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First Report of an Emerging Technology

Stefanie S. Jeffrey, MD; Robyn L. Birdwell, MD; Debra M. Ikeda, MD; Bruce L. Daniel, MD; Kent W. Nowels, MD; Frederick M. Dirbas, MD; Stephen M. Griffey, DVM, PhD

Arch Surg. 1999;134:1064-1068.

Hypothesis  Radiofrequency (RF) energy applied to breast cancers will result in cancer cell death.

Design  Prospective nonrandomized interventional trial.

Setting  A university hospital tertiary care center.

Patients  Five women with locally advanced invasive breast cancer, aged 38 to 66 years, who were undergoing surgical resection of their tumor. One patient underwent preoperative chemotherapy and radiation therapy, 3 patients received preoperative chemotherapy, and 1 had no preoperative therapy. All patients completed the study.

Interventions  While patients were under general anesthesia and just before surgical resection, a 15-gauge insulated multiple-needle electrode was inserted into the tumor under sonographic guidance. Radiofrequency energy was applied at a low power by a preset protocol for a period of up to 30 minutes. Only a portion of the tumor was treated to evaluate the zone of RF ablation and the margin between ablated and nonablated tissue. Immediately after RF ablation, the tumor was surgically resected (4 mastectomies, 1 lumpectomy). Pathologic analysis included hematoxylin-eosin staining and enzyme histochemical analysis of cell viability with nicotinamide adenine dinucleotide–diaphorase (NADH-diaphorase) staining of snap-frozen tissue to assess immediate cell death.

Main Outcome Measure  Cancer cell death as visualized on hematoxylin-eosin–stained paraffin section and NADH-diaphorase cell viability stains.

Results  There was evidence of cell death in all patients. Hematoxylin-eosin staining showed complete cell death in 2 patients. In 3 patients there was a heterogeneous pattern of necrotic and normal-appearing cells within the ablated tissue. The ablated zone extended around the RF electrode for a diameter of 0.8 to 1.8 cm. NADH-diaphorase cell viability stains of the ablated tissue showed complete cell death in 4 patients. The fifth patient had a single focus of viable cells (<1 mm) partially lining a cyst. There were no perioperative complications related to RF ablation.

Conclusions  Intraoperative RF ablation results in invasive breast cancer cell death. Based on this initial report of the use of RF ablation in breast cancer, this technique merits further investigation as a percutaneous minimally invasive modality for the local treatment of breast cancer.

From the Departments of Surgery (Drs Jeffrey and Dirbas), Radiology (Drs Birdwell, Ikeda, and Daniel), and Pathology (Dr Nowels), Stanford University School of Medicine, Stanford, Calif; and the Comparative Pathology Laboratory, School of Veterinary Medicine, University of California, Davis (Dr Griffey). Dr Ikeda has stock in a venture capital corporation that has a small amount of stock in RadioTherapeutics Corp, Mountain View, Calif.

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