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Jouffrieau C, Cazzato RL, Gabriele V, Faller E, Weiss J, Host A, Garnon J, Garbin O, Gangi A. Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall. J Minim Invasive Gynecol 2023; 30:890-896. [PMID: 37422051 DOI: 10.1016/j.jmig.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis. DESIGN Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up. SETTING Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed. PATIENTS Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022. INTERVENTIONS Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging. MEASUREMENTS AND MAIN RESULTS Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm3; range 0.6-36.4; p <.05). CONCLUSION Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.
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Affiliation(s)
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Victor Gabriele
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Emilie Faller
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julia Weiss
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Aline Host
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julien Garnon
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Afshin Gangi
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
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Cazzato RL, Garnon J, Koch G, Dalili D, Rao PP, Weiss J, Bauones S, Auloge P, de Marini P, Gangi A. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465. [DOI: 10.1259/bjr.20200465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Windmill Rd, Oxford OX3 7LD, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julia Weiss
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Salem Bauones
- Department of Radiology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
- Department of Interventional Radiolgy, Guy's and St Thomas' NHS Foundation Trust, King's College London, London WC2R 2LS, United Kingdom
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Percutaneous MR-Guided Cryoablation of Low-Flow Vascular Malformation: Technical Feasibility, Safety and Clinical Efficacy. Cardiovasc Intervent Radiol 2020; 43:858-865. [PMID: 32236672 DOI: 10.1007/s00270-020-02455-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively assess the technical feasibility, safety and clinical efficacy of percutaneous MR-guided cryoablation of low-flow vascular malformations (LFVM). MATERIALS AND METHODS Between July 2013 and May 2019, 9 consecutive patients (5 male; 4 female; mean age 39.4 ± 15.3 years, range 15-68) underwent MR-guided cryoablation of LFVM. Patients were treated due to pain in all cases. Procedural data, complications and clinical results were analyzed. RESULTS Technical success defined as complete coverage of the LFVM by the iceball without involvement of nearby non-target thermal-sensitive structures was achieved in 9/9 (100%) cases. Mean procedure time was 122 ± 20 min (range 90-150); 2-6 cryoprobes (mean 3.7 ± 1.2) and 2-4 freezing cycles (mean freezing time 19.8 ± 11.8 min; range 4-40) were applied. No complications were noted. Mean time from the first treatment to the last follow-up was 548 days (range 30-1776). Persistent/recurring pain was noted in 3/9 cases (33%) 30, 133 and 639 days after cryoablation, respectively, and was related in all cases to MR-confirmed local residual/recurring disease. A second cryoablation treatment was performed in these 3 cases with complete pain control at the last available follow-up (153, 25, 91 days, respectively). In the whole population, at mean 161 days (range 25-413) after the last treatment, on the numerical pain rate scale, pain significantly dropped from mean 6.4 ± 2.1 (range 3-9/10) before CA to mean 0.3 ± 0.9 (range 0-3/10) after (p = 0.009). CONCLUSIONS Percutaneous MR-guided cryoablation is technically feasible, safe and effective for the treatment of symptomatic LFVM. LEVEL OF EVIDENCE Level 3b, retrospective cohort study.
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Putzer D, Schullian P, Bale R. Locoregional ablative treatment of melanoma metastases. Int J Hyperthermia 2019; 36:59-63. [DOI: 10.1080/02656736.2019.1647353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Daniel Putzer
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Bregeon B, Nguyen JM, Varey E, Quereux G, Saint-Jean M, Peuvrel L, Khammari A, Dreno B. Positive margins after surgical excision of locoregional cutaneous melanoma metastasis and their impact on patient outcome. Eur J Dermatol 2018; 28:661-667. [PMID: 30378546 DOI: 10.1684/ejd.2018.3402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For melanoma patients, surgery is a standard treatment for locoregional skin metastasis (LSM). To assess the frequency and risk factors for positive margins after excision of LSM and their impact on patient overall survival (OS) and progression-free survival (PFS). A monocentric, retrospective observational study was performed including 87 patients with LSM who had undergone surgical excision. Positive margins were found in 45% of patients after excision. After additional excision, 28% of patients still had positive margins. Interestingly, there was no difference in PFS or OS for clear margins after the first or additional excision or for margins that remained positive without additional excision. LSM size was the only identified predictive factor for positive margins. This is the first reported study investigating the frequency of, and risk factors for positive margins of cutaneous LSM, which raises the question of whether additional excision should be performed following positive margin excision.
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Affiliation(s)
- Barbara Bregeon
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - Jean-Michel Nguyen
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, PIMESP-SEB, Saint-Jacques Hospital, Nantes, France
| | - Emilie Varey
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, Service de dermatologie, CIC 1413, CRCINA INSERM 1232, CHU de Nantes, Nantes, France
| | - Gaelle Quereux
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, Service de dermatologie, CIC 1413, CRCINA INSERM 1232, CHU de Nantes, Nantes, France
| | - Mélanie Saint-Jean
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, Service de dermatologie, CIC 1413, CRCINA INSERM 1232, CHU de Nantes, Nantes, France
| | - Lucie Peuvrel
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, Service de dermatologie, CIC 1413, CRCINA INSERM 1232, CHU de Nantes, Nantes, France
| | - Amir Khammari
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, Service de dermatologie, CIC 1413, CRCINA INSERM 1232, CHU de Nantes, Nantes, France
| | - Brigitte Dreno
- Service de dermatologie, Hôtel-Dieu, CHU de Nantes, Nantes, France, Service de dermatologie, CIC 1413, CRCINA INSERM 1232, CHU de Nantes, Nantes, France
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Cazzato RL, Garnon J, Shaygi B, Tsoumakidou G, Caudrelier J, Koch G, Gangi A. How to Perform a Routine Cryoablation Under MRI Guidance. Top Magn Reson Imaging 2018; 27:33-38. [PMID: 29406413 DOI: 10.1097/rmr.0000000000000158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the last decade, the spectrum of interventional magnetic resonance imaging (MRI)-guided procedures, including percutaneous ablation, has substantially grown, and among the available MRI-compatible ablative techniques, cryoablation is progressively gaining a predominant position.The aim of the present narrative review is to discuss the technical requirements necessary to perform a percutaneous MRI-guided cryoablation in a closed-bore machine; to highlight the relative advantages and drawbacks; and to briefly summarize the results available in the literature.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Behnam Shaygi
- Interventional Radiology Department, Royal Devon and Exeter Hospital NHS Trust, Exeter, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), Strasbourg, France
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors. Diagn Interv Imaging 2017; 98:635-644. [DOI: 10.1016/j.diii.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
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