***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To test the feasibility of noninvasive magnetic resonance ( MR ) imaging-guided focused ultrasound surgery ( FUS ) of benign fibroadenomas in the breast . MATERIAL S AND METHODS Eleven fibroadenomas in nine patients under local anesthesia were treated with MR imaging-guided FUS . Based on a T2-weighted definition of target volumes , sequential sonications were delivered to treat the entire target . Temperature-sensitive phase-difference-based MR imaging was performed during each sonication to monitor focus localization and tissue temperature changes . After the procedure , T2-weighted and contrast material -enhanced T1-weighted MR imaging were performed to evaluate immediate and long-term effects . RESULTS Thermal imaging sequences were improved over the treatment period , with 82 % ( 279 of 342 ) of the hot spots visible in the last seven treatments . The MR imager was used to measure temperature elevation ( 12.8 degrees -49.9 degrees C ) from these treatments . Eight of the 11 lesions treated demonstrated complete or partial lack of contrast material uptake on posttherapy T1-weighted images . Three lesions showed no marked decrease of contrast material uptake . This lack of effective treatment was most likely due to a lower acoustic power and /or patient movement that caused mis registration . No adverse effects were detected , except for one case of transient edema in the pectoralis muscle 2 days after therapy . CONCLUSION MR imaging-guided FUS can be performed to noninvasively coagulate benign breast fibroadenomas BACKGROUND In 1976 , we initiated a r and omized trial to determine whether lumpectomy with or without radiation therapy was as effective as total mastectomy for the treatment of invasive breast cancer . METHODS A total of 1851 women for whom follow-up data were available and nodal status was known underwent r and omly assigned treatment consisting of total mastectomy , lumpectomy alone , or lumpectomy and breast irradiation . Kaplan-Meier and cumulative-incidence estimates of the outcome were obtained . RESULTS The cumulative incidence of recurrent tumor in the ipsilateral breast was 14.3 percent in the women who underwent lumpectomy and breast irradiation , as compared with 39.2 percent in the women who underwent lumpectomy without irradiation ( P<0.001 ) . No significant differences were observed among the three groups of women with respect to disease-free survival , distant-disease-free survival , or overall survival . The hazard ratio for death among the women who underwent lumpectomy alone , as compared with those who underwent total mastectomy , was 1.05 ( 95 percent confidence interval , 0.90 to 1.23 ; P=0.51 ) . The hazard ratio for death among the women who underwent lumpectomy followed by breast irradiation , as compared with those who underwent total mastectomy , was 0.97 ( 95 percent confidence interval , 0.83 to 1.14 ; P=0.74 ) . Among the lumpectomy-treated women whose surgical specimens had tumor-free margins , the hazard ratio for death among the women who underwent postoperative breast irradiation , as compared with those who did not , was 0.91 ( 95 percent confidence interval , 0.77 to 1.06 ; P=0.23 ) . Radiation therapy was associated with a marginally significant decrease in deaths due to breast cancer . This decrease was partially offset by an increase in deaths from other causes . CONCLUSIONS Lumpectomy followed by breast irradiation continues to be appropriate therapy for women with breast cancer , provided that the margins of resected specimens are free of tumor and an acceptable cosmetic result can be obtained Purpose . To investigate the safety , efficacy and feasibility of using high-intensity focused ultrasound ( HIFU ) as a non-invasive treatment for patients with breast cancer . Patients and Methods . Twenty-two patients with breast cancer were enrolled into this non-r and omized prospect i ve trial . Disease TNM stage was classified as stage I in 4 patients , stage IIA in 9 patients , stage IIB in 8 patients , and stage IV in 1 patient . Tumor size ranged from 2 to 4.8 cm in diameter ( mean 3.4 cm ) . All patients received chemotherapy , radiation and tamoxifen , following HIFU for the primary lesions . Outcome measures included radiological and pathologic assessment of the treated tumor , cosmesis , and local recurrence . A cumulative survival rate is calculated by using the Kaplan – Meier method . Results . No severe complications were encountered after HIFU . Post-operative imaging demonstrated positive response and regression of all treated lesions . Follow-up biopsy revealed coagulation necrosis of target tumor and subsequent replacement by fibroblastic tissue . After a median follow-up of 54.8 months , 1 patient died , 1 was lost to follow-up , and 20 were still alive . Two of 22 patients developed local recurrence . Five-year disease-free survival and recurrence-free survival were 95 % and 89 % , respectively . Cosmetic result was judged as good to excellent in 94 % of patients . Conclusions . HIFU treatment is safe , effective , and feasible for patients with breast cancer . But , large-scale , multiple-center clinical trials will be needed to determine the future role of this novel modality PURPOSE To evaluate the feasibility of treating breast neoplasms with use of magnetic resonance ( MR ) imaging-guided focused ultrasound ( US ) surgery . MATERIAL S AND METHODS Twenty-four female patients , each with a single biopsy-proven breast carcinoma , who were considered to be at increased surgical risk or who had refused surgery underwent MR imaging-guided focused US surgery as an adjunct to their chemotherapeutic regimen of tamoxifen .  Follow-up included routine studies to rule out metastatic disease and MR studies with and without contrast material infusion in the treated breast ( 10 days and 1 , 3 , and 6 months after the treatment session ) . Percutaneous biopsy was performed after 6-month follow-up , and if residual tumor was present , a second MR imaging-guided focused US surgery treatment session was performed , followed by repeat biopsy 1 month later . RESULTS Twenty-three of 24 patients completed the protocol , with only one minor complication associated with the treatment sessions ( second-degree skin burn resolved with local treatment ) . Follow-up MR studies demonstrated a varying hypointense treatment margin ( range , 1 - 11 mm ) , which represents destruction of tissue beyond the visible tumor . Absence of enhancement may be an indicator of tumor destruction ( 18 of 19 patients with negative biopsy results ) whereas persistent enhancement suggested tumor residue ( three of five patients with residual tumor ) . Overall , 19 of 24 patients ( 79 % ) had negative biopsy results after one or two treatment sessions . CONCLUSION MR imaging-guided focused US surgery of breast tumors is a safe , repeatable , and promising method of focal tumor destruction Proliferation , invasion , immortalization and metastasis are the main malignant characteristics of cancer . Previous studies have shown that high-intensity focused ultrasound ( US ) , or HIFU , can induce irreversible damage both to breast cancer cells and to tumor blood vessels . However , light microscopy alone may not always show this clearly . In this study , molecular biologic techniques were used to examine any changes in molecular markers associated with malignant behavior after exposure to HIFU . A total of 48 women with breast cancer were r and omized to a  control group ( mastectomy )  and a  HIFU group ( HIFU followed by mastectomy ) . Immunohistochemical staining , messenger RNA ( mRNA ) in situ hybridization and telomere-repeat amplification protocol -enzyme-linked immunosorbent assay ( TRAP-ELISA ) techniques were used to detect tumor expression of proliferating cell nuclear antigen ( PCNA ) , cell adhesion molecule CD44v6 , matrix metalloproteinase-9 ( MMP-9 ) , erbB2 mRNA , and to measure telomerase activity in both groups . The results demonstrated that there were significant alterations in expression of PCNA , CD44v6 , MMP-9 , erbB2 mRNA , and a dramatic decrease in telomerase activity in the HIFU group . It is concluded that malignant tumor characteristics are arrested by HIFU , and that biologic factors are potential markers for assessing HIFU efficacy BACKGROUND Magnetic resonance-guided focused ultrasound surgery ( MRgFUS ) is a noninvasive technique that has been shown to coagulate benign and malignant tumors . The purpose of this study was to evaluate MRgFUS  safety and effectiveness for the ablation of breast carcinomas . STUDY DESIGN Thirty women with biopsy-proved breast cancer underwent MRgFUS treatment . Gadolinium-enhanced MR images were used for treatment planning and posttreatment radiologic assessment of treated tissue , and temperature-sensitive MR images provided real-time treatment monitoring . After MRgFUS , all 30 women underwent wide excision or mastectomy .  The extent of thermal ablation was assessed with tumor histology . RESULTS Treatment was well tolerated , with a minimum of adverse effects , especially when performed under local anesthesia . On pathologic examination , mean ( + /-SD ) necrosis of the targeted breast tumors was 96.9 + /- 4 % ( median 100 % , range 78 % to 100 % ) of tumor volume . Fifteen ( 53.5 % ) of 28 evaluable patients had 100 % necrosis of the ablated tumor ; only 3 patients ( 10.7 % ) had less than 95 % necrosis . In 28 ( 93.3 % ) patients , 100 % of the malignancy was within the treatment field , and 98 % and 95 % of tumor lay within the treatment field in 2 remaining patients . Retrospective analysis in two patients with residual tumor showed treatment was not delivered to the full recommended area , reaffirming the need for precise localization and the value of contrast-enhanced images for treatment planning . CONCLUSIONS MRgFUS has great potential to become a viable noninvasive replacement for lumpectomy . Additional studies focusing on posttreatment image-based evaluation are needed 
    Output:
    
Correlation of contrast enhancement on pretreatment and post-treatment MRI successfully predicted the presence of residual disease .
CONCLUSION HIFU treatment can induce coagulative necrosis in breast cancers .
Complete ablation has not been reported consistently on histopathology and no imaging modality has been able confidently to predict the percentage of complete ablation .