Image-guided Percutaneous Ablation of Small Breast Cancer: Which Technique is Leading the Pack?

In the past few decades, the surgical treatment of early breast cancer has evolved from radical mastectomy to breast conservation surgery and the current practice of segmental mastectomy and radiotherapy. As these less invasive techniques have gained acceptance with excellent long-term rates of local-regional control, there has been a growing interest in the surgical community in techniques to ablate the primary tumor percutaneously with the ultimate goal of omitting the need for surgical excision of the primary tumor. There are two basic categories of techniques that are used to physically destroy the breast tumor in situ: 1) those that heat up the tumor to a sufficient tempera-ture during a prescribed time sequence to achieve the denaturation of proteins and result in coagulation necrosis that will encompass the entire tumor (thermal therapy) and 2) those that freeze the tumor long enough to achieve cell death (cryotherapy). Recently, however, irreversible electroporation, which uses a dif-ferent physical approach and can be compared to the “electrocution ” of the tumor, has been introduced in the arena of percutaneous ablation techniques. Irreversibl