Which patients with breast nodules are suitable for microwave ablation treatment? What should be paid attention to after the operation?

Author: David, chief physician of Beijing Hospital

Reviewer: Liang Zhen, Chief Physician, Peking University Cancer Hospital

Breast nodules are very common in clinical practice. For most benign small nodules, such as nodules smaller than 1 cm, patients have no symptoms and no clinical signs. You can observe them first and then have a check-up every six months to see the development of the nodules before making a decision.

For some large benign nodules or some malignant breast nodules, active treatment is necessary, such as traditional surgery, minimally invasive excision, microwave ablation, etc. Today we will talk about microwave ablation for breast nodules.

1. What is microwave ablation therapy?

There are many ablation methods, including thermal ablation, cold ablation, and other methods such as high-energy focused ultrasound, but the most commonly used one is thermal ablation. Thermal ablation uses thermal coagulation to kill cells and seal blood vessels, making the entire nodule inactive and then gradually absorbed by the normal glandular tissue next to it.

Microwave ablation is a type of thermal ablation. The microwave ablation needle it uses is only 1.6 mm in diameter. The tip of the needle is like a household microwave oven, which can generate heat and instantly reach a temperature of 60℃-90℃.

As we all know, nodule cells are most afraid of heat. When the temperature reaches above 60℃, the cells will immediately undergo thermal coagulation and necrosis, so the effect is immediate. Moreover, the thermal coagulation range formed at the tip of the needle is very regular, it is an ellipsoid, so by using this particularly regular thermal coagulation range, effective ablation treatment of nodules can be performed.

Figure 1 Original copyright image, no permission to reprint

2. Which breast nodules are suitable for microwave ablation treatment?

First, the size of the nodule. If the nodule is very small and the patient has no symptoms, it can be observed and there is no need for treatment. So generally speaking, the diameter of the breast nodule must be more than 1 cm before microwave ablation can be considered.

Second, ablation therapy is very suitable for multiple or even bilateral breast nodules, with more than 2, 3 or 4 nodules on each side. Some patients who undergo ablation treatment may have more than 30 nodules in both breasts, and the size of the nodules may even reach 3 cm.

For breast nodules, the treatment time for a single nodule is not long. The more nodules there are, the longer the ablation time. However, for multiple nodules, the effect of microwave ablation treatment is incomparable to surgery. First, it is impossible to remove all the nodules by surgery; second, ablation is highly efficient. It only takes a few seconds to ablate a single small nodule.

Of course, if the patient desires minimally invasive treatment of nodules, even if the nodule is single, microwave ablation treatment can also be chosen.

For example, young women in their teens and twenties who have cosmetic needs may be concerned about postoperative scars. Ablation therapy does not form surgical scars, so it is very suitable for such patients. If it is a relatively large single nodule, ablation therapy can also be considered for the patient.

The fourth situation is that elderly patients with cardiovascular and cerebrovascular diseases cannot be anesthetized, so they cannot undergo traditional surgical resection. However, the tumor is relatively malignant and needs to be treated in time. In this case, microwave ablation is also very effective.

Figure 2 Original copyright image, no permission to reprint

3. What should you pay attention to after microwave ablation of breast nodules?

After microwave ablation, the first thing to do is to take care of the local breast puncture site, especially for those with multiple nodules. You may need to apply more dressings for two or three days.

Although it is a minimally invasive treatment, patients are inevitably nervous. At this time, you must try to stay in bed and rest well. And try to avoid strenuous exercise within a week, including running and playing ball.

Because the body is still in a non-normal state at this time, exercise will cause sweating, which will affect the puncture point. The main thing is to keep the puncture point dry to avoid secondary infection. So try to exercise less and rest more on the day after ablation.

Second, from the perspective of diet, because microwave ablation treatment will definitely have some impact on the body, we require patients to eat light food as much as possible three days after the operation, avoid spicy food, and eat easily digestible food.

Third, observe the body temperature. Especially after the ablation of multiple nodules, there will definitely be absorption of necrotic tissue, and in some cases, absorption heat will be generated, so check whether the body temperature has risen. Generally, if it does not exceed 38°C, no special treatment is required. Physical cooling methods, including drinking more water, urinating more, etc., can be used to lower the temperature.

Generally speaking, after about a week of recovery, the patient can basically return to normal and live a normal life.