Cryotherapy

An Introductory Course for the Ultrasound-Experienced Surgeon

This course is designed for the physician with strong ultrasound skills, including both diagnostic and interventional experience (biopsy of lesions or marker placement), who is interested in expanding this knowledge to the field of breast cryoablation. Breast cancer genomics has provided a clearer understanding of tumor biology, allowing for a more tailored approach to patient management that includes de-escalation in of surgical approaches and adjuvant therapies. A natural evolution has been to suggest that we can identify a subset of patients with low-risk, early-stage breast cancer who could avoid surgical intervention altogether. Due to better understanding of tumor cryoablation, technological innovations of cryo-systems, and precise patient selection, cryoablation currently is considered a safe, effective, and adaptable technique. Cryoablation is particularly appealing in older patients because it can be performed in an office setting using local anesthesia, with better patient tolerance, improved cosmesis, and potential cost savings. The participant will be exposed to a refresher in ultrasound interventional skills required for proper cryoprobe placement. Didactic sessions will cover current data on cryoablation for benign and malignant disease as well touch on upcoming trial opportunities. In addition, through both didactic and hands-on modules, the participants will learn skills for accurate probe placement and freeze / thaw tissue physiology for tumor kill of benign and malignant breast lesions. The faculty will share their personal experiences of utilizing cryoablation within a surgical practice.

The workshop will have stations for practicing ultrasound guided interventional techniques. They will include Ultrasound Systems, Phantoms and either wires, marker introducers and/or biopsy needles. There will be several stations with actual Cryo systems. They will also have ultrasound systems and phantoms. The attendee will have the opportunity to place a cryo probe, understand the positioning of the probe in relationship to the lesion, based on tumor size and demonstrate accurate positioning and measurement of the cryoablation ice ball. In both station types, the skill of placement within the center of a lesion will be stressed; demonstrating the technique of 90-degree transducer rotation and measurements from the device to the edges of the lesion to document accurate placement.

At the conclusion of this course, participants should be able to:

• Summarize the data supporting the use of breast cryoablation
• Explain how cryoablation works at a molecular level
• Demonstrate ultrasound-guided cryoprobe placement and ice-ball measurements
• Discuss the results of the most recent clinical trials of cryoablation in breast cancer
• Understand the ASBrS Clinical Registry Trial and be prepared to participate