757 - Practical Guide to Breast Cryoablation: Technique, Pearls, and Pitfalls

Learning Objectives: 1. Review patient selection, regulatory context, and current outcomes for cryoablation of fibroadenoma and select breast cancer.
2. Demonstrate step-by-step ultrasound‑guided breast cryoablation technique.
3. Share pearls and pitfalls for challenging scenarios, complication prevention, and post‑ablation imaging and follow-up.

Background: Percutaneous cryoablation is an established minimally invasive treatment for fibroadenoma, offering excellent cosmetic outcomes and high patient satisfaction. More recently, it has emerged as a potential alternative to surgery for carefully selected breast cancer. Prospective data, including the multicenter ICE3 trial, demonstrate favorable results and safety profiles, although regulatory approval for oncologic indication remains pending. Successful cryoablation requires careful patient selection, precise technical execution, and structured follow-up. Challenges include maintaining appropriate margins relative to the lethal isotherm, protecting adjacent structures, and recognizing expected evolution of the ablation zone.

Clinical Findings/Procedure Details: This educational exhibit will:
• Review patient selection and pre-procedure planning, emphasizing imaging-pathology concordance and lesion characteristics.
• Describe the technical approach including ultrasound guidance, probe alignment, multi-probe strategies, freeze-thaw cycles, and ice-ball margin goals.
• Highlight protective maneuvers for skin, nipple-areolar complex, implants, and chest wall using hydrodissection, pneumodissection, and external warming methods.
• Discuss intraprocedural endpoints and troubleshooting, including margin assessment and management of challenging locations.
• Outline post-procedural course and follow-up imaging with attention to ablation zone and common minor complications.
• Address special considerations in cancer patients, including investigational status, adjunctive therapy, and structured surveillance.

Conclusion and/or Teaching Points: Breast cryoablation is an established treatment for fibroadenoma and an emerging minimally invasive option for select breast cancer. Success relies on meticulous technique, particularly achieving adequate ice-ball margins and protecting adjacent structures. In the oncologic setting, patient selection should follow evidence-based trial criteria with counseling on regulatory status and multidisciplinary care integration. Radiologists equipped with technical pearls and pitfalls can safely and effectively perform breast cryoablation, offering a well-tolerated alternative to surgery.