Benign breast lumps can now be treated without surgery
By Betsy C. McElfresh CONTRIBUTING WRITER

Lisa Billings/Chesterfield Observer Dr. James V. Pellicane does a follow-up visit with patient Becky Gettings of Midlothian at the Virginia Breast Center.

When Ashley Reynolds found a lump in her breast last January, she spent two nervous days waiting for her biopsy results. Thoughts of her 7-year-old daughter preoccupied her.

"All I could think about was, 'If this is cancer, what am I going to do?'" recalls Reynolds, an intensive care unit nurse at St. Francis Medical Center.

She was very relieved when she learned the tumor was benign. Because it was large and painful, she consulted with Dr. James Pellicane, founder of Virginia Breast Center, who suggested cryoablation.

Cryoablation, the use of extreme cold to kill tissue, is not new, but it is a new option for treating benign breast tumors. The process was revolutionized three years ago by a newer system, which uses liquid nitrogen instead of argon and helium gases.

"It takes less time to freeze the tumor," says Pellicane.

While 80 percent of breast biopsies reveal benign tumors indicating no cancer, lumps in the breast can be bothersome. The most common benign tumor is a fibroadenoma. Up until now, there had been two options for fibroadenomas: observation or surgical removal. Most often, fibroadenomas are removed if they are large or women just don't want a lump in their breast, notes Pellicane.

Thousands of cases of cryoablation have been performed, showing it is safe and effective, Pellicane cites. One advantage over surgery is that there is no scarring of the breast, which can alter the appearance of future mammograms. The procedure is cost effective because it is done in the office using local anesthesia and takes about 30 minutes.

Reynolds had heard of cryosurgery for other conditions, but not for treating breast tumors.

"I didn't want to have surgery, but I wanted it gone," Reynolds notes.

She was concerned about scarring and deformity from having a lumpectomy.

After cryoablation, Reynolds suffered some swelling and bruising, but it subsided quickly. At her six-month follow-up visit, the tumor had shrunk to one-eighth of its size. The incision was almost imperceptible, she adds.

Candidates for cryoablation must have fibroadenomas under 4 cm; otherwise the tumors must be surgically removed. To date, 40 patients have received cryoablation at Virginia Breast Center.

"For young women with large fibroadenomas behind the nipple, surgery increases the risk of disrupting the breast ducts, making it impossible to breast feed. Cryoablation does not do that," states Pellicane.

Before having cryoablation, the tumor requires a biopsy to prove that it is in fact benign. The doctor can then use the same incision used in the biopsy for cryoablation. Using an ultrasound, a needle is guided through the center of the tumor. Liquid nitrogen circulates through the needle at low pressure to freeze the tumor.

"It forms an ice ball that engulfs the tumor. Cryoablation damages and kills the cells, and they are absorbed by the body. It will take anywhere from six to 12 months for the fibroadenoma to be completely absorbed," explains Pellicane.

"It is a very attractive technology, but it's not the only one out there," says Dr. Harry D. Bear, director of the Breast Health Center at the Massey Cancer Center.

Other technologies use heat for destroying tumors without surgery, including radio-frequency ablation, microwave, laser and highintensity ultrasound, he adds. But, Bear does not know of anyone in Richmond performing these techniques.

Studies are under way to use cryoablation to treat breast cancer. The Virginia Breast Center was chosen as a study center to conduct Phase III trials. It is already one of nine national reference centers for the Visica cryoablation system.

Bear is also interested in these studies. Although the trials use cryoablation and freeze the cancerous tumors, they are still surgically removed rather than left in the body.

"It sounds like a potential advantage. I'm not sure how big, given that we've learned to do lumpectomies and partial mastectomies that leave good cosmetic results," Bear considers.

Women with biopsy-proven breast cancer, 2 cm or less, will be candidates for cryoablation. Patients will have an MRI before and after the tumor is frozen and removed to see how much of the cancer was destroyed.

"Potentially, cryoablation will be used to treat breast cancer as a 20-minute office procedure, with little cosmetic defect and acceptable recurrence rates," concludes Pellicane.

Reynolds believes, "If this could be an option, it would be fantastic."