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    Research Grants Awarded

    Breast Magnetic Resonance Assessment of Tumor Viability After Radiofrequency Ablation

    Study Section:
    Detection, Diagnosis and Prognosis

    Scientific Abstract:
    Background: Breast conservation (lumpectomy and radiation) is possible for most patients with breast cancer. However, some women experience unwanted side effects of lumpectomy including pain, infection, wound problems, and cosmetic deformity. Radiofrequency ablation (RFA) is a minimally invasive in vivo ablative treatment that has been used to treat a variety of tumors. The major limitation of RFA for breast cancer is determining the completeness of tumor ablation using standard imaging techniques. Magnetic resonance imaging (MRI) of the breast is being used increasingly in the clinical setting because of its high sensitivity. Objective/Hypothesis: In this proposal, breast cancer patients will be studied with high-field (4 T) MRI before and after RFA. The investigators have developed novel methods of determining tumor viability that utilize dynamic susceptibility contrast-enhanced (DSC) MRI. Three quantitative parameters will be measured from the post-RFA MR data: percent enhancement (PE) and signal enhancement ratio (SER) from the DCE-MRI scans, and maximum signal intensity change ( ? SI max ) from perfusion-based DSC-MRI scans. Specific Aims: The aims of this study are: 1) to determine the percentage of patients whose tumors will undergo complete tumor necrosis after RFA and 2) to determine the sensitivity and specificity of high-field DSC-MRI for detecting residual cancer post-RFA. Study Design: Eligible breast cancer patients will undergo MRI before and after RFA. RFA will be performed by an experienced surgeon and breast radiologist in an outpatient clinic. After the post-RFA MRI, patients will undergo standard breast cancer treatment (mastectomy or lumpectomy). The histologic findings will be compared to the MRI images to determine the ability of DSC-MRI to predict tumor viability after RFA. Thirty patients will be recruited over 2 years. Potential Outcomes and Benefits of the Research: If DSC-MRI can determine the completeness of tumor necrosis after RFA ablation, then minimally invasive treatment may be feasible for more breast cancer patients. In addition, the techniques described in this research may be applicable to other clinical situations such as: 1) determining tumor viability after cryosurgical ablation of breast cancer, 2) determining tumor viability after preoperative chemotherapy, and 3) determining residual cancer after lumpectomy in patients with close or positive surgical margins.

    Lay Abstract:
    Background: Most patients with breast cancer can receive lumpectomy instead of mastectomy. However, some women experience unwanted side effects of lumpectomy including pain, infection, wound problems, and cosmetic deformity. Radiofrequency ablation (RFA) is a minimally invasive treatment that utilizes heat to kill tumor cells and may replace lumpectomy for some breast cancer patients. The major limitation of RFA for breast cancer is determining whether all cancer cells have been destroyed by the procedure. Magnetic resonance imaging (MRI) of the breast is being used increasingly in the clinical setting because of its high sensitivity to detect small cancers. Objective/Hypothesis: In this proposal, breast cancer patients will be studied with a high-field MRI before and after RFA. The investigators have developed novel methods of determining tumor viability with MRI. Three quantitative parameters will be measured from the post-RFA MRI to determine whether all breast cancer cells were destroyed. Specific Aims: The aims of this study are: 1) to determine the percentage of patients whose tumors will undergo complete tumor necrosis (killing) after RFA and 2) to determine the sensitivity and specificity of high-field MRI for detecting residual cancer after RFA. Study Design: Eligible breast cancer patients will undergo MRI before and after RFA. RFA will be performed by an experienced surgeon and breast radiologist in an outpatient clinic. After the post-RFA MRI, patients will undergo standard breast cancer surgery. The microscopic findings will be compared to the MRI images to determine the ability of MRI to predict tumor necrosis after RFA. Thirty patients will be recruited over 2 years. Potential Outcomes and Benefits of the Research: If MRI can accurately predict complete tumor necrosis after RFA ablation, then minimally invasive treatment may be feasible for more breast cancer patients. In addition, the techniques described in this research may be applicable to other clinical situations such as: 1) determining tumor viability after cryosurgical ablation of breast cancer, 2) determining tumor viability after preoperative chemotherapy, and 3) determining residual cancer after lumpectomy in patients with close or positive surgical margins.