(a) MR images obtained before (Pre) and six weeks
after (Post) cryotherapy of multifocal left upper outer
quadrant cancer. Left image, T1-weighted axial image shows the spiculated,
1.6-cm dominant mass in the left outer quadrant (arrow). Another
biopsy-confirmed cancer in the same quadrant was seen in different image planes.
Middle image, fat-subtracted T1-weighted image obtained after the administration
of gadolinium shows brisk tumor enhancement. Right image, T1-weighted,
fat-subtracted, gadolinium-enhanced MR image obtained six weeks after
cryotherapy shows a rim of enhancement corresponding to a healing cryotherapy
rim, which also covered the other cancer. The microlumpectomy sampling (ie,
Mammotome removal) of the tumor region before initiation of the freeze made our
first BC procedure more complex. US visualization of the tumor site became
distorted by blood during the vacuum-assisted biopsies, which are no longer
used. Despite poor visualization of any remaining tumor margin, thorough
ablation margins were still achieved by placing the cryoprobes along the outer
margins of these microlumpectomy sites. Biopsy of three slightly nodular areas
of rim enhancement showed no residual cancer or DCIS. (b) Images
obtained at five-year follow-up. Top left image, T1-weighted axial MR image
shows minimal scarring and/or distortion at the cryosite (arrow). Slightly
smaller left breast was initially present and lateral scar indentation
(arrowhead) is a scar from abscess débridement performed one year before
this study (ie, four years after cryotherapy), which also confirmed no residual
tumor throughout the original cryotherapy site. Bottom left image, T1-weighted
fat-subtracted, gadolinium-enhanced MR image shows no enhancement of the
previous ablation and subsequent resection sites (arrow). Right image,
compression mammogram of the left upper outer quadrant shows no mass effect and
minimal scarring, likely related to resection one year ago rather than original
cryotherapy five years ago.