía con ultrasonido focalizado guiada con resonancia magnética (MRgFUS) en el tratamiento de los miomas uterinos.

Uterine fibroids are a significant source of morbidity for women of reproductive age, and can result in substantial symptoms affecting their quality of life. Definitive treatment has traditionally been a myomectomy, but increasingly women are not prepared to undergo such an invasive procedure for a benign and usually self-limiting condition. Focused ultrasound ablation is one of the least invasive treatment options outside medical therapy and does not require an anesthetic.Magnetic resonance guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging guidance for therapy and thermal feedback provided by magnetic resonance imaging. This paper provides an overview of the MRgFUS technique, including a brief description of the treatment system, guidelines for selection of patients and follow-up, and a comparison with other treatment techniques.

Radiofrequency ablation of invasive breast carcinomas: a phase II trial.

BACKGROUND: Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We conducted a phase II trial to evaluate radiofrequency ablation (RFA) of invasive breast carcinomas. METHODS: Consecutive patients from two Mexican Institutions with invasive breast cancers < 4 cm, with no multicentric tumors and no previous chemotherapy were included in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RFA electrode followed by surgical resection. Routine pathologic analysis and viability evaluation with NADPH-diaphorase stain were performed to assess tumor ablation. Procedure-associated morbidity was recorded. RESULTS: Twenty-five patients were included. Mean patient age was 55.3 years (range 42-89 years). Mean tumor size was 2.08 cm (range 0.9-3.8 cm). Fourteen tumors (56%) were < 2 cm. The mean ablation time was 11 minutes using a mean power of 35 W. During ablation, the tumors become progressively echogenic that corresponded with the region of severe RFA injury at pathologic examination. Of the 25 patients treated, NADPH stain showed no evidence of viable malignant cells in 19 patients (76%), with significant difference between tumors < 2 cm (complete necrosis in 13 of 14 cases, 92.8%) vs. those > 2 cm (complete necrosis 6 of 11 cases, 54.5%) (P < .05). No significant morbidity was recorded. CONCLUSIONS: RFA is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.

Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation.

BACKGROUND: It is important to optimize the localization technique for non-palpable breast lesions. METHODS: One hundred consecutive women with non-palpable breast lesions were randomized to radioguided occult lesion localization (ROLL) or wire localization (WL). For ROLL technique (99m)Tc-labeled particles of human serum albumin were injected under breast-imaging control. Localization of the lesion was done in the operating room with the aid of a gamma-probe. All lesions were identified in an X-ray control of the surgical specimen. Categorical variables were analyzed with the Chi-square method. Significance was considered at P < 0.05. RESULTS: All procedures were performed on the same day of excision, on ambulatory basis. Both techniques resulted in 100% retrieval of the lesions. Localization time was reduced with ROLL (P < 0.001). Clear margins were achieved in 88.9% ROLLs and 62.5% WLs (P < 0.05) reducing the requirement of re-excision. There were significant differences in the subjective ease of the procedures in favor of ROLL technique as rated by surgeons and radiologists. CONCLUSIONS: ROLL technique is as effective as WL for excision of non-palpable breast lesions, reduce localization time and probably the incidence of pathologically involved margins of excision. ROLL appears to improve the learning curve for surgical residents and cosmesis. ROLL is an attractive alternative to WL.