A comparative analysis of the clinical effect of multiple treatments for benign breast tumors

Abstract

Purpose

This retrospective study aimed to compare the clinical outcomes, safety profiles, and postoperative recovery characteristics of conventional open surgery, ultrasound-guided minimally invasive rotary cutting, and microwave ablation in the treatment of benign breast tumors, using historical patient data.

Methods

In total, 164 patients with benign breast tumors treated at Haidian Hospital, Beijing, from January 2020 to January 2023 were selected as study participants. Based on the treatment received by the patients, they were divided into three groups: open surgery group (87 patients treated with conventional open excision surgery), rotary cutting group (65 patients treated with Micromotion minimally invasive rotary cutting under color Doppler ultrasound guidance), and ablation group (12 patients treated with microwave ablation). Subsequently, key indicators, including operation time, intraoperative blood loss, incision length, incision healing time, postoperative pain score, incidence of postoperative complications, and aesthetic outcome of the breast, were comprehensively compared and analyzed among the three groups.

Results

Statistical analysis revealed significant differences (P < 0.05) among the groups in terms of operation time, intraoperative blood loss, incision length, incision healing time, and postoperative pain scores at 24, 48, and 72 h. Specifically, the ablation group showed significantly lower values for these parameters compared with the rotary cutting and open surgery groups. The rotary cutting group exhibited better outcomes than the open surgery group across these metrics. In addition, the incidence of postoperative complications and aesthetic outcome of the breast in the ablation and rotary cutting groups were significantly better than those in the open surgery group (P < 0.05). However, no significant differences were observed in the incidence of postoperative complications and the aesthetic outcome of the breast between the ablation and rotary cutting groups (P > 0.05).

Conclusion

Compared with conventional open surgery, microwave ablation and Micromotion minimally invasive rotary cutting under color Doppler ultrasound guidance demonstrate superior surgical outcomes, lower postoperative pain levels, and reduced incidence of postoperative complications in the treatment of benign breast tumors. Microwave ablation offers shorter operation time, less intraoperative blood loss, faster postoperative recovery, and significantly greater pain relief while providing better aesthetic outcome of the breast.

Introduction

Breast tumors are a common ailment among women, particularly affecting young females. In recent years, there has been a notable increase in the incidence of breast tumors, posing significant health challenges. Approximately 80% of breast tumors are benign, emphasizing the need for effective treatment strategies for managing this condition. Various established methods have been reported for treating benign breast tumors.^1,2 Surgery remains an indispensable component of these treatment strategies, with both conventional open excision and Micromotion minimally invasive rotary cutting under color Doppler ultrasound guidance offering distinct advantages and disadvantages. However, given the complexity of multifocal tumors that may spread throughout the breast, these approaches often fail to achieve comprehensive eradication of all lesions. Therefore, a common clinical strategy involves prioritizing the excision of larger and higher-risk tumors while closely monitoring and observing smaller remaining lesions through follow-up. In this context, microwave ablation technology has emerged as a promising novel method in the field of benign breast tumor treatment. ³ This technique employs targeted microwave energy to induce localized high-temperature effects within the tumor, leading to coagulative necrosis of tumor cells and effective tumor ablation. Microwave ablation has demonstrated significant success in treating tumors of the thyroid, liver, lungs, and other organs,^4,5 and its application in breast tumor treatment is gradually gaining popularity, offering hope for patients with multifocal breast tumors.^3,6 This study focused on exploring and comparing treatment modalities for benign breast tumors, particularly analyzing the specific outcomes and differences among conventional open excision surgery, Micromotion minimally invasive rotary cutting under color Doppler ultrasound guidance, and microwave ablation in clinical practice. Through scientific comparative analysis and comprehensive evaluation, this study aimed to provide clinicians with more precise and personalized treatment options for patients with benign breast tumors, ultimately striving for optimal therapeutic outcomes and improved prognosis.

Materials and methods

This retrospective study selected 164 female patients diagnosed with benign breast tumors who were treated at Haidian Hospital in Beijing from January 2020 to January 2023. Based on the differences in surgical approaches, these patients were divided into three groups: open surgery group (87 patients who underwent conventional open excision surgery), rotary cutting group (65 patients who underwent Micromotion minimally invasive rotary cutting under color Doppler ultrasound guidance), and ablation group (12 patients who underwent microwave ablation therapy). All study procedures were performed in accordance with the Helsinki Declaration of 1975, as revised in 2013.

Patients in the open surgery group were in the age range of 20–65 years, with a mean age of 38.05 ± 10.07 years. The tumor diameter ranged from 1.0 to 3.0 cm, with an average diameter of 1.85 ± 0.56 cm.

Patients in the rotary cutting group were in the age range of 21–65 years, with a mean age of 37.35 ± 8.94 years. The tumor diameter ranged from 0.8 to 2.5 cm, with an average diameter of 1.60 ± 0.48 cm.

Patients in the ablation group were in the age range of 23–60 years, with a mean age of 41.06 ± 11.50 years. The tumor diameter ranged from 0.5 to 2.8 cm, with an average diameter of 1.73 ± 0.54 cm.

Statistical analysis indicated that there were no significant differences among the three groups in terms of age, tumor diameter, and other general characteristics (P > 0.05).

This study has been officially reviewed and approved by the Ethics Committee of the Haidian District Hospital of Beijing under the approval number M202391. The inclusion criteria were as follows: (a) benign breast tumors confirmed via puncture pathology; (b) tumor diameter ≤3.0 cm; and (c) at least 1 cm distance between the tumor and the skin, posterior breast space, and areolar region. Furthermore, the exclusion criteria were as follows: (a) puncture pathology findings indicating malignant breast tumors or borderline tumors; (b) co-occurrence of major organ dysfunction; (c) history of breast augmentation surgery; (d) coagulation dysfunction or mental illness; and (e) pregnant or lactating women.

Instruments and equipment

The instruments and equipment used in this study were as follows:

1. Johnson & Johnson’s SCM23 Micromotion (Suzhou, China) minimally invasive rotary cutting system, equipped with Bard Medical’s ECP017GV rotary cutting needle.

2. Apogee 6300 color Doppler ultrasound diagnostic system produced by Shantou Ultrasonic Electronics Co. Ltd. (Shantou, China), with a probe frequency of 5–15 MHz.

3. MIT-5AT cold cycle microwave ablation system produced by Nanjing Great Wall Microwave System Engineering Co. Ltd. (Nanjing, China), equipped with XR-A1610W disposable microwave ablation needle. The ablation needle is 100-mm long and has a diameter of 1.4 mm and a microwave radiation frequency of 2450 MHz.

Surgical treatment procedures

Open surgery group

Conventional open excision surgery was performed among patients in this group. The patients were placed in the supine position with the affected upper limb extended toward the head. Following routine disinfection and draping, the surgery was performed after achieving satisfactory local anesthetic effect. Depending on the preoperative ultrasound localization of the tumor, either an arcuate incision around the areola or a radial incision on the tumor surface, with a length of 3–5 cm, was chosen. After excising the tumor along with 0.5-cm region of the surrounding glandular tissue, hemostasis was performed. The incision was closed layer by layer using absorbable sutures, followed by compression dressing. The specimen was then sent for pathological examination.

Rotary cutting group

In this group, treatment was performed using the Micromotion minimally invasive rotary cutting system under ultrasound guidance. Patients were placed in the supine or lateral decubitus position with the affected upper limb extended toward the head. Preoperatively, the number and location of tumors were determined using ultrasound, and puncture points were marked (typically chosen at the lower edge, outer edge of the breast, or below the areola, thereby avoiding major blood vessels). After routine disinfection and draping, local anesthesia was administered.

The incision length was 0.5 cm. Under ultrasound guidance, the rotary cutting knife was inserted immediately posterior to the breast tumor, and the rotary cutting procedure was initiated in a fan-shaped pattern. The vacuum slot of the knife was used to suction and fragment the tumor tissue and local hematoma. Once the tumor was completely excised, the rotary cutting knife was withdrawn. Typically, one tumor is excised at a time. For smaller tumors along the same path, sequential rotary cutting without withdrawing the needle may be considered.

Local compression was applied at the site of the rotary-cut tumor for 5–10 min. The incision was disinfected with iodine, covered with sterile gauze or sealed with sterile wound adhesive, and then compressed with elastic bandages for approximately 48 h. The specimen was then sent for pathological examination.

Ablation group

In this group, treatment was performed using a microwave ablation system under ultrasound guidance. Patients were placed in the supine position with the affected upper limb extended toward the head, and preoperative ultrasound localization was conducted. After routine disinfection and draping, local anesthesia was administered.

A mixture of adrenaline and saline was injected around the tumor under ultrasound guidance to create a barrier and reduce thermal damage to surrounding tissues. The microwave ablation needle was inserted along the long axis of the tumor, and the output power was set between 25 and 30 W. Each ablation session lasted 15–30 s, aiming to achieve multi-point, multi-plane ablation of the tumor until the tumor was completely covered by strong echoes and ultrasound revealed complete disappearance of blood flow signals, indicating complete tumor ablation.

Postoperatively, ice packs were applied to the surgical area to alleviate burning pain sensations.

Observation indicators

We compared several surgical and postoperative parameters, including operation time, intraoperative blood loss, incision length, and incision healing time during surgery, among the three patient groups. Additionally, we assessed the postoperative pain levels among the three groups. We used the visual analog scale (VAS) scoring method to quantify pain severity in patients at 24, 48, and 72 h postoperatively.

The VAS score ranges from 0 to 10, with higher scores indicating greater pain. The incidences of complications such as incision infection, subcutaneous hematoma, subcutaneous ecchymosis, skin damage and breast deformation were compared among the three groups within 1 month after operation. Strictly in accordance with the Harris standard, “excellent” indicated that both breasts are in a symmetrical state without obvious surgical scars; “good” indicated that there is a certain difference in appearance between both sides of the breast with no obvious surgical scar; “fair” indicated that there are obvious appearance differences, asymmetry, and obvious surgical scars on both sides of the breast; and “bad” indicated that the two breasts are significantly different, there are obvious surgical scars, and the breast is hard to touch. The 1-year follow-up data via outpatient visit showed differences in breast appearance among patients in this study. Statistical analysis was conducted using SPSS 26.0 software. Continuous variables were presented as mean ± SD. One-way analysis of variance was used for comparisons among multiple groups. For post-hoc pairwise comparisons of groups with homogeneous variances, LSD t-tests were employed; for groups with heterogeneous variances, Tamhane’s T2 tests were used. Categorical data were expressed as frequencies (percentages), and comparisons among groups were performed using the chi-square test. For statistical analysis, we set the significance level at P < 0.05 to determine whether differences were statistically significant. By integrating these analysis methods, we comprehensively assessed the changes in postoperative pain at different time points and their differences among various groups.^7,8

Results

A summary of the study findings is presented below.

The ablation group showed superiority over the rotary cutting and open surgery groups in terms of various surgical parameters, such as operation time, intraoperative blood loss, incision length, incision healing time, and hospital stay; postoperative pain scores at 24, 48, and 72 h; and postoperative complication rates. The specific findings were as follows:

1. The ablation group exhibited significantly lower operation time, intraoperative blood loss, incision length, and incision healing time compared with the rotary cutting and open surgery groups. Moreover, the rotary cutting group showed significantly lower values for these parameters than the open surgery group (P < 0.05). The detailed results are presented in Table 1.

2. The ablation group showed significantly lower VAS pain scores at 24, 48, and 72 h postoperatively compared with the rotary cutting and open surgery groups. Additionally, the rotary cutting group exhibited significantly lower pain scores than the open surgery group (P < 0.05). Detailed results are presented in Table 2.

3. The incidences of postoperative complications in the ablation (8.33%) and rotary cutting (9.23%) groups were significantly lower than that in the open surgery group (20.69%). Additionally, there was no significant difference in complication rates between the ablation and rotary cutting groups (P > 0.05). Detailed data are presented in Table 3 and Figure 1.

4. The ablation and rotary cutting groups exhibited significantly superior aesthetic outcome of the breast compared with the open surgery group (P < 0.05). However, no significant differences were observed between the ablation and rotary cutting groups in terms of postoperative complication rate and aesthetic outcome of the breast (P > 0.05), as shown in Table 4.

Table 1.

Comparison of surgical parameters among three groups of patients with benign breast tumors.

Group	Operation time (min)	Intraoperative blood loss (mL)	Incision length (cm)	Healing time (days)
Open surgery group (n = 87)	36.93 ± 12.64	15.5 ± 5.39	4.05 ± 1.05	6.85 ± 1.52
Rotary cutting group (n = 65)	29.52 ± 6.67	5.62 ± 2.98	0.55 ± 0.05	3.52 ± 1.05
Ablation group (n = 12)	18.39 ± 7.05	4.12 ± 1.51	0.32 ± 0.05	2.18 ± 1.02
F	73.465	162.365	257.162	90.835
P	<0.05	<0.05	<0.05	<0.05

Table 2.

Comparison of postoperative 24-, 48-, and 72-h pain VAS scores among three groups of patients with benign breast tumors.

Group	Postoperative 24-h VAS score	Postoperative 48-h VAS score	Postoperative 72-h VAS score
Open surgery group (n = 87)	6.12 ± 1.52	4.85 ± 1.72	3.50 ± 1.51
Rotary cutting group (n = 65)	4.21 ± 1.38	3.11 ± 1.28	2.10 ± 1.32
Ablation group (n = 12)	3.05 ± 1.21	2.05 ± 1.05	1.02 ± 0.98
F	66.732	46.664	38.675
P	<0.05	<0.05	<0.05

VAS: visual analog scale.

Table 3.

Comparison of postoperative complications within 1 month after surgery among three groups of patients with benign breast tumors.

Group	Incision infection	Subcutaneous hematoma	Subcutaneous ecchymosis	Skin damage	Mammary deformity	Complication rate
Open surgery group (n = 87)	5	4	5	2	2	20.69%
Rotary cutting group (n = 65)	0	3	2	1	0	9.23%
Ablation group (n = 12)	0	1	0	0	0	8.33%

Figure 1.

Postoperative complications in the ablation, rotary cutting, and open surgery groups.

Table 4.

Comparison of the aesthetic outcome of the breast among three groups of patients with benign breast tumors.

Group	Excellent	Good	Fair	Bad
Open surgery group (n = 87)	50	19	12	6
Rotary cutting group (n = 65)	55	5	4	1
Ablation group (n = 12)	10	1	1	0

Discussion

With improvements in the overall quality of life and the widespread implementation of health screenings, the detection rate of breast tumors has steadily increased. The mechanisms underlying breast tumor occurrence are complex and multifaceted, encompassing factors such as endocrine influences, lifestyle habits, psychological stress, and genetic predisposition. ⁹ Fibroadenomas are a common type of benign breast tumors. Despite the potential risk of malignant transformation, surgical excision has been proven to be an effective treatment method. Conventional open surgery, while ensuring effective tumor removal and reducing residual rates, imposes significant trauma on breast tissue owing to its longer surgical incision (typically ranging from 3 to 5 cm), resulting in longer postoperative recovery periods and noticeable scars, which can be challenging for younger patients to accept.

Currently, minimally invasive surgery is the mainstay of treatment for benign breast tumors. In particular, Micromotion minimally invasive excision under ultrasound guidance has become prominent in recent years.^9,10 In addition, microwave ablation under ultrasound guidance, as an emerging minimally invasive treatment technology, has gradually demonstrated its unique value in the treatment of benign breast tumors in recent years. This technique employs high-frequency electromagnetic waves to precisely ablate tumors smaller than 3 cm, causing rapid heating and coagulative necrosis of the tumor tissue upon absorption of microwave energy, ultimately achieving tumor tissue inactivation. Compared with conventional surgical methods, microwave ablation shows significant advantages in terms of ablation range and operation time. ¹¹

Microwave ablation therapy is typically performed in order of increasing power to avoid charring phenomena. ¹² Postoperatively, due to tissue inflammatory response, initial tissue edema occurs, followed by gradual softening and eventual disappearance or fibrosis of the ablated tumor.^9,12,13 The results of the current study indicated that compared with the rotary cutting and open surgery groups, the ablation group showed significantly superior performance in terms of operation time, intraoperative blood loss, incision length, and incision healing time (P < 0.05).

In clinical practice, rotary cutting surgery, owing to the need for repeated cutting of tumors, can lead to increased intraoperative bleeding and postoperative complications such as residual tumor masses.^14,15 Additionally, patients often experience discomfort or reduced comfort during the required 48-h elastic bandage compression postoperatively. Once the bandage is removed, the tumor excision site is prone to bruising and hematoma, while the bandaged area may develop adverse reactions such as blisters and rashes, increasing the psychological burden on patients. In comparison, microwave ablation therapy demonstrates significant advantages. Its treatment process does not require tissue cutting, is minimally invasive and straightforward, offers high safety, and does not cause any scarring. In particular, for multiple breast tumors, conventional surgery and minimally invasive rotary cutting often fail to achieve complete excision.^16,17 In this study, patients were followed up for 1 year postoperatively, and the results showed that “excellent” and “good” aesthetic outcomes of the breast were achieved by 100% of patients in the ablation group, 95.38% of those in the rotary cutting group, and only 79.31% of those in the open surgery group. The differences between the groups were statistically significant (P < 0.05). Further analysis showed that patients in the ablation group achieved significantly better aesthetic outcomes of the breast than those in the open surgery group; however, there was no significant difference compared with the rotary cutting group. This result suggests that both microwave ablation and gyrotomy can preserve breast aesthetics to the greatest extent, which is consistent with the findings of previous reports.^11,12,17 Based on the above findings, we can draw the following conclusions and recommendations. First, microwave ablation therapy has shown important clinical application value in the management of breast tumors. Its unique non-cutting treatment not only reduces the surgical trauma and pain of patients but also significantly improves the postoperative aesthetic outcome of the breast, which is of significance for improving the quality of life of patients and promoting postoperative psychological rehabilitation. As long incision and lengthy postoperative recovery period associated with conventional open surgery are prevented, the postoperative pain experienced by patients treated with microwave ablation is significantly reduced, and the recovery time is significantly shortened.^14,18 This not only reduces the dependence of patients on pain medications but also enables early return to normal life and work, which effectively reduces the psychological anxiety and depression caused by treatment. Therefore, when available, microwave ablation should be considered as a preferred option for breast tumor treatment. Second, although gyrotomy holds value in some aspects, such as better suitability for some specific types or sizes of tumors, the greater intraoperative blood loss, higher postoperative complications, and other problems cannot be ignored. Therefore, in clinical practice, physicians should choose the most appropriate treatment plan according to the specific situation of a patient and consider various factors comprehensively. We emphasize the importance of regular postoperative follow-ups because these enable physicians to promptly understand patient recovery, evaluate treatment effectiveness, and ensure timely management of potential problems. At the same time, follow-up data are important for evaluating the advantages and disadvantages of different treatment methods, which is crucial for guiding clinical decision. ¹⁹

In addition, microwave ablation therapy has shown considerable potential in precision medicine. Using precise, image-guided techniques, such as ultrasound or computed tomography, physicians can accurately target the tumor tissue, achieving precise ablation of the lesion while minimizing damage to the surrounding normal tissue. This highly accurate treatment approach not only improves the therapeutic effect but also reduces unnecessary tissue damage, further improving patient satisfaction and quality of life. It is noteworthy that with continuous technological advancements and growing accumulation of clinical experience, the selection of indications for microwave ablation therapy is also gradually expanding.^20,21 In addition to being suitable for the treatment of benign breast tumors, it shows a good application prospect in some early breast cancer patients. For these patients, microwave ablation may become a treatment option that involves less trauma, faster recovery, and better breast retention and aesthetics, thereby meeting patients’ dual needs for quality of life and aesthetics. ²²

Although microwave ablation offers superior cosmetic outcomes and minimal invasiveness, its limitations—particularly delayed tissue absorption and economic burden—must be weighed against the immediate lesion clearance and cost-effectiveness of rotary excision. Shared decision-making should integrate tumor characteristics, patient preferences, and socioeconomic factors. Tumor cells undergo immediate necrosis after ablation; the clearance of necrotic tissue depends on macrophage phagocytosis, which typically takes several months to 2 years, with a median absorption time of 8–12 months. During this period, approximately 15%–30% of patients may still exhibit a firm mass, potentially causing anxiety; therefore, thorough preoperative counseling is essential. Furthermore, absorption rates vary significantly among individuals owing to factors such as age, metabolic status, and lesion size, with an estimated 5%–10% risk of incomplete absorption.^11,20,23

In summary, microwave ablation therapy has established its effectiveness in the management of breast tumors owing to its unique advantages, showing significant potential in improving patients’ quality of life and enhancing treatment outcomes. With continuous technological advancement and refinement, microwave ablation therapy is expected to play an increasingly important role in the treatment of breast tumors in the future. However, the current study included a limited number of cases, and future studies that involve larger sample sizes and prolonged follow-up periods are needed to validate the current findings.

Data availability statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.