Interventional breast radiology can boost sustainability efforts

Minimally invasive breast interventions can contribute to best sustainability practices, a series of presentations given at ECR 2025 suggested.

Researchers made their case for why interventions such as vacuum-assisted biopsy, thermoablation and cryoablation techniques, and follow-up and monitoring can help reduce the carbon footprint.

“In this modern era, we have imaging and interventional tools to challenge traditional ways of working,” said Nisha Sharma, MBChB, from Leeds Teaching Hospitals NHS Trust.

Sustainability has been the word of the week at ECR 2025, with research presentations and expert insights showing ways radiologists can work toward the benefit of the planet. Interventional radiologists can also aid in these efforts through procedures that can cut hospital and resource use down.

In her talk, Sharma discussed how vacuum-assisted biopsy has its environmental benefits when assessing BIRADS 2 and 3 lesions.

Nisha Sharma, MBChB, at ECR 2025 explains how vacuum-assisted biopsy can contribute to best practices in sustainability through reduced carbon emissions.

She and colleagues found that vacuum-assisted excision leads to 7.29 kg of CO2 emissions compared with the 29.56 kg of emissions from Magseed-guided surgical excision and 24.71 kg of emissions from surgical excision via wire.

“This is a viable, sustainable alternative to surgery,” Sharma said.

For successful implementation of vacuum-assisted excision, Sharma said that imaging should be reviewed to best decide how to perform the excision. If the lesions are visible only through mammography, then a stereo-guided excision should be chosen, while tomosynthesis guidance should be used on lesions visible only through tomosynthesis, she said. Sharma added that if the lesion can be seen on mammography and ultrasound, ultrasound may be used to guide excisions.

She highlighted vacuum-assisted biopsy’s ability to help “deliver a modern patient-centered pathway that focuses on patient needs and this starts by minimizing overtreatment of high-risk lesions.”

Ablation meanwhile has grown in popularity in recent years, with proponents saying this minimally invasive technique effectively cooks (thermoablation) or freezes (cryoablation) tumors within minutes and is safe for patients.

Leo Razakamanantsoa, MD, from Sorbonne Université in Paris, France, discussed how ablation can aid in sustainability by reducing energy use from operating rooms and using less resources.

“You can use minimal local anesthesia instead of using general sedation,” he said, talking about ablation preparation. “You [also] use fewer disposable medical supplies.”

Other areas of opportunity for ablation include procedures taking place in an outpatient setting, meaning shorter hospital stays, and fewer pre- and postoperative visits. Razakamanantsoa added that ablation leads to less medication use and faster recovery and uses a cryogen-based approach.

“Technological advancements in imaging, pathology, and treatment modalities continue to refine breast cancer management,” he said.

In another talk, Ludovica Incardona, MD, from Careggi University Hospital in Florence, Italy, discussed the benefits of comprehensive monitoring after minimally invasive breast interventions are performed. These include procedures such as vacuum-assisted excision or cryoablation.

“The integration of these techniques into breast care pathways allows for a more personalized, patient-centered approach, optimizing outcomes while reducing surgical overtreatment,” Incardona said.

She and colleagues evaluated trends in using both methods at their institution. They found that vacuum-assisted excision led to a 4.5% upgrade rate and that this method grew in use in B-RADS 3 lesions while surgeries went down. In 2021, the team reported 67 vacuum-assisted excisions were performed compared to 103 surgeries in women with these lesions. In 2024, biopsy rose to use in 110 cases while surgeries decreased to 12.

The center also performed cryoablation on 90 malignant lesions between 2022 and January 2025 that were visible on ultrasound. Tumors that were excised were less than 30 mm in length and were early-stage, low- to intermediate-grade invasive carcinomas. And the center performed cryoablation on 42 benign lesions in this same period. About 90% of these lesions were palpable and had a diameter range of 24 mm to 45 mm.

Incardona said that long-term imaging surveillance strategies -- whether through mammography, tomosynthesis, or ultrasound -- are important to monitor treatment response and find potential recurrences.

She outlined how these surveillance strategies are employed at her center:

• For tomosynthesis-guided vacuum biopsy, mammography or tomosynthesis follow-up is performed at six months postprocedure, and contrast-enhanced mammography (CEM) should be performed at 12 months.
• For ultrasound-guided vacuum biopsy, ultrasound should be performed six months postprocedure while CEM is performed at 12 months.
• For cryoablation, ultrasound is performed at one, three, and six months while CEM is performed at 12 months.

“Minimally invasive procedures…represent effective alternatives to surgery for selected breast lesions, offering comparable outcomes with reduced morbidity,” Incardona said.

Click here for full coverage from ECR 2025.