Cryoablation

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Breast cryoablation is a minimally invasive technique that uses ultra-cold temperatures to destroy the breast tumor by freezing. It is performed in the office under ultrasound guidance and local anaesthesia. Recovery time is short, making the procedure comfortable and convenient for patients.

How is Breast Cryoablation performed?
Under Ultrasound guidance, a thin, needle-like cryoprobe is inserted into the targeted tissue.
Ultra-cold liquid nitrogen is passed into the cryoprobe in a closed loop system and an ice ball begins to form around the tumor. A freeze-thaw-freeze cycle is performed to ensure maximum tumor destruction. After the last thaw step, the cryoprobe is extracted and a small steri-strip or band-aid is placed over the small incision. Over time the necrotic debris of the destroyed tumor is removed by the body through natural processes.

Is this a new technique?
Cryoablation has been used for many years to treat liver, kidney, skin, and cervical cancers, as well as benign tumors within the breast. Its use in treating breast cancer is relatively new but preliminary results from several ongoing studies suggest that cryoablation may be an effective treatment for breast cancer, as an alternative for lumpectomy/surgery.

Who can have cryoablation?
Most cryoablation trials have included women with invasive ductal carcinoma which is less than 2cm, Estrogen and Progesterone receptors positive and Her-2 neu negative. Although, there are no conclusive studies showing the effectiveness of cryoablation in the treatment of breast cancers greater than 2 cm, non-hormone dependent breast cancer (like triple negative breast cancer), Her 2 neu positive breast cancer, non-invasive breast cancer (ductal carcinoma in situ or DCIS), or invasive lobular breast cancers, if the cancerous area can be clearly seen by Ultrasound and is confined to a specific area delineated well by imaging, there is a reasonable expectation that it could be accurately targeted and effectively treated with cryoablation using multiple overlapping probes.

Benefits of Cryoablation
Cryoablation offers several potential benefits as a treatment for certain types of breast cancer, including:

• Minimally invasive: Cryoablation is a minimally invasive procedure, which means it requires only a small incision and can often be performed on an outpatient basis. This can lead to faster recovery times and fewer complications compared to traditional surgery.
• Localized treatment: Cryoablation targets only the tumor and a small amount of surrounding tissue, sparing healthy tissue from damage. This can help preserve organ function and reduce the risk of side effects.
• Repeatable: In some cases, cryoablation can be repeated if needed, making it a flexible treatment option.
• Reduced side effects: Cryoablation typically causes less pain, bleeding, and scarring compared to surgery. It may also have fewer systemic side effects, such as those associated with chemotherapy or radiation therapy.
• Shorter treatment time: Cryoablation is usually a shorter procedure compared to surgery, which can mean less time spent in the hospital or clinic.
• Abscopal effect: Some studies have shown the shrinking or disappearance of tumors in parts of the body that were not the direct target of local therapy, such as cryoablation. It is thought that in the abscopal effect, the immune system is stimulated to fight cancer in the whole body as a result of the local therapy.
• Potential for use in combination with other treatments: Cryoablation can be used in combination with other treatments, such as chemotherapy, or radiation therapy, depending on the specific type and stage of cancer.

How is Cryoablation performed?

Breast cryoablation is typically performed as an outpatient procedure and involves the following steps:

1. Preparation: You will be positioned lying down on a table, and the breast area will be cleaned and sterilized.
2. Local anesthesia: The area around the tumor will be numbed with a local anesthetic to minimize discomfort during the procedure.
3. Imaging guidance: Using ultrasound, the doctor will locate the tumor and guide the cryoablation probe to the correct position.
4. Probe insertion: A thin probe, which contains a freezing gas, such as liquid nitrogen, is inserted through a small incision in the skin and into the center of the tumor.
5. Freezing the tumor: The freezing gas is released through the probe, causing the tumor to freeze. The freezing process destroys the cancer cells by forming ice crystals within them.
6. Thawing and additional freezing: The tumor is allowed to thaw partially, and then the freezing process will be repeated to ensure that all cancer cells are destroyed.
7. Probe removal: Once the cryoablation is complete, the probe is removed, and the incision is closed with steri-strips or band-aid.

After the procedure, patient will be monitored for a short time to ensure there are no immediate complications. You may experience some discomfort, bruising, or swelling in the treated area, but these symptoms are usually mild, well- tolerated and temporary lasting few hours to days. Most people can resume normal activities within a few minutes after the procedure. Patients may experience a palpable lump at the cryoablation site, usually for few months to occasionally for several years.


Does cryoablation obviate the need for any additional treatment for breast cancer?
No. The cryoablation does not obviate need for any other recommended treatment for breast cancer like radiotherapy, chemotherapy, endocrine therapy or any other. Cryoablation may be a substitute for surgical lumpectomy, which will be determined on a case by case basis. Consultation with other medical providers like breast surgeon, medical oncologist, radiation oncologist is recommended to discuss various treatment options and allow multidisciplinary, integrated, comprehensive, individualized care for the patient.

How much does cryoablation of breast tumor cost?
The cost of cryoablation for breast cancer depends on size and number of masses. This service is currently not covered by Medicare or commercial insurances. Payments for cryoablation may be made using cash, credit cards, wire transfer, Zelle, or cashier's checks made out to URPrecious 3D Breast Ultrasound LLC. After Dr. Krishnan has reviewed your imaging, we will be able to give you the cost for the procedure at the time of your free consult appointment.

We also utilize CareCredit which helps you pay for this procedure, or any other out of pocket expenses for you and your family, if needed.

Follow up Imaging after Cryoablation
If, as sometimes happens, you have your follow-up imaging at a radiology facility that is not familiar with the appearance of the Cryoablation site on Mammogram, Ultrasound or MRI, then Dr. Krishnan, would be able to give you second opinion on your images. You may submit that request via the second opinion page of the practice website (3dbreastultrasound.com) or via your patient portal. We may be able to bill your insurance, otherwise, the consult fee would be $250, which includes obtaining all your outside imaging, reviewing them, having a video consult session with you to go over the imaging findings, answer questions and give you a formal radiologist report. If not billable to your insurance, we can provide a Super bill that you may submit to your insurance for reimbursement for that consultation.

What next?
If you are able to travel to Scottsdale, please book an Ultrasound appointment, so we can best evaluate you in person. Otherwise, please schedule a remote video consultation appointment with Dr. Meghna Krishnan and Dr. Belinda Barclay - White, who will review your imaging and discuss with you if you may be a candidate for cryoablation. Cost for this is $250 (insurance billing is available. For out of network insurances, Superbill can be issued)
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We can submit a claim to your insurance (if we are in network with them) and then refund you any adjusted amount after the claim is processed.
A Superbill can be issued for out of network insurance patients to submit towards out of network benefits.

If you are an existing patient, you may schedule your onsite breast Ultrasound appointment or remote cryoablation video consult via your Onpatient portal.

Otherwise, if a new patient, select the 'Book Cryoablation Consult Appointment' button below to schedule your appointment.
Please ensure to select your appropriate time zone from the drop down list while scheduling your appointment.

After you schedule your second opinion appointment,
1. Please upload, if you have, any available reports of your outside imaging reports via your Onpatient portal.
2. You may self upload your outside imaging exams (if you have them perhaps in a CD) via your computer with CD drive or at your nearest CVS store photo kiosk by the Mymedical images portal. Otherwise, our staff will obtain your outside imaging, directly from the facilities, if you can let us know the names of the facilities while booking your appointment.

We look forward to meeting you at your appointment and helping you in your journey to recovery.

Please check out Breast Cryoablation publications