Imaging in Interventional Radiology: Breast Cryoablation

The approach to breast cancer diagnosis and treatment has evolved significantly in recent years. Overall, there has been a shift away from aggressive surgical interventions, such as radical breast mastectomies and complete lymph node dissections, toward lumpectomies and sentinel node sampling.[1] Specifically for older patients with lower-risk cancers, less aggressive approaches and de-escalation therapies are being considered more frequently.[2] As a result, there have been more investigative efforts and interest in locoregional treatments of breast cancers, such as radiofrequency ablation,[3] cryoablation,[4] [5] high-intensity focused ultrasound,[6] and microwave ablation.[7] Of these, cryoablation is one of the most studied modalities and holds great promise for breast cancer treatment in the future.

Cryoablation uses either liquid nitrogen or argon gas to create freezing and thawing cycles within targeted tissue to induce cellular death.[8] The mechanism of cellular injury occurs through direct and indirect means. Direct injury results as osmotic shifts during a first freeze allow fluid efflux, cell shrinkage, and the formation of ice crystals within cells, which damage organelles and the cell membrane.[8] This is followed by a passive thaw, during which the intracellular compartment becomes hypertonic, and the intracellular fluid shift causes the cell to burst.[8] [9] By contrast, indirect injury occurs as a result of microvascular ischemia as ice crystals form within the blood vessels and lead to endothelial damage. Ischemia causes an inflammatory response, vascular permeability, tissue edema, and, subsequently, an immunologic response.[8] [9] [10]

The typical breast cryoablation procedure can be performed in less than 45 minutes and in an outpatient setting. Real-time image guidance is used to localize the primary lesion and accurately target the cancer percutaneously, typically only requiring local anesthetic. In contrast to standard more invasive interventions, breast cryoablation allows for quicker recovery times, better cosmetic outcomes, and decreased pain postprocedurally. Consequently, patients experience increased quality of life and decreased financial burden.[11]

Imaging remains a crucial component in the preprocedural workup, intraprocedural guidance, and postprocedural follow-up to monitor for cancer recurrence. In this article, we will highlight the different imaging modalities used during these different phases of care, as well as the benefits and limitations each has when utilized for percutaneous treatment via cryoablation.

Publication History

Article published online:
27 March 2025

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