Optimisation of treatment time in ultrasound guided High Intensity Focused Ultrasound (HIFU) in the treatment of breast fibroadenomata.

Peek, Mirjam (2014) Optimisation of treatment time in ultrasound guided High Intensity Focused Ultrasound (HIFU) in the treatment of breast fibroadenomata.

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Abstract:Introduction: Breast fibroadenomata (FAD) are the most common breast lesions in woman. High intensity focused ultrasound (HIFU) is a promising non-invasive ablative technique for the treatment of these FAD. In HIFU, an ultrasound (US) beam propagates through tissue as a high-frequency pressure wave elevating the temperature within a few seconds without causing damage to the direct adjacent tissues. Two systematic reviews were performed evaluating the current evidence of HIFU and minimally invasive ablative techniques in the treatment of breast cancer. In the "HIFU in the treatment of breast Fibroadenomata" (HIFU-F) trial, circumferential HIFU treatment was performed to isolate the FAD from its blood supply. Outcome measures were volume decrease on US, short-term complication rate, decrease in treatment time and patient recorded outcome measures. Methods: Two systematic reviews were conducted following the Cochrane Handbook and STROBE statement. Patients (age ≥ 18 years) were recruited with symptomatic palpable FAD which had to be visible on US (graded either benign or indeterminate). Patients were treated using the USguided - Echopulse device (Theraclion Ltd, Malakoff, France) under local anaesthesia. Two circumferential rings of pulses were applied by deselecting the centre of the FAD. Patients were followed-up at two weeks, three, six and 12 months. Results: The systematic review demonstrated that very small studies have been conducted to HIFU and other ablative techniques. From December 2013, 25 patients with symptomatic palpable FAD underwent circumferential HIFU treatment. Nine patients opted for HIFU due to pain or discomfort. Average treatment time was 38.5 minutes (SD 12.0 minutes). Circumferential treatment significantly reduced treatment time by an average of 36.4% (SD 18.9%) (T-test, P=0.0001, two tailed). At two weeks short-term complications were erythema (n=6), ecchymosis (n=8), numbness of the skin (n=1), hypo-pigmentation (n=1), dimpling of the skin (n=1), a firstdegree skin burn (n=1) and reduced pain in 5/8 patients with resolution in two patients. At three months all local complications had resolved apart from hyper-pigmentation (n=6). Reduction of pain was seen in 7/8 patients with resolution of pain in six. Two weeks post-treatment a volume reduction of 14.3% (SD 24.9%) was seen on US and at three months the reduction was 41.7% (SD 28.6%). Conclusion: Circumferential HIFU ablation of FAD is feasible with a significant reduction in treatment time. Further patient follow-up and large prospective trials are needed to demonstrate consistent tumour and margin necrosis, reliable follow-up imaging and establish the effect of HIFU treatment.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/70748
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