Detection and minimally invasive treatment of small breast cancers

The outline of this thesis is divided into three parts. Part 1 describes and explores different minimally invasive treatment options for small breast cancers. Chapter 2 introduces the current available diagnostic and therapeutic minimally invasive techniques. Chapter 3 describes the current status of, and provides insight into possible future research on the breast lesion excision system (BLES) as a diagnostic and therapeutic device. For minimally invasive treatment, and especially for use with the BLES, it is essential to know in advance that the lesion is smaller than the excision needle. Therefore, in Chapter 4 we determine the reliability of MRI-based tumor size measurements to select patients for minimally invasive therapy. In Chapter 5 we investigate the feasibility of complete excision of small breast cancers using the BLES under ultrasound guidance. Finally, we describe in Chapter 6 a new study proposal to evaluate under what conditions vacuum-assisted excision under ultrasound guidance could be useful as a minimally invasive treatment method. Detection at an early stage, which will be described in Part 2, is essential for small breast cancers. In Chapter 7 and Chapter 8 two prototype DWI sequences are evaluated to determine if these sequences can improve lesion detection in unenhanced DW images. Part 3 provides a general discussion and summaries in both English and Dutch regarding the studies in this thesis.