Cryoablation of Axillary Lymph Node Metastases for the Curative and Palliative Treatment of Breast Cancer.

For patients who are at high risk for developing complications during or after surgery, cannot undergo surgery, or decline surgery, breast cryoablation has been performed safely and effectively for curative and palliative breast cancer treatment. Cryoablation of axillary lymph node metastases may also be performed safely and effectively and may improve oncologic outcomes (improved disease-free survival and local tumor control) without lymphedema or other significant complications. Before cryoablation, patients should be screened for neutropenia, anemia, and conditions that increase the risk of bleeding or infection. Pre-cryoablation imaging, axillary sonography with supplemental CT or MRI of the brachial plexus, is critical to maximize the likelihood of complete ablation and minimize the risk of skin, nerve, or muscle injury. The axillary lymph node cryoablation protocol is similar to the one for breast tumors and generally involves two to three freeze-thaw cycles. Destruction of tissue surrounding the lymph node is not required unless there is evidence of extranodal extension. For cryoablation of axillary lymph nodes, the best modality for imaging guidance is sonography, although CT and MRI guidance may also be utilized. After cryoablation, axillary and regional nodal ultrasound permits confirmation of technical success and monitoring for residual or recurrent disease.