The majority of specialists working in medical imaging are diagnostic radiologists, while a relatively small number practise interventional radiology, with a focus on therapy. They take advantage of their imaging skills to intervene in the treatment of patients, a good example being uterine artery embolisation for fibroids. Earlier today at the European Congress of Radiology in Vienna, there was a symposium entitled “Minimally-invasive local treatment of breast cancer: the time is now.” The moderator was Alexandra Athanasiou from Greece who set the stage by emphasising that “less is more” and asking: What is the role of the interventional radiologist in managing breast cancer?
Federica Pediconi from Italy (seen below) presented the case for tumour ablation with high intensity focused ultrasound (HIFU) in which the target tissue is selectively destroyed but thermal damage to surrounding structures is avoided. The procedure is completely non-invasive and is applied with real-time visualisation using either ultrasound – when treating benign lesions – or with magnetic resonance imaging (MRI) for malignant tumours, employing the ExAblate system from InSightec. Although treatment takes about two hours, and the equipment is expensive, Pediconi argued that her results, and those from the literature, are sufficiently encouraging for HIFU’s use to be expanded.
Another approach that utilizes high thermal damage to breast cancer cells is radio-frequency ablation (RFA), presented by Boris Brkljačić from Croatia. Performed under local anaesthesia and ultrasound image guidance, a needle is passed through the skin into the tumour and the tip is then heated to a temperature of 60o Celsius. The procedure takes only 15 to 20 minutes but is limited to small (<2 cm) cancers that are not close to the skin – to avoid thermal damage – and elderly patients who are not good candidates for general anaesthesia.
The final presentation was by Michael Fuchsjäger from Austria who spoke about a relatively new treatment modality: cryotherapy. As with RFA, a needle is introduced into the tumour under local anaesthesia and then, using argon gas or liquid nitrogen, the tip is rapidly cooled to a temperature between -180o and -40o Celsius. Using two freeze-thaw-freeze cycles, the procedure takes approximately 45 minutes and can be performed on an outpatient basis with better cosmetic results than conventional surgery.
The panel discussion at the end considered the question: How can we overcome resistance from other clinical specialists to refer eligible women to radiology? Fuchsjäger made the point that no speciality “owned” the patient and a team approach should therefore be adopted.