Figure 2.

(a) US- guided cryotherapy for local control. Left image, BC performed with two cryoprobes (curved arrow) and a thermocouple (straight arrow) for an irregular 2.0-cm mass using technique planning noted in Figure 1b for tumors closer to the chest wall. As this was our second patient, this procedure also highlighted the need for better circumferential posterior visualization of the iceball near the chest wall, which was better provided with CT guidance. Middle image, Axial US image through the largest portion of the irregular mass shows more posterior placements of cryotherapy probes (curved arrows) and cross-section of a thermocouple en route to the superior tumor (straight arrow). Despite the cancer being near the chest wall, its medial location gave it a relatively superficial position for good US visualization. Right image, sagittal US image shows the posterior course of a thermocouple, which measured −57°C after ~8 minutes of the second freeze cycle at the superior tumor margin. The mobile nature of this tumor allowed substantial retraction off the chest wall in addition to saline injection. (b) MR images obtained before and four weeks after cryotherapy for local control. Left image, axial T1-weighted MR image obtained before cryotherapy at a similar tumor level as in Figure 2a. The tumor is causing retraction but does not involve the skin. Right image, MR image obtained four weeks after cryotherapy shows a low-signal-intensity rim of edema (black arrows) surrounding an ovoid zone of avascular necrosis that extended approximately 1 cm beyond all visible tumor margins but without extension into the chest wall. The wheelchair-bound patient, who was not a candidate for surgery, continued to do well with tumor involution of the primary and no further progression of distant metastases on anastrozole (Arimidex; AstraZeneca Pharmaceuticals, Delaware City, Delaware) alone until her death two years later.