Thermal ablation as a minimally invasive alternative to surgery for primary breast cancer: a review

Recent diagnostic advances have facilitated a transition from invasive surgery toward minimally invasive interventions for early breast cancer. Although breast-conserving surgery (BCS) remains the standard treatment, it can result in postoperative breast deformities and a low cosmetic satisfaction in some patients. Breast cancer patients increasingly demand surgical treatments that ensure robust oncological control while simultaneously preserving breast cosmesis. Minimally invasive local treatments, especially thermal ablation techniques such as cryoablation (CRYO) and radiofrequency ablation (RFA), have been developed as potential alternatives to surgery. Thermal ablation has emerged as a modality offering local control rates comparable to traditional surgery. In 2023, RFA for early breast cancer was approved for coverage under the Japanese Ministry of Health, Labour, and Welfare insurance system, and has been implemented as a treatment performed by surgeons. This review highlights the principles, clinical outcomes, and the evolving role of the surgeon, who must transcend being a mere “operator” to master these techniques as essential therapeutic options within their surgical repertoire. CRYO induces tumor cell death through rapid freezing and thawing, whereas RFA applies frictional heat to achieve coagulative necrosis. Phase II studies, such as ACOSOG Z1072 and ICE3, have demonstrated complete ablation rates of 92% and low recurrence rates in small, low-risk tumors. The RAFAELO study reported a 5-year ipsilateral breast tumor-free survival rate of 98.6%, forming the basis for insurance approval for RFA in Japan. Both modalities offer shorter procedure times, minimal scarring, and superior cosmetic outcomes compared to BCS. The Japan Breast Cancer Society instituted an operator accreditation system to ensure procedural quality and safety. Thermal ablation achieves favorable local control with excellent cosmetic results in selected patients with small localized breast cancers. Surgeons must integrate these techniques into multidisciplinary care through refined clinical decision-making processes. As diagnostic advances increase the detection of small tumors, thermal ablation could become an alternative standard to BCS, reducing surgical invasiveness and improving the quality of life for patients with early breast cancer.