Cryoablation – then and now

Dr Cassandra Mbanje shares the history and development of cryoablation and how modern-day cryoablation fits into breast cancer management.

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Cryoablation aka cryotherapy or cryosurgery sounds like something out of a futuristic science fiction movie. In truth, it actually dates back to the 19^th century, with local applications of cooling used to manage pain and treat advanced cancers. Even so, the use of the cold to treat injuries and inflammation goes back even further to the ancient Egyptians in 2500 BCE.

Modern-day cryoablation

The current definition of cryoablation is that of a procedure in which an extremely cold liquid or an instrument called a cryoprobe is used to freeze and destroy abnormal tissue.

This more modern approach is a result of a collaboration between physician, Dr Irving Cooper, and engineer, Arnold Lee. Together, they developed the cryosurgical probe that has served as a baseline model for all subsequent cryoprobe models. Further, the cold liquid used to freeze abnormal tissue is typically liquid nitrogen. The commonly used nitrogen spray device used today was first developed by a dermatologist, Dr Douglas Torre, in 1965, and further modified to a handheld spray device, in 1968, by Dr Setrag Zacarian.

Breast cancer

With regards to breast cancer specifically, cryoablation is an alternate procedure to surgery. Typically, the cryoablation procedure is performed following local numbing of the skin and breast. Under ultrasound guidance, a hollow 10-gauge probe is precisely positioned within the tumour. Liquid nitrogen flows from the console via tubing to the probe. The probe is a closed system that is insulated except for a short segment close to the tip. This area gets so cold that the tissue around the probe freezes and an ice-ball forms. Provided that the uninsulated or uncovered part of the probe is at the centre of the tumour, the tumour itself will be entirely engulfed by ice. The ice-ball needs to be large enough to surround the tumour and still have a 1cm margin. Two 10 to 13-minute cycles of freezing and thawing result in cellular death within the ice-covered lesion.

Soon thereafter, the tumour and adjacent tissue form fat necrosis that resorbs over a period of months. In more simple terms, the breast tumour is surrounded by a ball of ice that is so cold that it essentially kills the cancer cells it surrounds. This ball of ice then breaks down over time.

Eligible candidates

This may sound scary and unbelievable, but many global studies over the past decade have confirmed successful outcomes. However, as with all other forms of breast cancer management, there are conditions to be met for cryoablation to be an appropriate treatment option.

So, who exactly qualifies for this procedure? Simply put, patients who present with early stage, hormone receptor positive breast cancer of 1.5cm or less. At the Breast Care Centre of Excellence (BCCE), we have successfully provided this treatment to patients with tumours of up 2.5cm.

Benefits of cryoablation

For those who meet the criteria, benefits include the non-requirement for hospital admission as it’s an in-office procedure; there is no need for sedation; there is a marked reduction in post-treatment pain; and, of course, this is a minimally invasive procedure.

An additional benefit that varies in level of importance with each person is the satisfying aesthetic result.

Possible complications

However, as with any treatment, there are also possible complications. These include retained fat necrosis, infection, breast pain, swelling, skin discolouration, frostbite, and skin burns. That being said, across various studies and within the BCCE, reported complications have been minor.

Not a stand-alone treatment

Cryoablation isn’t the be-all and end-all treatment. That is, it should be accompanied by appropriate endocrine-or immunotherapies. Still, it can have a significant positive future impact on breast cancer care with more long-term research and greater accessibility.

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