In Review | Interventional Radiology Programme | Oncology | Breast Cancer
CT-Guided Cryoablation for Breast Cancer: A Minimally Invasive, Image-Guided Approach
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CT-guided cryoablation offers a safe, minimally invasive treatment option for breast cancer, showing promise in both curative and palliative settings.
This article is a summary and review of a recent study published in the journal Cancer. It does not constitute original research, nor is it intended to replace or replicate the original study. Unless otherwise referenced, all information presented remains the intellectual property of the original authors. For full details and context, readers are encouraged to access the original publication and consult the complete disclaimer information.
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Cancer rates in South Africa are expected to almost double between 2019 and 2030.1. Breast cancer remains the most prevalent cancer among women, and the incidence has been steadily increasing over the last 20 years.2
This global pattern is mirrored in countries like Germany, the setting for our next study, where over 70,000 new breast cancer cases are diagnosed each year.3
The growing burden of disease highlights an urgent need for therapeutic approaches that are both effective and well-tolerated, particularly for patients who are not suitable for surgery or who opt out of operative treatment.
As clinical interest in less invasive options continues to expand, cryoablation (CA) has gained momentum as a viable, image-guided technique for treating breast cancer. This technique offers several advantages over conventional therapies — notably reduced procedural morbidity, no requirement for general anaesthesia, and favourable cosmetic outcomes.
However, while cryoablation is already widely used in the treatment of tumours of the liver, kidneys, and lungs, its application in breast oncology is still relatively novel, with many existing studies focused on early-stage or small-volume disease.
The role of cryoablation in more complex clinical scenarios, such as patients with larger or multiple tumours, or those with metastatic disease, remains under active investigation.
Against this background, this retrospective, single-centre study conducted at University Hospital Frankfurt explored the use of CT-guided cryoablation using a liquid-nitrogen-based system to enhance the clinical evidence supporting its use as a therapeutic option in the broader population
This study, by Vogl and Bielfeldt et al., evaluated not only procedural safety and local control outcomes but also provided valuable insights into progression-free and overall survival, making a compelling case for the role of image-guided cryoablation as a viable component of modern breast cancer care.
Let's take a Closer Look
Between May 2019 and May 2023, the researchers reviewed a series of patients treated with cryoablation (CA) for breast cancer at the University Hospital Frankfurt.
This cohort consisted of women over the age of 18 who either could not undergo surgery due to their overall health condition or who had declined operative treatment.
To be eligible, patients presented with three or fewer breast tumours, each measuring less than 4 cm in diameter, with no evidence of skin infiltration. Crucially, all target lesions needed to be clearly visible on computed tomography to allow for precise probe placement and monitoring during ablation.
Patients were not considered for CA if they had ongoing local or systemic infections, significant bleeding disorders, an allergy to local anaesthesia, or were experiencing unstable cardiovascular or respiratory conditions.
The final cohort included 45 female patients, the mean age of whom was 55.6 years (range 31.3–86.0)
For those with multiple tumours, ablation was performed in staged sessions, ensuring each lesion was individually targeted and treated. This careful selection process was essential to ensure patient safety and maximise the effectiveness of this minimally invasive technique
The Cryoablation Procedure
In this study, all procedures were performed utilising liquid nitrogen (LN) to form the ice ball required to freeze and destroy tumour tissue. It should be noted, however, that argon gas is more commonly used in South Africa,
Prior to ablation, high-resolution breast MRIs were obtained, including T1-, T2-weighted, diffusion-weighted, and contrast-enhanced dynamic sequences, to precisely locate tumours.
A planning CT scan was first conducted to determine the optimal entry point and trajectory of the cryoprobe, ensuring coverage of the full tumour volume. The cryoprobe was inserted percutaneously through a small incision under local anaesthesia.
Once placed inside the tumour, the CA cycle included an initial freeze cycle, followed by passive thawing, and a second freeze cycle, monitored continuously via CT imaging. When necessary, hydrodissection with sterile saline was performed to create a buffer between the tumour and nearby structures (e.g., skin or chest wall), minimising thermal injury.
Where the first freeze cycle lasted longer than five minutes, a dewar refill was performed before the second cycle. After completion, warm nitrogen gas was circulated through the probe to thaw the tissue and enable probe removal. To be effective, the ice ball extended at least 5 mm beyond the tumour margin in all directions.
The entire procedure was conducted in an outpatient setting, with patients typically being discharged the same day after undergoing short observation and receiving pain management.
A follow-up MRI was performed within 24 hours to assess the completeness of the ablation. Contrast-enhanced scans helped detect any residual enhancing tissue, which triggered a repeat ablation. Ongoing surveillance imaging was scheduled at 3, 6, 9, and 12 months, and biannually thereafter. CT imaging was used to assess for distant metastasis.
Results: Efficacy, Safety, and Outcomes
In total, 56 procedures were carried out on 56 tumours in the 45 patients. Patients presenting with multiple tumours underwent staged ablations on separate occasions.
Among the cohort, 11 tumours were recurrences following prior surgery, radiotherapy, or systemic therapy. Additionally, nearly half of the patients (21/45) had metastatic disease at the time of treatment, with the majority of those (86%) showing axillary lymph node involvement.
Tumour size at baseline was modest, with a mean diameter of 1.6 cm (range: 0.7–3.7 cm). Most lesions (82%) were 2 cm or smaller, and the average tumour volume treated was 2.3 mL.
This aligns with the study’s focus on early-stage or small-volume disease, particularly in patients unsuitable for or unwilling to undergo surgery.
The cryoablation itself was highly standardised. The two-cycle freeze-thaw approach resulted in predictable and effective ice ball formation. Notably, the second ice ball was larger than the first — a phenomenon attributed to reduced tissue perfusion following the initial freeze. The average cumulative freezing time was 16.6 minutes.
Post-procedure MRIs revealed a mean ablation zone diameter of 5.3 cm, which then showed a marked volume reduction of over 69% at 3 months, and over 80% on longer-term imaging.
As for long-term outcomes, local tumour progression (LTP) occurred in 4 patients (8.9%), intramammary distant recurrence (IDR) in 6 (13.3%), and extramammary progression (ETP) in 7 (15.6%).
Patients without metastases at baseline accounted for only a minority of these recurrence events.
The mean overall survival (OS) was 4.13 years, while progression-free survival (PFS) averaged 2.5 years. At 12 months, the local progression-free survival (PFS) rate remained a promising 80%.
New Perspectives
This study offers insight into the use of CT-guided cryoablation (CA) for treating breast tumours in a diverse patient population, including individuals with prior oncologic treatments and those with metastatic disease.
Across the 56 ablation procedures performed, the study recorded a 100% complete initial ablation rate, with no procedure-related complications or adverse events reported. This finding underscores the safety of CT-guided cryoablation when performed in a controlled, image-guided environment. One notable aspect of the study cohort was its clinical heterogeneity. A significant proportion of patients had received previous therapies, including surgery, radiation, or systemic treatments, and nearly half presented with metastatic disease.
Despite these factors, the outcomes were promising.
Local tumour progression (LTP) occurred in only 8.9% of cases, while intramammary distant recurrence (IDR) and extra-mammary progression (ETP) were observed in 13.3% and 15.6% of patients, respectively. These recurrence rates are considered acceptable given the advanced or complex disease profiles of many patients treated.
The absence of systemic side effects, minimal recovery time, and the outpatient nature of the procedure further highlight its suitability for frail or elderly populations, as well as for patients with limited options or who decline surgery. The mean overall survival (OS) was 4.13 years, while progression-free survival (PFS) averaged 2.5 years. At 12 months, the local PFS rate remained a promising 80%.
Cryoablation’s technical characteristics—such as the ability to monitor ice ball formation in real-time, the absence of general anaesthesia, and the relatively short treatment times—make it an appealing option in multidisciplinary care settings. The average ice ball size of 4.3 cm was adequate for most tumour volumes encountered, and hydrodissection provided an effective safeguard when treating lesions near the skin or chest wall.
In relation to the recurrence rates, which were slightly higher than those previously reported, the researchers attribute that to the broader inclusion criteria used in the study. Specifically, that enrolment was not limited to tumours under 2 cm or to non-metastatic disease, reflecting a more real-world application of CA.
Importantly, this study did not include histopathologic correlation via surgical excision, a common approach in many cryoablation studies. However, the researchers posit that the imaging-based follow-up protocol, combined with high-resolution MRI, provided robust surveillance and enabled the timely identification of incomplete ablation or recurrence.
Taken together, the results suggest that CT-guided cryoablation is a safe, well-tolerated, and effective technique for treating both early-stage and recurrent or metastatic breast tumours in appropriately selected patients.
Further prospective studies will help refine patient selection criteria, long-term outcomes, and the optimal role of cryoablation in the evolving breast cancer treatment landscape
What the Panel Says
Dr Gareth Bydawell
Breast cryoablation is poised to become a safe and effective treatment option for early-stage breast cancer, especially in patients for whom surgery is not ideal. While the study employed liquid nitrogen, argon gas is more commonly used in settings such as South Africa, so this detail may not be universally applicable and should be presented within a broader context.
Dr Dale Creamer
The use of cryoablation in complicated breast cancer cases where surgery is either declined or contraindicated provides another tool in the armamentarium of the oncologist to provide local control of disease. This is further proof that there are always options, and when you face difficulty, consulting your friendly interventional radiologist can provide valuable assistance.
This article is one of three articles in this CPD series.
To complete your CPD points, you should read all three articles and complete the associated CPD questionnaires. Please remember to Log-in access the Questionnaire.
Original Study
Vogl TJ, Bielfeldt J, Kübler U, Adwan H. CT-Guided Percutaneous Cryoablation of Breast Cancer: A Single-Center Experience. Cancers. 2024; 16(13):2373. https://doi.org/10.3390/cancers16132373
1.Finestone, E., & Wishnia, J. (2022). Estimating the burden of cancer in South Africa. SA Journal of Oncology, 6(1). https://hdl.handle.net/10520/ejc-sajo_v6_i0_a220
2. Ismail, S. (2021). Radioguided occult lesion localisation (ROLL) as a diagnostic and therapeutic procedure: Clinical review at a single tertiary hospital in South Africa [Master's thesis, Cape Peninsula University of Technology]. Cape Peninsula University of Technology Institutional Repository. https://etd.cput.ac.za/handle/20.500.11838/3618
3. Katalinic, A.; Eisemann, N.; Kraywinkel, K.; Noftz, M.R.; Hübner, J. Breast Cancer Incidence and Mortality before and after Implementation of the German Mammography Screening Program. Int. J. Cancer 2020, 147, 709–718 https://doi.org/10.1002/ijc.32767
Article Information
Published on MedED: 27 May 2025
Type of article: Clinical Review CPD Series
MedED Catalogue Reference: MMERD002
Category: Interventional Radiology
Cross Reference: Oncology, Women's Health
Keywords: breast cancer, CRYO, RFA, guided imagery
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