Minimally invasive techniques in breast cancer treatment

Breast conservation therapy has largely replaced mastectomy as the surgical treatment of choice for early-stage breast cancer. As the sentinel lymph node mapping procedure, rather than routine axillary node dissection, becomes the standard of care, the next challenge is how to treat the primary tumor without surgery. Minimally invasive ablation of the primary tumor is possible with a variety of approaches; the goal is to either excise the tumor percutaneously or cool it (with cryotherapy) or heat it (with radiofrequency ablation (RFA), focused ultrasound, or laser interstitial therapy) sufficiently to cause complete cell death. These developing technologies may provide treatment options that are psychologically and cosmetically more acceptable to the patient than traditional therapies, but they need further investigation to prove that they are oncologically sound. This new frontier of surgery without scalpels will require surgeons to develop radiologic expertise and to acquire a basic understanding of molecular biology.