The classical treatment methods in oncology are surgery, radiotherapy and chemotherapy. Interventional oncology is a branch of interventional radiology that has been involved in cancer treatment for the last 20 years. Interventional oncology has made some important changes in the diagnosis and treatment of cancer in recent years:
1. The biopsy method in cancer has changed radically: In the past, patients had to be operated and a piece of their tumors should be removed to diagnose cancer; In other words, even for the diagnosis, patients were operated and sometimes the patient's main treatments such as chemotherapy could not be started due to side effects of surgery. This situation first changed in the breast, thyroid and liver tumors and the diagnosis of these tumors was made with ultrasound-guided needle biopsies. Later, such biopsies were started to be made also in organs such as lung, kidney, pancreas, bone and spleen. Today, with the help of imaging methods such as ultrasound, tomography and MRI, tissue biopsy can be performed with special needles from almost every region of the body. In this way, patients avoid unnecessary surgeries, diagnosis can be made early and correctly and the necessary treatments can be started as soon as possible.
2. Image-guided minimally invasive treatments for cancer have begun: The possibility to perform needle biopsy from a tumor using devices such as ultrasound and tomography has also made it possible to treat tumors with special needles using the same imaging devices. In this method, which is called percutaneous ablation, special needles are placed directly into the tumor from the skin and the tumor is destroyed by heating, freezing or giving high doses of electric current. In many studies in the literature, these interventions have been shown to destroy the tumor completely, just like a surgical operation. Unlike surgery, percutaneous ablation can be performed through a needle hole under local anesthesia, and the patient can usually return home on the same or following day. If there is a recurrence of the tumor, percutaneous ablation may be repeated as many times as needed.
Vacuum biopsy is also performed under local anesthesia and ultrasound guidance. Through a 3-4 mm incision at the skin, the vacuum biopsy needle is inserted and placed behind the mass. When the device is switched on, the vacuum biopsy needle sucks the tissue towards itself and cuts it into strips with cutter blades, and collects these pieces into a small chamber.
For these reasons, methods that may be an alternative to surgical biopsy have been developed in cases where the whole tumor or a large tissue must be removed in the breast.
These methods are known as BLES and vacuum biopsy. In BLES or Breast Lesion Excision System, a 4-5mm thick needle is inserted from the skin and when the tumor is reached under ultrasound guidance and the device is activated, special wires come out from the tip of the needle. These wires heat and cut the surrounding tissue with radiofrequency energy and grasp the mass like a scoop. The mass is then taken out through a 4-5 mm incision in one intact piece.
Both BLES and vacuum biopsy have unique advantages and disadvantages. Since BLES heats the tissue, bleeding is very small and the mass is taken as a single piece. However, only the masses less than 2.5cm in diameter can be removed with this method. Vacuum biopsy does not have a diameter limit, but since the mass is removed in pieces the bleeding is slightly higher. Both methods are used successfully in the treatment of benign tumors such as fibroadenoma in the breast, besides for biopsy purposes.
