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array:24 [ "pii" => "S2173510724000715" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2022.12.011" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1460" "copyright" => "SERAM" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2024;66:228-35" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833823000188" "issn" => "00338338" "doi" => "10.1016/j.rx.2022.12.007" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1460" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2024;66:228-35" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Crioablación guiada con ecografía: tratamiento percutáneo alternativo a la cirugía en las lesiones fibroadenomatosas de la mama, nuestra experiencia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "228" "paginaFinal" => "235" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ultrasound-guided cryoablation: Our experience in percutaneous treatment as an alternative to surgery for fibroadenomas of the breast lesions" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 954 "Ancho" => 2007 "Tamanyo" => 168360 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A y B) Fibroadenoma de 6<span class="elsevierStyleHsp" style=""></span>cm, dado su tamaño se utilizaron 2<span class="elsevierStyleHsp" style=""></span>agujas Ice Rod Ithaw® 17 G. Dos agujas atravesando el fibroadenoma a lo largo de su eje mayor. C-E) Mismo nódulo en planos ortogonales. Formación de las 2 bolas de hielo que acaban uniéndose hasta englobar el fibroadenoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Díaz de Bustamante Durbán, M.J. Roca Navarro, Y. Navarro Monforte, D. Garrido Alonso, F. García Martínez, M.V. Córdoba Chicote, J.M. Oliver Goldaracena" "autores" => array:7 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Díaz de Bustamante Durbán" ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Roca Navarro" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Navarro Monforte" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Garrido Alonso" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "García Martínez" ] 5 => array:2 [ "nombre" => "M.V." "apellidos" => "Córdoba Chicote" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Oliver Goldaracena" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510724000715" "doi" => "10.1016/j.rxeng.2022.12.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000715?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833823000188?idApp=UINPBA00004N" "url" => "/00338338/0000006600000003/v2_202406060641/S0033833823000188/v2_202406060641/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173510723001520" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2023.04.006" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1505" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2024;66:236-47" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Update in Radiology</span>" "titulo" => "Update in imaging tests used for the localization of parathyroid pathology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "236" "paginaFinal" => "247" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización de las pruebas de imagen utilizadas en la localización de patología paratiroidea" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1742 "Ancho" => 1340 "Tamanyo" => 165039 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0140" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Right lower parathyroid adenoma seen on PET/CT with 18F-choline. (a) 18F-choline PET, (b) CT without intravenous contrast, (c) 18F-choline PET/CT. Obtained from a patient at our hospital.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Adarve Castro, D. Domínguez Pinos, V. Soria Utrilla, J.A. O’Farrell del Campo, F. Sendra Portero, M.J. Ruiz-Gómez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Adarve Castro" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Domínguez Pinos" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Soria Utrilla" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "O’Farrell del Campo" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Sendra Portero" ] 5 => array:2 [ "nombre" => "M.J." "apellidos" => "Ruiz-Gómez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833823001017" "doi" => "10.1016/j.rx.2023.04.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833823001017?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510723001520?idApp=UINPBA00004N" "url" => "/21735107/0000006600000003/v1_202406210542/S2173510723001520/v1_202406210542/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510724000727" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2022.11.009" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1449" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2024;66:219-27" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "New reference nomograms for the study of ventricular size in preterm infants" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "227" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevos nomogramas de referencia para el estudio de la talla ventricular en neonatos pretérmino" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2224 "Ancho" => 1675 "Tamanyo" => 232521 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Frontal horn thickness longitudinal reference curves, with scatter plot (a) and percentiles 3, 25, 50, 75 and 97 (b).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Navarro-Ballester, R.E. Rovira-Ferrando, J.M. Ródenas-Hernández, A. Bandura, P. Fernández-García, S.F. Marco Doménech" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Navarro-Ballester" ] 1 => array:2 [ "nombre" => "R.E." "apellidos" => "Rovira-Ferrando" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Ródenas-Hernández" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Bandura" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Fernández-García" ] 5 => array:2 [ "nombre" => "S.F." "apellidos" => "Marco Doménech" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833823000036" "doi" => "10.1016/j.rx.2022.11.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833823000036?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510724000727?idApp=UINPBA00004N" "url" => "/21735107/0000006600000003/v1_202406210542/S2173510724000727/v1_202406210542/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>" "titulo" => "Ultrasound-guided cryoablation: Our experience in percutaneous treatment as an alternative to surgery for fibroadenomas of the breast lesions" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "228" "paginaFinal" => "235" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "T. Díaz de Bustamante Durbán, M.J. Roca Navarro, Y. Navarro Monforte, D. Garrido Alonso, F. García Martínez, M.V. Córdoba Chicote, J.M. Oliver Goldaracena" "autores" => array:7 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Díaz de Bustamante Durbán" "email" => array:1 [ 0 => "tesabus@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Roca Navarro" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Navarro Monforte" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Garrido Alonso" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "García Martínez" ] 5 => array:2 [ "nombre" => "M.V." "apellidos" => "Córdoba Chicote" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Oliver Goldaracena" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Unidad de Patología Mamaria, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Crioablación guiada con ecografía: tratamiento percutáneo alternativo a la cirugía en las lesiones fibroadenomatosas de la mama, nuestra experiencia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1284 "Ancho" => 1675 "Tamanyo" => 113732 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Volume of fibroadenomas: evolution over time in the 12 cases. The vertical axis shows the volume in cc and the horizontal axis shows the time elapsed since cryoablation (months).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fibroadenomas are the most common benign tumours of the female breast. Although they mostly commonly appear in the second and third decades of life, they can occur at any age. Approximately 10% of women will have a fibroadenoma in their lifetime, with multiple fibroadenomas occurring in 20% of women. They are proliferative lesions made up of epithelial and connective elements, which originate in the lobules of breast tissue. They are oestrogen-dependent and can grow.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the majority of cases fibroadenomas are managed conservatively using imaging tests, usually ultrasound, to confirm stability in follow-up. However, in some patients, they may be symptomatic (palpable, painful), cause breast deformity, increase in size or cause anxiety. Surgical removal is the traditional treatment in these cases. Minimally invasive percutaneous ablative techniques offer the opportunity to treat fibroadenomas without surgery, avoiding the possible complications of surgery as well as general anaesthesia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The efficacy and safety of cryoablation of fibroadenomas have been demonstrated in multiple publications.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the United States, cryoablation and percutaneous excisional vacuum-assisted biopsy (VAB) have been approved for use in clinical practice by the Food and Drug Administration for the treatment of fibroadenomas and are included in the management algorithm for fibroadenomas in the American Society of Breast Surgeons’ Guidelines.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Cryoablation may be particularly useful in women with multiple fibroadenomas who have previously undergone surgery for one of them or who prefer to avoid surgical intervention<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> and as an alternative to VAB for nodes too large to be removed by this technique.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this retrospective study is to review the mid-term tolerance and efficacy of ultrasound-guided cryoablation as an alternative treatment to surgery and VAB in fibroadenomas of the breast in our unit.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We retrospectively studied the cases of 12 patients with fibroadenomas treated with cryoablation at our centre between November 2020 and July 2022.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In all cases except one, where treatment was indicated for several large fibroadenomas, the indication for cryoablation in palpable fibroadenomas was the enlargement of the lesion in at least two of the three ultrasound measurements. All were women seeking treatment and procedures to treat single stable fibroadenomas were excluded.</p><p id="par0045" class="elsevierStylePara elsevierViewall">After finding an enlarged fibroadenoma on follow-up ultrasound, ultrasound-guided core needle biopsy (CNB) was performed to confirm the diagnosis histologically prior to treatment. Diagnostic CNBs were performed with 14<span class="elsevierStyleHsp" style=""></span>G Acecut from Léleman® (TSK Laboratory, Hirayanagi-Cho, Tochigi-Ken, Japan) or 14<span class="elsevierStyleHsp" style=""></span>G Bip-HistoCore® (BIP GmbH, Türkenfeld, Germany) needles, obtaining 3–5 cylinders.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Before undergoing the cryoablation procedure, patients signed an informed consent form, which described the technique and its possible risks and benefits as well as guaranteeing the anonymity of any images and information from their medical records should they be used for teaching or scientific purposes.</p><p id="par0055" class="elsevierStylePara elsevierViewall">An Acuson 2000 ultrasound machine® (Siemens, Berlin, Germany) with an 18<span class="elsevierStyleHsp" style=""></span>MHz transducer was used.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The ICEfx Galil Boston Scientific® (Boston Scientific Way, Marlborough, MA, USA) with argon gas using 14 and 17<span class="elsevierStyleHsp" style=""></span>G needles and the Prosense Ice Cure® (IceCure Medical, Caesarea, Israel) with liquid nitrogen using 13<span class="elsevierStyleHsp" style=""></span>G needles were used interchangeably for the cryoablation. In one case, two needles were employed at the same time on the same lesion. In six cases, ice ball coverage of the nodule was found to be incomplete after a first freeze-thaw-freeze cycle, so a second cycle was performed after repositioning the needle to ensure that the ice ball completely engulfed the remaining part of the fibroadenoma.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The cryoablation procedures were performed by the seven radiologists at the Breast Unit, with between five and 25 years of experience.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The procedure was performed with the patient in the supine position. After administering local anaesthetic at the access point, ultrasound guidance was used to insert the cryoablation needle through the centre of the nodule along its long axis, going about 5<span class="elsevierStyleHsp" style=""></span>mm beyond the nodule. Orthogonal images were obtained to document the central positioning of the needle in the fibroadenoma.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The usual freeze-thaw-freeze protocol was applied, with phases of varying duration depending on the system used, the size of the fibroadenoma, its distance from the skin and the desired ablation margin. Cold adds to the local anaesthetic effect of the injected anaesthesia.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Ultrasound was used to monitor the formation and growth of the ice ball in real time until it completely engulfed the nodule (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). When the lesions were very superficial, a warm saline bag was applied to the patient's skin during the procedure to minimise the possibility of frostbite.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">After the procedure, following removal of the needle, compression was applied to the access point until haemostasis was achieved.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Patients were asked to rate the degree of pain as mild, moderate or severe at the end of the procedure and at the first follow-up at three months.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Ultrasound check-ups were performed three and six months after the procedure, with six-monthly check-ups to 18 months post-procedure.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The following variables were recorded: number of patients, age (years), measurement of the long axis (mm) and volume (cc) of the fibroadenoma before cryoablation, distance between the most superficial edge of the lesion and the skin (mm), cryoablation system and needle used, total duration of the protocol applied (minutes), pain (mild, moderate or severe), other complications, measurement of the long axis (mm) and volume (cc) of the fibroadenoma and ultrasound findings at each subsequent check-up.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Quantitative data were described by median, mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0110" class="elsevierStylePara elsevierViewall">We examined the cases of 12 patients aged between 16 and 47 years old (median 35, mean 34.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.6).</p><p id="par0115" class="elsevierStylePara elsevierViewall">All the fibroadenoma were palpable, ranging between 23 and 64<span class="elsevierStyleHsp" style=""></span>mm in size along the long axis (median 37.5; mean 40.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.5), with volumes of between 3.9 and 61.5 cc (median 14.3; mean 19.4±<span class="elsevierStyleHsp" style=""></span>18.3). The distance from the most superficial edge of the lesion to the skin ranged between 0 and 9<span class="elsevierStyleHsp" style=""></span>mm (median 2.1; mean 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.6).</p><p id="par0120" class="elsevierStylePara elsevierViewall">The procedure took a total of between 15 and 52<span class="elsevierStyleHsp" style=""></span>min (median 30; mean 29.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.7).</p><p id="par0125" class="elsevierStylePara elsevierViewall">All patients tolerated the procedure well; while two referred to moderate pain in the hours following the procedure, there were no other complications (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Currently, follow-up ranges from 90 and 675 days (mean 237). The main finding during follow-up was the reduction in the size of the fibroadenoma. The mean reduction in volume at three months was 47.07<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29%, median 50%, at six months of 73.95<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18%, median 75%, at 12 months of 78.20<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13%, median 71% and at 18 months of 88.81<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12%, median 89% (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Nodules presented with a less defined border that made measurements difficult. Doppler studies of the lesion showed a significantly reduced or absent signal. An echogenic band that represented oedema, haemorrhage and fat necrosis, as well as hypoechoic areas, suggesting fibrosis surrounding the fibroadenoma.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Fibroadenomas smaller than 3<span class="elsevierStyleHsp" style=""></span>cm ceased to be palpable at between three and six months. In the remaining cases the patient noticed a change in volume on palpation.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Cryoablation significantly reduces the volume of fibroadenomas.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The low temperatures reached cause cell death by direct and indirect mechanisms. The technique is performed in three phases: first freezing, passive thawing and second freezing. In the first freezing phase, the extracellular water freezes earlier due to higher intracellular osmolarity, which causes the water to leave the cell and the cell to dehydrate. Ice crystals that also form inside the cell during this phase damage organelles and membranes. During passive thawing, the osmotic gradient is reversed, the cell swells and ruptures. The influx of water into the cell lowers intracellular osmolarity, raising the freezing point and increasing intracellular ice. The freezing phase is repeated because the damaged tissue efficiently transmits the low temperatures and thus expands the area of necrosis.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Endothelial damage, platelet aggregation, microthrombus formation and the resulting ischaemia are among the additional indirect mechanisms by which cryoablation causes tissue damage.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">There are two possible mechanisms of action in cryoablation equipment, both of which form an ice ball along the distal area of the needle. The lethal zone (< −30<span class="elsevierStyleHsp" style=""></span>°C) is about 5<span class="elsevierStyleHsp" style=""></span>mm inside the margin of the ice ball visible on ultrasound.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In liquid nitrogen devices, as liquid nitrogen circulates through the uninsulated distal part of the needle, the temperature in the surrounding tissue decreases rapidly. In general, these devices generate large ice balls more quickly than argon gas devices. These systems support a single cryoablation needle per procedure. Although they are beginning to be used in other parts of the body, they are currently principally used in the breast.</p><p id="par0165" class="elsevierStylePara elsevierViewall">In argon gas-powered equipment, the mechanism of action is based on the Joule-Thomson cooling effect caused by the rapid decompression of argon gas through the valve at the tip of the cryoablation needle. With these systems, multiple needles can be used at the same time, allowing for greater customisation of the size and shape of the ice ball. Argon gas devices are also used for ablation in other parts of the body.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a>(<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>)</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">The American Society of Breast Surgeons recommends the following as criteria for indicating possible cryoablation or percutaneous excision of fibroadenomas using VAB: correct visualisation of the lesion with ultrasound, histological confirmation of fibroadenoma prior to treatment, diagnosis concordant with imaging findings, physical examination and patient history, and lesions smaller than 4<span class="elsevierStyleHsp" style=""></span>cm at their long axis; however, it does not establish fibroadenomas over this size as a contraindication.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Treatment of fibroadenomas is nowadays a cheaper and more readily available procedure, with many centres employing excision with VAB. Cryoablation is a simple, less invasive technique associated with fewer complications, which can be very useful in the treatment of nodules too large to be removed by VAB. In our experience cryoablation of fibroadenomas longer than 4<span class="elsevierStyleHsp" style=""></span>cm is feasible and safe.</p><p id="par0180" class="elsevierStylePara elsevierViewall">This procedure is claimed to be effective, thanks to the possibility of customising the size and shape of the ice ball according to the number of needles used and the different gauges chosen in argon gas systems, and the formation of large ice balls when liquid nitrogen systems are used.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Ultrasound means the proximity of the ice to the skin can be monitored throughout the process.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Published studies mention that the most suitable lesions for cryoablation are located at least 5<span class="elsevierStyleHsp" style=""></span>mm, and ideally 1<span class="elsevierStyleHsp" style=""></span>cm, from the skin.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Some teams describe the injection of saline between the fibroadenoma and the skin thus increasing the distance between them and protecting the skin from possible frostbite in the case of very superficial nodules.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,8</span></a> In our patients the proximity of the lesion to the skin did not cause any complications. Where lesions were very superficial, a warm saline bag was applied over the patient's skin throughout the procedure to protect it.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Possible complications of cryoablation described are pain during or in the hours following the procedure, frostbite with blistering, ecchymosis or haematoma, infection and depigmentation.</p><p id="par0200" class="elsevierStylePara elsevierViewall">The response to treatment and the speed of fibroadenoma resorption may be related to the initial size of the fibroadenoma. The number of freezing cycles, the duration of the freezing and thawing phases, the size of the ice ball and the temperature applied are factors that may also influence the speed of fibroadenoma resorption.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">In published work, fibroadenomas smaller than 2<span class="elsevierStyleHsp" style=""></span>cm have been shown to respond best, while larger fibroadenomas appear to have slower rates of volume reduction and incomplete resorption.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Previous studies have concluded that there is a 73–99% volume reduction at 12 months in fibroadenomas measuring up to 4.2<span class="elsevierStyleHsp" style=""></span>cm and an average volume reduction of 40.6% at 6 months and 87.3% at 12 months.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,12</span></a> In fibroadenomas up to 2<span class="elsevierStyleHsp" style=""></span>cm (on average) the volume reduction at 12 months is 89–97%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Golatta et al. found a 100% reduction at 12 months in 93% of the 58 treated fibroadenomas measuring a maximum of 3<span class="elsevierStyleHsp" style=""></span>cm, with a mean volume of 1.2 cc.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Kaufman et al. postulated that the entire lesion may be resorbed within two to three years following cryoablation; they presented 17 fibroadenomas smaller than 2<span class="elsevierStyleHsp" style=""></span>cm which at 12 months have a mean volume reduction of 100%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In our patients, the mean reduction in fibroadenoma volume at three months was 47.07%, at six months 73.95%, at 12 months of 78.20% and at 18 months of 88.81%. There are limitations to our study, namely the small number of patients and limited follow-up time.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Although a larger number of patients and longer follow-up is necessary, it seems clear that cryoablation reduces the volume of fibroadenomas. However, the number of cases and follow-up time presented in this study are not sufficient to demonstrate that this technique may lead to the complete disappearance of the nodule and it is possible that very large fibroadenomas will not disappear completely. In these cases they decrease in size, stop growing and become palpable. That said, it is also not our aim to make the nodule disappear completely, as they are benign lesions.</p><p id="par0230" class="elsevierStylePara elsevierViewall">The technique has several advantages over VAB in that it is simple, less invasive and has fewer complications. In the case of partial excision with VAB, it is possible that the residual lesion will continue to grow, whereas with cryoablation this does not occur.</p><p id="par0235" class="elsevierStylePara elsevierViewall">Follow-up ultrasound findings included less well-defined fibroadenoma margins, a significantly reduced or absent signal on Doppler study and an echogenic band representing oedema, haemorrhage and fat necrosis, or hypoechoic areas suggestive of fibrosis surrounding the lesion (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0240" class="elsevierStylePara elsevierViewall">VAB is an accepted and cheap procedure that is habitually used. In the case of large fibroadenoma, cryoablation is a simple to manage, less invasive, technique with fewer complications. Cryoablation achieves a significant reduction in the volume of fibroadenomas that may even disappear. It is an innovative, safe and effective technique, minimally invasive for the patient, and is well tolerated. Complications are infrequent, minor and it offers a better cosmetic result as it avoids scarring. It is performed on an outpatient basis with local anaesthetic, thus avoiding hospital admission and general anaesthesia, saving health and economic resources, as well as helping to manage surgical waiting lists.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Author contributions</span><p id="par0300" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0245" class="elsevierStylePara elsevierViewall">Research coordinators: TDBD and MJRN.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0250" class="elsevierStylePara elsevierViewall">Development of study concept: TDBD, MJRN, MVCC, DGA, YNM, FGM.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0255" class="elsevierStylePara elsevierViewall">Study design: TDBD, MJRN, MVCC and JMOG.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0260" class="elsevierStylePara elsevierViewall">Data collection: TDBD, MJRN, DGA, MVCC, YNM, FGM and JMOG.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0265" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: TDBD, MVCC, DGA and YNM.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0270" class="elsevierStylePara elsevierViewall">Statistical analysis: TDBD.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0275" class="elsevierStylePara elsevierViewall">Literature search: TDBD, MJRN, YNM, and JMOG.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0280" class="elsevierStylePara elsevierViewall">Writing of article: TDBD, MJRN, MVCC, DGA.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9</span><p id="par0285" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions: JMOG.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10</span><p id="par0290" class="elsevierStylePara elsevierViewall">Approval of the final version: TDBD, MJRN, MVCC, DGA, YNM, FGM and JMOG.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0295" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2169127" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1839431" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2169128" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1839432" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Author contributions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-10-20" "fechaAceptado" => "2022-12-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1839431" "palabras" => array:5 [ 0 => "Ultrasound-guided cryoablation" 1 => "Ablation technique" 2 => "Cryotherapy" 3 => "Breast" 4 => "Fibroadenoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1839432" "palabras" => array:5 [ 0 => "Crioablación guiada por ultrasonidos" 1 => "Técnica de ablación" 2 => "Crioterapia" 3 => "Mama" 4 => "Fibroadenoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To review the tolerance to and medium-term efficacy of ultrasound-guided cryoablation as an alternative to surgical treatment of fibroadenomas of the breast in our hospital.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We analyzed data from the 12 patients with fibroadenomas treated with ultrasound-guided cryoablation in our hospital between November 2020 and July 2022. Cryoablation was performed with a system using argon gas (Galil Boston Scientific®) or liquid nitrogen (Prosense Ice Cure®) following a triple-phase (freeze-thaw-freeze) protocol of variable duration depending on the size of the lesion. Patients were followed up with ultrasonography at 3, 6, 12, and 18 months.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">All patients tolerated the procedure well. Two patients reported moderate pain in the hours immediately after the procedure; no other complications occurred. The findings during follow-up included decreased volume of the fibroadenoma (47.07% at 3 months, 77.79% at 6 months, 81.77% at 12 months, and 88.81% at 18 months), blurring of the nodule’s margins, a significantly reduced or absent signal within the lesion in the Doppler study, an echogenic band (representing edema, hemorrhage, and fat necrosis), and hypoechoic areas suggestive of fibrosis surrounding the fibroadenoma.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Cryoablation is done on an outpatient basis, avoiding general anesthesia, thus making it less expensive. Cryoablation yields better cosmetic results than surgery.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Revisar la tolerancia y la eficacia a medio plazo de la crioablación guiada con ecografía realizada como tratamiento alternativo a la cirugía en lesiones fibroadenomatosas de mama en nuestro hospital.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se recogieron de los archivos los datos de las 12 pacientes con fibroadenomas tratados con crioablación guiada con ecografía entre noviembre 2020 y julio 2022 en nuestro hospital. Para la crioablación se utilizaron los sistemas Galil Boston Scientific® con gas argón y Prosense Ice Cure® con nitrógeno líquido, con protocolo triple fase (congelación-descongelación-congelación) de duración variable dependiendo del tamaño de la lesión. Se hizo el seguimiento con ecografías, la primera a los 3 meses del procedimiento y posteriomente semestrales hasta los 18 meses.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Todas las pacientes toleraron bien el procedimiento, dos de ellas refirieron dolor moderado en las horas siguientes, no hubo ninguna otra complicación. Los hallazgos en el seguimiento fueron: disminución del volumen del fibroadenoma (del 47,07% a los 3 meses, 77,79% a los 6 meses,81,77% a los 12 meses y 88,81% a los 18 meses), peor definición de los márgenes del nódulo, disminución significativa o desaparición del flujo en el estudio Doppler en la lesión, una banda ecogénica (que representaba edema, hemorragia y necrosis grasa) y zonas hipoecoicas sugerentes de fibrosis rodeando el fibroadenoma.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La crioablación se realiza de forma ambulatoria, evita una anestesia general es menos costosa y tiene mejor resultado cosmético.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1292 "Ancho" => 2007 "Tamanyo" => 201815 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound-guided cryoablation procedure. (A) The cryoablation needle passes through the fibroadenoma along its long axis. (B) Ice ball formation: convex linear echogenic image with posterior acoustic shadow. (C) The ice ball increases in size until the fibroadenoma is completely engulfed. The prescribed time is maintained. Subsequently, passive thawing starts followed by a new freezing phase. (D) In another case, a concavity is observed on the surface of the ice ball due to heating of the adjacent blood vessel (orthogonal plane).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 954 "Ancho" => 2007 "Tamanyo" => 160461 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A and B) Fibroadenoma of 6<span class="elsevierStyleHsp" style=""></span>cm. Given its size, two Ice Rod Ithaw® 17<span class="elsevierStyleHsp" style=""></span>G needles were used. Two needles passing through the fibroadenoma along its long axis. (C–E) Same nodule in orthogonal planes. Formation of the two ice balls that end up joining together to engulf the fibroadenoma.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1196 "Ancho" => 2007 "Tamanyo" => 205745 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Fibroadenoma of 38<span class="elsevierStyleHsp" style=""></span>mm, cryoablation with Icepearl needle® 14<span class="elsevierStyleHsp" style=""></span>G, covering the entire nodule in two freeze-thaw-freeze cycles. (A) Fibroadenoma of 38<span class="elsevierStyleHsp" style=""></span>mm in the UOQ of the left breast. (B) First freeze-thaw-freeze cycle covering the internal two thirds of the fibroadenoma. (C) A portion of the fibroadenoma remains uncovered by the ice ball. (D) Second cycle covering the remaining external portion after repositioning the needle.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1284 "Ancho" => 1675 "Tamanyo" => 113732 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Volume of fibroadenomas: evolution over time in the 12 cases. The vertical axis shows the volume in cc and the horizontal axis shows the time elapsed since cryoablation (months).</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 576 "Ancho" => 2007 "Tamanyo" => 109145 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Galil Boston Scientific® cryoablation system. (A) Device with four double ports for eight needles and argon gas bullet. (B) IceSphere needle®. (C) Pre-testing of the needle with formation of the ice ball in a serum bath. (D) Introduction of two needles into the lesion, guided by ultrasound.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1044 "Ancho" => 2007 "Tamanyo" => 248091 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Fibroadenoma of 42<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>mm before and after cryoablation. (A) B-mode ultrasound of the fibroadenoma before the procedure. (B) Doppler study of the nodule before cryoablation. (C) Same fibroadenoma, B-mode ultrasound, follow-up 12 days after the procedure, the nodule measures 37<span class="elsevierStyleHsp" style=""></span>mm, with surrounding echogenic halo. (D) Same nodule, B-mode ultrasound three months after cryoablation. The fibroadenoma measures 35<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mm, with a less well-defined border surrounded by an echogenic halo. (E) Same fibroadenoma, Doppler study, follow-up at seven months. The size (26<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>mm) and vascularisation have decreased. Echogenic halo is observed. (F) Same nodule, B-mode ultrasound at 17 months, the fibroadenoma measures 25<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>mm, has a less well-defined border, associated echogenic halo and a hypoechoic area of fibrosis (arrow).</p>" ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">System/Needle \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration full protocol (min)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Distance to skin (mm)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrogen</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrogen</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, Ice Rod I-Thaw® 17<span class="elsevierStyleHsp" style=""></span>G, 2 needles</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 14<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 17<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 14<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrogen</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 17<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 14<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 17<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, Ice force® 14<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argon, IcePearl® 14<span class="elsevierStyleHsp" style=""></span>G</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Average \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.75</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.94</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3573010.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twelve patients with fibroadenomas treated with cryoablation.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Size (mm) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Volume (cc) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% vol. reduction 3 months \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% vol. reduction 6 months \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% vol. reduction vol. 12 months \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% vol. reduction 18 months \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3573011.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Follow-up: volume reduction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review of ablative techniques in the treatment of breast fibroadenomata" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.C.L. Peek" 1 => "M. Ahmed" 2 => "S.E. Pinder" 3 => "M. Douek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40349-016-0045-z" "Revista" => array:8 [ "tituloSerie" => "J Ther Ultrasound." "fecha" => "2016" "volumen" => "4" "numero" => "1" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26788322" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S154235652200605X" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryosurgery for breast fibroadenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Niu" 1 => "B. Wu" 2 => "K. Xu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2227-684X.2012.08.02" "Revista" => array:8 [ "tituloSerie" => "Gland Surg." 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