Background: Image guided cryoablation is an emerging therapeutic technique for the treatment of breast cancer and is an effective alternative to surgery in select cases. Several tumor features impact efficacy of cryoablation, underscoring the importance of follow-up imaging in this patient population. Contrast-enhanced mammography (CEM) is a more recently developed imaging modality with increasing utilization in both screening and diagnostic settings. CEM may provide utility for imaging in the post-cryoablation setting due to high sensitivity for tumor detection and advantages in positive predictive value, time, cost, eligibility, and accessibility compared to contrast-enhanced MRI.
Learning Objectives: 1. Describe basic principles of cryoablation for breast cancer and novel use of CEM in the post-cryoablation setting. 2. Summarize advantages and disadvantages of CEM for follow-up imaging post-cryoablation compared to alternative imaging modalities. 3. Analyze expected post-procedural CEM findings and specific findings suggestive of residual or recurrent tumor. 4. Demonstrate appropriate utilization of the recently published CEM-specific Breast Imaging Reporting and Data System (BI-RADS) lexicon supplement in the interpretation of post cryoablation imaging.
Abstract Content/Results: An illustrative, case based, pictorial review from a large cancer center demonstrating our experience with delivery of image-guided cryoablation for the treatment of breast cancer as well as the utilization and interpretation of CEM in serial post-ablation imaging follow-up. Five cases will be shown, incorporating conventional mammographic, sonographic and MRI correlation, as well as multiple time points to achieve the learning objectives. Specific structural outline as follows: 1. Background a. Ultrasound guided cryoablation- basic procedural overview, indications/contraindications, advantages/disadvantages b. CEM- basic technical and reporting principles 2. CEM imaging findings after cryoablation a. Expected initial imaging findings b. Expected evolution of imaging findings c. Imaging findings worrisome of residual, new, or recurrent disease d. BI-RADS assessment post-cryoablation utilizing the CEM-specific BI-RADS lexicon supplement 3. Benefits and limitations of CEM for post-cryoablation imaging follow-up a. Comparison to mammography, ultrasound, and contrast-enhanced MRI b. Role of serial imaging follow-up
Conclusion: CEM is a feasible way to monitor patients post-procedurally for residual or recurrent disease following image guided cryoablation of breast cancer and has several advantages compared to alternate modalities. By presenting expected and suspicious imaging findings on CEM in the post-cryoablation setting, we will educate radiologists to interpret CEM exams in this unique setting.
