One type of benign lesions that can occur in the breast is a fibroadenoma. This combination of glandular and connective tissue forms a lesion in the breast. Once this has been diagnosed by triple assessment which includes 1) physical examination, 2) mammography or ultrasound and, 3) by biopsy, there are two choices. Either the fibroadenoma can be left in place (and followed-up) or it can be removed. Surgical removal always leaves the patient with a scar, and fibroadenomas could return in other places in the breast as well. Mirjam Peek, a Technical Medicine student at the University of Twente, is working on the first trial of a non-invasive method for treating fibroadenomas. With this research she won a Young Investigators award.
Ms Peek works at Guy's and St Thomas’ hospitals, where she is involved in the HIFU-F trial. The trial’s full name is “High Intensity Focused Ultrasound in the treatment of breast Fibroadenomata”. High intensity focused ultrasound (HIFU) is a non-invasive ablative technique which can be used to treat fibroadenomas. No incision is required, so there is no post-treatment scarring. In HIFU, a directed ultrasound beam propagates through the soft tissue of the breast as a high-frequency pressure wave. This beam is focused onto a small volume of tissue (2 by 9 cubic mm), heating the tissue up to 65°C to 90°C within a few seconds. This results in tissue necrosis (the final stage of cell death). The tissue surrounding this focused volume remains undamaged. Over the course of the next few months, deprived of its blood supply, the treated fibroadenoma gradually shrinks in size.
“In January 2014, we started using this new technique to treat women with fibroadenomas. I have presented the initial results on our first twenty patients at the focused ultrasound symposium in Washington. Our study is unique in a way that we only treat the surface of the fibroadenoma, rather than the entire lesion. This isolates the central region of the fibroadenoma from its blood supply. Ours trial is the first trial to use HIFU in this way. Our goal was to shorten the treatment time, which is still a major drawback of this technique. Initially, it took one to three hours to fully treat a fibroadenoma with a volume of a couple of cubic centimetres. Our approach has now cut this treatment time to 45-60 minutes. Not only does this involve a lot less discomfort for patients, we are also able to treat the patients under local anaesthesia so the patient can go home right after the treatment.”
Young Investigators Award
The Young Investigators Awards were created to enable young researchers to give a oral or poster presentation at a major scientific conference. The Focused Ultrasound Foundation organises conferences in this field and encourages clinicians and trainee research assistants to carry out high-level research. Ms Peek explains that “I won the award on the basis of my CV and a letter of recommendation from my medical supervisor, Michael Douek. The committee also examined an abstract that I submitted. I was ultimately able to give both a oral and a poster presentation at this symposium.”
Mirjam Peek
Mirjam Peek, a sixth-year Technical Medicine student, is currently working on the final phase of her degree (the graduation itself is scheduled for December 5). The HIFU-F trial is her master thesis project. “I went to London last September, for a three-month internship. During that period, I was involved in the preparations for the HIFU-F trial. I also started writing two systematic reviews, one about HIFU and the other on ablation techniques in general. Those three months proved to be so enjoyable and productive that it was decided that I should graduate in London. My systematic reviews have been submitted to journals for peer review, and I’m now writing an article on the initial results of the HIFU-F trial. I plan to remain in London after my graduation to study for a PhD here, starting in January. This will focus on the remaining part of the present trial and on an entirely new trial. "
