***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 determine the mammographic and ultrasonographic ( US ) findings at cryoablation of small solitary invasive breast cancers and compare them with presence of residual malignancy after treatment . MATERIAL S AND METHODS Institutional review board approval and informed patient consent were obtained . Nine patients with small solitary invasive breast cancers diagnosed at core biopsy were treated with US-guided cryoablation and a 2.7-mm cryoprobe .  Mean cancer size was 12 mm ( range , 8 - 18 mm ) ; four were palpable . Tabletop argon gas-based cryoablation system with a double-freeze-thaw protocol was used to treat cancers in outpatient setting . Tumor sites were excised at lumpectomy 2 - 3 weeks after cryoablation . Findings at mammography and US before , during , and after cryoablation were assessed to categorize densities and masses on mammograms and masses on US images with Breast Imaging Reporting and Data System ( BI-RADS ) ; maximum cancer size was measured . Imaging findings and clinical breast examination data were compared with histologic findings from lumpectomy specimens to determine presence of intraductal or invasive cancer . RESULTS With US guidance , ice balls ( maximal mean size , 4.4 cm ) were formed around cancers . Before excision , eight patients underwent mammography ; all had new focal densities ( maximum size , 2.5 - 5.0 cm ) at cancer sites . Six patients underwent preexcisional US ; 100 % of them had new hyperechogenicity in tissue surrounding cancer site . Seven ( 78 % ) of nine patients had no residual cancer ; specimens contained fat necrosis . One patient had a small focus of invasive cancer ; one had extensive multifocal ductal carcinoma in situ . Patients with BI-RADS category 1 or 2 densities on mammograms or nonpalpable tumors had no residual malignancy . No residual invasive cancer occurred in tumors 17 mm or smaller or in cancers without spiculated margins at US . CONCLUSION After cryoablation , there was increased echogenicity at US and increased density at mammography ; these findings were observed in areas that approximated location and size of the ice ball . Tumor size , mammographic density , and US characteristics may be indicators of likelihood of complete cryoablation Abstract Objectives To evaluate the accuracy of MRI of the breast ( DCE-MRI ) in a st and -alone setting with extended indications . Material s and methods According to the inclusion criteria , breast specialists were invited to refer patients to our institution for DCE-MRI .  Depending on the MR findings , patients received either a follow-up or biopsy .  Between 04/2006 and 12/2011 a consecutive total of 1,488 women were prospect ively examined . Results Of 1,488 included patients , 393 patients were lost to follow-up , 1,095 patients were evaluated . 124 patients were diagnosed with malignancy by DCE-MRI  ( 76 TP , 48 FP , 971 TN , 0 FN cases ) . Positive cases were confirmed by histology , negative cases by MR follow-ups or patient question naires over the next 5 years in 1,737 cases ( sensitivity 100 % ; specificity 95.2 % ; PPV 61.3 % ; NPV 100 % ; accuracy 95.5 % ) . For invasive cancers only ( DCIS excluded ) , the results were 63 TP ; 27 FP ; 971 TP and 0 FN ( sensitivity 100 % ; specificity 97.2 % ; PPV 70 % ; NPV 100 % ; accuracy 97.5 % ) . Conclusion The DCE-MRI indications tested imply that negative results in  DCE-MRI  reliably exclude cancer . The results were achieved in a st and -alone setting ( single modality diagnosis ) . However , these results are strongly dependent on reader experience and adequate technical st and ards as prerequisites for optimal diagnoses . Key Points• DCE-MRI of the breast has a high accuracy in finding breast cancer . • The set of indications for DCE-MRI of the breast is still very limited . • DCE-MRI can achieve a high accuracy in a ‘ screening-like ’ setting . • Accuracy of breast DCE-MRI is strongly dependent on technique and reader experience . • A negative DCE-MRI effectively excludes cancer Background With recent improvements in breast imaging , our ability to identify small breast tumors has markedly improved , prompting significant interest in the use of ablation without surgical excision to treat early-stage breast cancer . We conducted a multi-institutional pilot safety study of cryoablation in the treatment of primary breast carcinomas . Methods Twenty-nine patients with ultrasound-visible primary invasive breast cancer ≤2.0 cm were enrolled . Twenty-seven ( 93 % ) successfully underwent ultrasound-guided cryoablation with a tabletop argon gas-based cryoablation system with a double freeze/thaw cycle . St and ard surgical resection was performed 1 to 4 weeks after cryoablation . Patients were monitored for complications , and pathology data were used to assess efficacy . Results Cryoablation was successfully performed in an office-based setting with only local anesthesia . There were no complications to the procedure or postprocedural pain requiring narcotic pain medications .  Cryoablation successfully destroyed 100 % of cancers < 1.0 cm . For tumors between 1.0 and 1.5 cm , this success rate was achieved only in patients with invasive ductal carcinoma without a significant ductal carcinoma-in-situ ( DCIS ) component . For unselected tumors > 1.5 cm , cryoablation was not reliable with this technique . Patients with noncalcified DCIS were the cause of most cryoablation failures . Conclusions Cryoablation is a safe and well-tolerated office-based procedure for the ablation of early-stage breast cancer . At this time , cryoablation should be limited to patients with invasive ductal carcinoma ≤1.5 cm and with < 25 % DCIS in the core biopsy . A multicenter phase II clinical trial is planned PURPOSE To evaluate in vivo the efficacy of a newly developed breast radiofrequency ( RF ) ablation system in human small invasive breast carcinomas in terms of induction of complete tumor necrosis , reproducibility of ablation lesion size and shape , and cosmetic outcome . MATERIAL S AND METHODS This study had institutional review board approval , and written informed consent was obtained . Thirty-four postmenopausal women ( mean age , 53 years + /- 5 [ st and ard deviation ] ; range , 49 - 62 years ) with small ( < or = 2 cm ) biopsy-proved invasive ductal breast carcinomas were enrolled .  RF energy was delivered through a 25-mm 15-gauge monopolar cool-tip needle electrode by using the temperature-controlled mode . Patients were divided into three groups according to their breast pattern as assessed at mammography . The volumetric size and geometry of the coagulation zone , together with ablation time , were determined . Histopathologic data were compared with postprocedural 3.0-T contrast material -enhanced magnetic resonance ( MR ) images . Cosmesis after RF ablation was assessed . Four weeks after RF ablation , patients underwent definitive surgery . RESULTS All ablation procedures were performed successfully . For 97 % of the procedures , nicotinamide adenine dinucleotide in its reduced form-diaphorase staining showed no evidence of viable cells . The mean induced ablation volume , as assessed with histologic analysis , was 12.50 cm(3 ) + /- 0.8 . Tumor ablation volume on the postablation MR images showed good correlation with results of histopathologic analysis ( r = 0.823 , P < .005 ) . No differences were observed in terms of duration of the procedure or ablation volume with respect to the gl and ular pattern of the breast ( P > .05 for both ) . The general shape of the induced necrosis was close to a sphere in all cases . Cosmesis was excellent in 28 patients . CONCLUSION A dedicated breast cool-tip RF ablation system can induce complete tumor necrosis and reproducible ablation volumes independently of breast gl and ular pattern , providing excellent cosmesis . Postablation MR images are a reliable tool in predicting histologic findings PURPOSE This phase I study was design ed to demonstrate the feasibility , safety , efficacy and predictability of percutaneous cryosurgery , guided under magnetic resonance ( MR ) imaging , in the treatment of invasive breast carcinoma . PATIENTS AND METHODS Under the guidance of near-real-time T1-weighted FSE images of a 0.5-T open-configuration MR system , percutaneous cryosurgery was performed in 25 patients with operable invasive breast carcinoma , 4 weeks prior to their scheduled mastectomy . Predictive assessment s by interventional radiologists using 4 breast-imaging techniques ( mammography , sonography , scintigraphy and MR ) were correlated with postmastectomy results of histopathology and assessed for predictability . Local and systemic morbidity were also evaluated during the month of follow-up preceding mastectomy . RESULTS Percutaneous cryosurgery result ed in no serious complications , either local or systemic . All tumoural tissues included in the cryogenic " iceball " were destroyed , with no viable histologic residues . Ablation was total in 13 of the 25 tumours treated . Combining periprocedural MR images with postprocedure scintimammographic findings enabled a 96 % rate for predicting the cryosurgical results . CONCLUSIONS MR-guided cryosurgery of breast carcinoma is feasible , safe and efficient , with predictable results . Major drawbacks are that the cryolesion ( a palpable iceball ) persists for a month or more after the procedure , undermining the reliability of the physical examination ; and that breast imaging ( mammography , ultrasound and MR ) presents the same difficulty of interpretation as the physical exam even 1 month after the procedure . More studies are required to refine this treatment method 
    Output:
    
No major complications were noted .
The cosmetic outcome was satisfactory .
Breast cancer cryoablation is safe , although local tumor control is suboptimal .
The best results are achieved with small ( < 15 mm ) ductal tumors treated by application of multiple cryoprobes