Radiofrequency ablation for early breast cancer: from local technique to system-based surgical therapy

Radiofrequency ablation (RFA) is a minimally invasive local treatment option for selected patients with early breast cancer, with potential advantages in cosmetic preservation and reduced physical burden. Breast RFA nevertheless requires organ-specific adaptation because abundant adipose tissue, superficial tumor location, and proximity to the skin and chest wall influence electrical impedance, heat conduction, ablation geometry, and safety. A meta-analysis of 17 studies involving 399 patients and 401 lesions smaller than 2 cm reported 99% technical success, 96% complete ablation, a mean ablation time of 15.8 minutes, and a pooled complication rate of 2%; however, most studies were small, and 65.7% of patients underwent post-ablation surgical excision. More recently, the multicenter, single-arm phase 3 RAFAELO study treated 370 patients with Tis-T1 tumors measuring 1.5 cm or less and reported 98.6% 5-year ipsilateral breast tumor recurrence-free survival among 353 patients completing follow-up, with two ipsilateral recurrences. These results are encouraging but remain conditioned by strict selection, mandatory radiotherapy, protocolized surveillance, and the absence of a concurrent randomized surgical control. This review therefore frames breast RFA as a system-based local therapy rather than an isolated technical maneuver. It details causes and recognizable patterns of insufficient ablation, proposes a minimum framework for reproducible technical and reporting standardization, summarizes quantitative efficacy and safety outcomes, and emphasizes post-ablation imaging, biopsy when indicated, and predefined rescue strategies. Breast RFA should not be regarded as a universal replacement for breast-conserving surgery; its safe use requires multidisciplinary selection, reproducible image-guided execution, objective procedural documentation, structured surveillance, and prospective comparative validation.