Assessment of Tumor Cell Death After Percutaneous Ultrasound– Guided Radiofrequency Ablation of Breast Carcinoma: A Prospective Study

Background: Current trends in breast cancer treatment include the use of lessaggressive surgeries to reduce morbidity, shorten hospital stays and improvecosmetic results. The aim of the study is to assess tumor cell viability afterpercutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for smallbreast cancer by a combination of staining techniques.Methods: A prospective study was conducted at a single institution from ۲۰۱۳to ۲۰۱۷. Twenty women with invasive ductal carcinoma of the breast measuring ≤۲۰ mm were treated with US-guided RFA followed immediately by surgicalresection. Tumor viability pre- and post-RFA was assessed with Hematoxylin andEosin (H&E), Nicotinamide adenine dinucleotide (NADH), Succinatedehydrogenase (SDH), Cytochrome c oxidase (COX), Terminal deoxynucleotidyltransferase dUTP nick end labeling (TUNEL) and Cytokeratin ۱۸ and ۱۹(CK۱۸/CK۱۹) staining techniques. Outcomes and correlation with the differenttechniques were evaluated with principal component analysis Cronbach’s alpha.Results: Oxidative enzymes in frozen sections showed loss of SDH and NADHin ۱۳ of the ۱۶ tumors (۸۱%) and COX in ۱۱ of the ۱۳ tumors (۸۴%). In paraffinembeddedtissues, CK۱۸ was negative or markedly reduced in ۹۸% and CK۱۹ in۱۰۰% of the cases. Lack of evidence of cell death was seen in ۳ cases where themaximum temperature achieved at the center of the tumor was ≤ ۷۰ºC. Thereliability and internal consistency between the different staining techniques washigh (Cronbach’s alpha, ۰.۸), with concordance between the staining results of theoxidative enzymes and of CK۱۸/CK۱۹.Conclusion: Loss of tumor viability in small breast tumors after US-guidedpercutaneous RFA could be assessed in our series with different staining methods.CK۱۸ and CK۱۹ could be used in paraffin-embedded tissues as surrogate markersof tumor cell viability after immediate RFA.

کلیدواژه ها:

Early breast cancer ، radiofrequency ablation ، ultrasound ، NADH-diaphorase staining ، cytokeratins