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Sparks H, Rink JS, Ramakrishnan A, Sung K, Ni J, Lu DSK, Raman SS, Lee EW, Chiang J. Characterization of Microwave Generator Energy and Ablation Volumes following Transarterial Embolization in an In Vivo Porcine Liver Model. J Vasc Interv Radiol 2024; 35:1227-1233. [PMID: 38754759 DOI: 10.1016/j.jvir.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/24/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To characterize the relationship between ablation zone volume (AZV) and microwave ablation (MWA) energy in an in vivo porcine liver model following arterial embolization. MATERIALS AND METHODS With Institutional Animal Care and Use Committee (IACUC) approval, 11 female swine underwent either right (n = 5) or left (n = 6) hepatic artery embolization under fluoroscopic guidance. Subsequently, ultrasound (US)-guided MWA was performed in each liver segment (left lateral, left medial, right medial, and right lateral) at either 30 W (n = 4 lobes), 60 W (n = 4), 65 W (n = 20), 90 W (n = 8), 120 W (n = 4), or 140 W (n = 4) continuously for 5 minutes. Postprocedural volumetric segmentation was performed on standardized multiphase T1 magnetic resonance (MR) imaging sequences. RESULTS Mean AZVs in embolized lobes (15.8 mL ± SD 10.6) were significantly larger than those in nonembolized lobes (11.2 mL ± SD 6.5, P < .01). MWA energy demonstrated significant positive linear correlation with both embolized (R2 = 0.66, P < .01) and nonembolized (R2 = 0.64, P < .01) lobes. The slope of the linear models corresponded to a 0.95 mL/kJ (SD ± 0.16) and 0.54 mL/kJ (SD ± 0.09) increase in ablation volume per applied kilojoule of energy (E) in embolized and nonembolized lobes, respectively. In the multivariate model, embolization status significantly modified the relationship between E and AZV as described by the following interaction term: 0.42∗E∗(embolization status) (P = .031). CONCLUSIONS Linear models demonstrated a near 1.8-fold increase in ratio of AZV per unit E, R(AZV:E), when applied to embolized lobes relative to nonembolized lobes. Absolute AZV differences between embolized and nonembolized lobes were greater at higher-power MWA.
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Affiliation(s)
- Hiro Sparks
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California.
| | - Johann S Rink
- Department for Radiology and Nuclear Medicine, Mannheim University Medical Centre, Mannheim, Germany
| | - Abinaya Ramakrishnan
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Kyunghun Sung
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Jason Ni
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - David S K Lu
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Edward W Lee
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Jason Chiang
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
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Ortiz CB, Derrick K, Dang A, Borrego M, Yamaguchi S, Grosser D, Bunegin L, Walker J, Lopera J. Changes in Microwave Ablation Zone Dimensions after Transarterial Embolization in an Ex Vivo Human Kidney Perfusion Model. J Vasc Interv Radiol 2024:S1051-0443(24)00406-8. [PMID: 38901493 DOI: 10.1016/j.jvir.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/21/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
PURPOSE To utilize a novel ex vivo perfused human renal model and quantify microwave ablation (MWA) size differences in renal tissue when combining MWA with transarterial embolization (TAE). MATERIALS AND METHODS Human kidneys (n = 5) declined for transplantation were obtained and connected to a fluoroscopy-compatible ex vivo perfusion system. Two ablations-1 standard MWA and 1 TAE-MWA-were performed in each kidney for 2 minutes at 100 W using a MWA system (Solero Angiodynamics). MWA alone was performed in the upper pole. In the lower pole, MWA was performed after TAE with 40-90 μm radiopaque microspheres to achieve angiographic stasis. Ablation zones of coagulative necrosis were sectioned along the long axis and segmented for maximal short-axis diameter (SAD) and long-axis diameter (LAD) measurements. RESULTS A total of 10 ablations (5 MWAs and 5 TAE-MWAs) were performed in 5 human kidneys. TAE-MWA resulted in significantly increased SAD, LAD, volume, and sphericity compared with standard MWA ± SD, with mean measurements as follows (5 standard MWAs ± SD vs 5 TAE-MWAs ± SD, 2-tailed t-test): (a) SAD, 1.8 cm (SD ± 0.1) versus 2.5 cm (SD ± 0.1) (P < .001); (b) LAD, 2.9 cm (SD ± 0.3) versus 3.2 cm (SD ± 0.1) (P = .039); (c) volume, 5.0 mL (SD ± 0.5) versus 11.0 mL (SD ± 0.7) (P < .001); and (d) sphericity, 0.4 (SD ± 0.2) versus 0.6 (SD ± 0.1) (P = .049). Histology demonstrated no differences in TAE-MWA other than concentrated microspheres. CONCLUSIONS This ex vivo human kidney perfusion model confirmed that combined MWA-TAE significantly increased ablation size and spherical shape compared with MWA alone.
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Affiliation(s)
- Carlos B Ortiz
- Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
| | - Kade Derrick
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Annie Dang
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Marina Borrego
- Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Seiji Yamaguchi
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; University Transplant Center, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Daniel Grosser
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
| | - Leon Bunegin
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Vascular Perfusion Solutions, San Antonio, Texas
| | - John Walker
- Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Jorge Lopera
- Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
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Berber E, Sarioglu AG, Akgun E. A comparison of three different microwave systems for laparoscopic liver tumor ablation. J Surg Oncol 2024; 129:1245-1253. [PMID: 38470544 DOI: 10.1002/jso.27621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Our aim was to perform a comparison of three current microwave ablation (MWA) systems widely used for laparoscopic liver ablations in terms of ablation kinetics and geometry of ablation zones. METHODS This was a retrospective, institutional review board-approved study comparing Emprint, Emprint HP, and NeuWave systems for laparoscopic liver ablation. Analyses were performed via Mann-Whitney U and χ2 tests. Continuous data are presented as median (interquartile range). RESULTS For Emprint, Emprint HP, and NeuWave groups, tumor size was 1.16 (0.8), 1.21 (0.7), and 1.27 (0.9) cm (p = 0.54). Ablation time per lesion was 7 (6), 4 (2.8), and 4 (3.3) min (p < 0.0001), yielding similar ablation zone volumes and margins. The time to first ablation bubble was 1 (0.13), 1.5 (0.85), and 0.75 (0.5) min, and total ablation times were 7 (4.4), 4 (2), and 3.5 (2.8) min (p < 0.0001). The roundness index A, B, and transverse were 0.94, 0.98, and 0.79; 0.95, 0.95, and 0.78; and 1.02, 0.95, and 0.96. CONCLUSIONS Although a saline-cooling system with Emprint system allowed for larger diameter spherical ablation zones to be created, it led to decreased efficiency compared to the CO2-cooled NeuWave system, which exposes the active antenna directly to tissue. Increased power delivered by Emprint HP improved the efficiency of saline-cooled design, as demonstrated by faster ablation times.
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Affiliation(s)
- Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ege Akgun
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Mathy RM, Giannakis A, Franke M, Winiger A, Kauczor HU, Chang DH. Factors Impacting Microwave Ablation Zone Sizes: A Retrospective Analysis. Cancers (Basel) 2024; 16:1279. [PMID: 38610957 PMCID: PMC11011160 DOI: 10.3390/cancers16071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Evaluation of the influence of intrinsic and extrinsic conditions on ablation zone volumes (AZV) after microwave ablation (MWA). METHODS Retrospective analysis of 38 MWAs of therapy-naïve liver tumours performed with the NeuWave PR probe. Ablations were performed either in the 'standard mode' (65 W, 10 min) or in the 'surgical mode' (95 W, 1 min, then 65 W, 10 min). AZV measurements were obtained from contrast-enhanced computed tomography immediately post-ablation. RESULTS AZVs in the 'standard mode' were smaller than predicted by the manufacturer (length 3.6 ± 0.6 cm, 23% below 4.7 cm; width 2.7 ± 0.6, 23% below 3.5 cm). Ablation zone past the tip was limited to 6 mm in 28/32 ablations. Differences in AZV between the 'surgical mode' and 'standard mode' were not significant (15.6 ± 7.8 mL vs. 13.9 ± 8.8 mL, p = 0.6). AZVs were significantly larger in case of hepatocellular carcinomas (HCCs) (n = 19) compared to metastasis (n = 19; 17.8 ± 9.9 mL vs. 10.1 ± 5.1 mL, p = 0.01) and in non-perivascular tumour location (n = 14) compared to perivascular location (n = 24, 18.7 ± 10.4 mL vs. 11.7 ± 6.1 mL, p = 0.012), with both factors remaining significant in two-way analysis of variance (HCC vs. metastasis: p = 0.02; perivascular vs. non-perivascular tumour location: p = 0.044). CONCLUSION Larger AZVs can be expected in cases of HCCs compared with metastases and in non-perivascular locations. Using the 'surgical mode' does not increase AZV significantly.
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Affiliation(s)
- René Michael Mathy
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
| | - Athanasios Giannakis
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
- 2nd Department of Radiology, University General Hospital, “ATTIKON” Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Mareike Franke
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
| | - De-Hua Chang
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
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Servin F, Collins JA, Heiselman JS, Frederick-Dyer KC, Planz VB, Geevarghese SK, Brown DB, Jarnagin WR, Miga MI. Simulation of Image-Guided Microwave Ablation Therapy Using a Digital Twin Computational Model. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 5:107-124. [PMID: 38445239 PMCID: PMC10914207 DOI: 10.1109/ojemb.2023.3345733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Abstract
Emerging computational tools such as healthcare digital twin modeling are enabling the creation of patient-specific surgical planning, including microwave ablation to treat primary and secondary liver cancers. Healthcare digital twins (DTs) are anatomically one-to-one biophysical models constructed from structural, functional, and biomarker-based imaging data to simulate patient-specific therapies and guide clinical decision-making. In microwave ablation (MWA), tissue-specific factors including tissue perfusion, hepatic steatosis, and fibrosis affect therapeutic extent, but current thermal dosing guidelines do not account for these parameters. This study establishes an MR imaging framework to construct three-dimensional biophysical digital twins to predict ablation delivery in livers with 5 levels of fat content in the presence of a tumor. Four microwave antenna placement strategies were considered, and simulated microwave ablations were then performed using 915 MHz and 2450 MHz antennae in Tumor Naïve DTs (control), and Tumor Informed DTs at five grades of steatosis. Across the range of fatty liver steatosis grades, fat content was found to significantly increase ablation volumes by approximately 29-l42% in the Tumor Naïve and 55-60% in the Tumor Informed DTs in 915 MHz and 2450 MHz antenna simulations. The presence of tumor did not significantly affect ablation volumes within the same steatosis grade in 915 MHz simulations, but did significantly increase ablation volumes within mild-, moderate-, and high-fat steatosis grades in 2450 MHz simulations. An analysis of signed distance to agreement for placement strategies suggests that accounting for patient-specific tumor tissue properties significantly impacts ablation forecasting for the preoperative evaluation of ablation zone coverage.
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Affiliation(s)
- Frankangel Servin
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
| | - Jarrod A. Collins
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
| | - Jon S. Heiselman
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
- Department of Surgery, Hepatopancreatobiliary ServiceMemorial Sloan Kettering Cancer CenterNew YorkNY10065USA
| | | | - Virginia B. Planz
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
| | | | - Daniel B. Brown
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
| | - William R. Jarnagin
- Department of Surgery, Hepatopancreatobiliary ServiceMemorial Sloan Kettering Cancer CenterNew YorkNY10065USA
| | - Michael I. Miga
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTN37235USA
- Department of OtolaryngologyVanderbilt University Medical CenterNashvilleTN37235USA
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Zhou F, Sun Y, Hou Y, Liu F, Yu X. Intratumoral perfusion may affect microwave ablation area of hepatocellular carcinoma. Int J Hyperthermia 2023; 40:2268892. [PMID: 37927295 DOI: 10.1080/02656736.2023.2268892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of intratumoral perfusion on microwave ablation (MWA) area in hepatocellular carcinoma (HCC). METHODS Patients who underwent curative MWA for HCC between October 2013 and May 2015 were enrolled. Three days before MWA, contrast-enhanced ultrasound (CEUS) was performed to illustrate the perfusion characteristics of the target lesion. Using the Sonoliver quantification software, time-intensity curves of dynamic CEUS were obtained, and quantitative parameters were extracted. Two microwave antennae were inserted into the center of the tumor and MWA was performed with a continuous power output of 50 W for 5 min. A second CEUS was performed to measure the size of the ablated region. Thereafter, an additional MWA procedure was performed until complete ablation with a 5-10-mm safety margin was achieved. RESULTS A total of 38 patients who underwent curative MWA for 39 HCC nodules were enrolled. The mean age was 57 years (34-80 years), and the median maximum diameter of the HCC was 3.4 cm (interquartile range, 2-6.8 cm). Time-intensity curves were obtained and the area under the curve (AUC) was selected as a parameter for intratumoral perfusion. The AUC was inversely and linearly correlated with the size of the MWA area, including long- and short-axis diameters and ablation volume. A 1,000-dB·s change in the AUC produced an average change of 1.17 ± 0.44 mm, 0.725 ± 0.355 mm, and 2.4995 ± 0.6575 cm³ in the long- and short-axis diameters and ablation volume, respectively. CONCLUSIONS The intratumoral perfusion of HCC was inversely correlated with MWA area size.
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Affiliation(s)
- Fubo Zhou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ya Sun
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yaxin Hou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Cafarchio A, Iasiello M, Brunese MC, Francica G, Rocca A, Andreozzi A. Emprint Microwave Thermoablation System: Bridging Thermal Ablation Efficacy between Human Patients and Porcine Models through Mathematical Correlation. Bioengineering (Basel) 2023; 10:1057. [PMID: 37760159 PMCID: PMC10525213 DOI: 10.3390/bioengineering10091057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
To investigate the in vivo ablation characteristics of a microwave ablation antenna in the livers of humans with tumors, a retrospective analysis of the ablation zones was conducted after applying Emprint microwave ablation systems for treatment. Percutaneous microwave ablations performed between January 2022 and September 2022 were included in this study. Subsequently, immediate post-ablation echography images were subjected to retrospective evaluation to state the long ablated diameter, short ablated diameter, and volume. The calculated ablation lengths and volume indices were then compared between in vivo and ex vivo results obtained from laboratory experiments conducted on porcine liver. The ex vivo data showed a good correlation between energy delivered and both increasing ablated dimensions (both p < 0.001) and volume (p < 0.001). The in vivo data showed a good correlation for dimensions (p = 0.037 and p = 0.019) and a worse correlation for volume (p = 0.142). When comparing ex vivo and in vivo data for higher energies, the ablated volumes grew much more rapidly in ex vivo cases compared to in vivo ones. Finally, a set of correlations to scale ex vivo results with in vivo ones is presented. This phenomenon was likely due to the absence of perfusion, which acts as a cooling system.
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Affiliation(s)
- Andrea Cafarchio
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Marcello Iasiello
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
| | - Maria Chiara Brunese
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy;
| | - Aldo Rocca
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Assunta Andreozzi
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
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Hui TCH, How GY, Chim MSM, Pua U. Comparative Study of Ablation Zone of EMPRINT HP Microwave Device with Contemporary 2.4 GHz Microwave Devices in an Ex Vivo Porcine Liver Model. Diagnostics (Basel) 2023; 13:2702. [PMID: 37627962 PMCID: PMC10453042 DOI: 10.3390/diagnostics13162702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Percutaneous microwave ablation (MWA) is an accepted treatment of non-operative liver cancer. This study compares the ablation zones of four commercially available 2.45 GHz MWA systems (Emprint, Eco, Neuwave, and Solero) in an ex vivo porcine liver model. (2) Methods: Ex vivo porcine livers (n = 85) were obtained. Two ablation time setting protocols were evaluated, the manufacturer's recommended maximum time and a 3 min time, performed at the manufacturer-recommended maximum power setting. A total of 236 ablation samples were created with 32 (13.6%) samples rejected. A total of 204 samples were included in the statistical analysis. (3) Results: For single-probe protocols, Emprint achieved ablation zones with the largest SAD. Significant differences were found in all comparisons for the 3 min time setting and for all comparisons at the 10 min time setting except versus Neuwave LK15 and Eco. Emprint produced ablation zones that were also significantly more spherical (highest SI) than the single-probe ablations from all other manufacturers. No statistical differences were found for ablation shape or SAD between the single-probe protocols for Emprint and the three-probe protocols for Neuwave. (4) Conclusions: The new Emprint HP system achieved large and spherical ablation zones relative to other 2.45 GHz MWA systems.
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Affiliation(s)
- Terrence C. H. Hui
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Guo Yuan How
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Michelle S. M. Chim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Laimer G, Bauer M, Scharll Y, Schullian P, Bale R. Multi-Probe RFA vs. Single-Probe MWA in an Ex Vivo Bovine Liver Model: Comparison of Volume and Shape of Coagulation Zones. BIOLOGY 2023; 12:1103. [PMID: 37626989 PMCID: PMC10451889 DOI: 10.3390/biology12081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES To compare the volumes and shapes of the coagulation zone (CZ) of a multi-probe RFA system (three RFA electrodes) and a single-probe MWA system from the same vendor in an ex vivo bovine liver model. MATERIAL & METHODS A total of 48 CZs were obtained in bovine liver specimens with three different ablation system configurations (single-probe MWA vs. multi-probe RFA with 20 mm inter-probe distance [confluent CZ] vs. multi-probe RFA with 50 mm inter-probe distance [three individual CZs]) at 4, 6, 8, and 10 min ablation time using a fixed ablation protocol. Ablation diameters were measured and ellipticity indices (EIs) and volumes calculated. Calculations for all systems/configurations were compared. RESULTS Volumes and diameters increased with ablation time for all configurations. At 4 and 6 min ablation time volumes obtained with the RFA 50 mm setup, and at 8 and 10 min with the RFA 20 mm setup were the largest at 26.5 ± 4.1 mL, 38.1 ± 5.8 mL, 46.3 ± 4.9 mL, 48.4 ± 7.3 mL, respectively. The single-probe MWA could not reach the volumes of the RFA setups for any of the ablation times evaluated. EI were very similar and almost round for RFA 20 mm and single-probe MWA, and differed significantly to the more ovoid ones for the RFA 50 mm configuration. CONCLUSIONS The multi-probe RFA system employing three electrodes achieved significantly larger ablation volumes in both configurations (confluent CZ and three individual CZs) per time as compared with a single-probe MWA system in this ex vivo bovine liver model.
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Affiliation(s)
| | | | - Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria; (G.L.)
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Barrow B, Martin Ii RCG. Microwave ablation for hepatic malignancies: a systematic review of the technology and differences in devices. Surg Endosc 2023; 37:817-834. [PMID: 36076101 DOI: 10.1007/s00464-022-09567-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients' comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists. METHODS A comprehensive review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative review of the literature was performed. RESULTS In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this review. Median patient age was 60.5 years (range 3-91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6-100%) and ablation success (range, 73.1-100%), as well as major complications (range, 0-9.1%). Local recurrence (range, 0-50%) was reported by 21 of the studies; however, new recurrence (range, 12.2-64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3-54.2%), extrahepatic distant recurrence (3.6-20%), and metastasis (1.1-36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively. CONCLUSION Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.
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Affiliation(s)
- Brooke Barrow
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Robert C G Martin Ii
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
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Andresciani F, Pacella G, Vertulli D, Altomare C, Bitonti MT, Bruno A, Cea L, Faiella E, Beomonte Zobel B, Grasso RF. Microwave ablation using two simultaneous antennas for the treatment of liver malignant lesions: a 3 year single-Centre experience. Int J Hyperthermia 2023; 40:2163309. [PMID: 36599421 DOI: 10.1080/02656736.2022.2163309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND sequential or simultaneous applications of multiple antennas have been proposed to create larger ablation zone; however, there is a lack of data in patients affected by liver tumors, with potentially different results from animal liver models. The purpose of this study was to evaluate efficacy and safety of liver percutaneous microwave ablation using simultaneous activation of two antennas to treat lesions bigger than 2,5 cm; particularly the focus was assessing whether the ratio of ablation zone volume in millimeters to applied energy in kilojoules [R(AZ:E)] differs between hepatocellular carcinoma in a cirrhotic liver and liver metastasis and if it is correlated to complications incidence or recurrence of disease. METHODS Fifty-five liver microwave ablation performed with two simultaneous antennas from March 2017 to June 2021 were retrospectively reviewed; 9 procedures were excluded due to the association with Chemoembolization. Size, shape, volume of lesions and ablation zones were recorded. Technical success was defined as complete devascularization of the treated area at the post-procedural CT. R(AZ:E) was determined dividing the ablation zone volume in mm3 by the amount of energy in kilojoules applied in each procedure and complications were reported. RESULTS Technical success was achieved in all the procedures. Mean R(AZ:E) was 0,75 ± 0,58. T-student test for patients with HCC and patients with metastasis about R(AZ:E) was significant (p = 0.03). The incidence of bilomas was lower for HCC (p = 0.022). One-month follow-up showed Complete Response (CR) in 44/46 (95,6%) patients; Three-six months follow-up demonstrated: CR in 43/46 (93.5%) cases and 12 months follow-up highlighted CR in 40/45 (88,9%) cases. CONCLUSIONS These results provide preliminary evidence of efficacy and safety of simultaneous liver MWA using two antennas, highlighting the importance of procedural indications.
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Affiliation(s)
- Flavio Andresciani
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giuseppina Pacella
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Daniele Vertulli
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Carlo Altomare
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Maria Teresa Bitonti
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Amalia Bruno
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Laura Cea
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | - Bruno Beomonte Zobel
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Rosario Francesco Grasso
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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12
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Ortiz CB, Dang A, Derrick K, O'Donnell B, Bitar R, Parker M, Veraza R, Bunegin L, Borrego M, Yamaguchi S, Walker JA, Lopera J. Creation of an Ex Vivo Renal Perfusion Model to Investigate Microwave Ablation. J Vasc Interv Radiol 2023; 34:40-45.e2. [PMID: 36244634 DOI: 10.1016/j.jvir.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
This study hypothesized that an ex vivo renal perfusion model can create smaller microwave ablation (MWA) measurements during perfused states compared with nonperfused states across multiple device settings. Nine bovine kidneys, a fluoroscopic compatible perfusion model, and a commercially-available clinical MWA system were used to perform 72 ablations (36 perfused and 36 nonperfused) at 9 different device settings. Comparing perfused and nonperfused ablations at each device setting, significant differences in volume existed for 6 of 9 settings (P < .05). Collapsed across time settings, the ablation volumes by power were the following (perfused and nonperfused, P value): 60 W, 2.3 cm3 ± 1.0 and 7.2 cm3 ± 2.7, P < .001; 100 W, 5.4 cm3 ± 2.1 and 11.5 cm3 ± 5.6, P < .01; and 140 W, 11.2 cm3 ± 3.7 and 18.7 cm3 ± 6.3, P < .01. Applied power correlated with ablation volume: perfused, 0.021 cm3/W and R = 0.462, P = .004, and nonperfused, 0.029 cm3/W and R = 0.565, P < .001. These results support that an ex vivo perfused organ system can evaluate MWA systems and demonstrate heat sink perfusion effects of decreased ablation size.
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Affiliation(s)
- Carlos B Ortiz
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
| | - Annie Dang
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Kade Derrick
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Barrett O'Donnell
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Ryan Bitar
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Matthew Parker
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | | | - Leonid Bunegin
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Vascular Perfusion Solutions, San Antonio, Texas
| | - Marina Borrego
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Seiji Yamaguchi
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Transplant Surgery, Department of Surgery, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - John A Walker
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Jorge Lopera
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
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13
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Lanza C, Carriero S, Ascenti V, Tintori J, Ricapito F, Lavorato R, Biondetti P, Angileri SA, Piacentino F, Fontana F, Venturini M, Ierardi AM, Carrafiello G. Percutaneous Application of High Power Microwave Ablation With 150 W for the Treatment of Tumors in Lung, Liver, and Kidney: A Preliminary Experience. Technol Cancer Res Treat 2023; 22:15330338231185277. [PMID: 37608585 PMCID: PMC10467382 DOI: 10.1177/15330338231185277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/27/2022] [Accepted: 06/07/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the feasibility, safety, and short-term effectiveness of a high-power (150 W) microwave ablation (MWA) device for tumor ablation in the lung, liver, and kidney. METHODS Between December 2021 and June 2022, patients underwent high-power MWA for liver, lung, and kidney tumors. A retrospective observational study was conducted in accordance with the Declaration of Helsinki. The MWA system utilized a 150-W, 2.45-GHz microwave generator (Emprint™ HP Ablation System, Medtronic). The study assessed technical success, safety, and effectiveness, considering pre- and post-treatment diameter and volume, lesion location, biopsy and/or cone beam computed tomography (CBCT) usage, MWA ablation time, MWA power, and dose-area product (DAP). RESULTS From December 2021 to June 2022, 16 patients were enrolled for high-power MWA. Treated lesions included hepatocellular carcinoma (10), liver metastasis from colon cancer (1), liver metastasis from pancreatic cancer (1), squamous cell lung carcinoma (2), renal cell carcinoma (1), and renal oncocytoma (1). Technical success rate was 100%. One grade 1 complication (6.25%) was reported according to CIRSE classification. Overall effectiveness was 92.8%. Pre- and post-treatment mean diameters for liver lesions were 19.9 mm and 37.5 mm, respectively; for kidney lesions, 34 mm and 35 mm; for lung lesions, 29.5 mm and 31.5 mm. Pre- and post-treatment mean volumes for liver lesions were 3.4 ml and 24 ml, respectively; for kidney lesions, 8.2 ml and 20.5 ml; for lung lesions, 10.2 ml and 32.7 ml. The mean ablation time was 48 minutes for liver, 42.5 minutes for lung, and 42.5 minutes for renal ablation. The mean DAP for all procedures was 40.83 Gcm2. CONCLUSION This preliminary study demonstrates the feasibility, safety, and effectiveness of the new 150 W MWA device. Additionally, it shows reduced ablation times for large lesions.
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Affiliation(s)
- Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Jacopo Tintori
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesco Ricapito
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Roberto Lavorato
- Diagnostic and Interventional Radiology Department, IRCCS Ca’ Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
- Department of Health Science, Università degli Studi di Milano, Milano, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Varese, Italy
- Insubria University, Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Varese, Italy
- Insubria University, Varese, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
- Department of Health Science, Università degli Studi di Milano, Milano, Italy
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14
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Comparison of Two 2.45 GHz Microwave Ablation Devices with Respect to Ablation Zone Volume in Relation to Applied Energy in Patients with Malignant Liver Tumours. Cancers (Basel) 2022; 14:cancers14225570. [PMID: 36428663 PMCID: PMC9688226 DOI: 10.3390/cancers14225570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: (i) to compare two 2.45 GHz MWA devices with respect to AZV in relation to the applied energy after MWA in patients with hepatocellular carcinoma (HCC) or colorectal liver metastasis (CRLM) and (ii) to identify potential confounders for this relationship. Methods: In total, 102 tumours, 65 CRLM and 37 HCC were included in this retrospective analysis. Tumours were treated with Emprint (n = 71) or Neuwave (n = 31) MWA devices. Ablation treatment setting were recorded and applied energy was calculated. AZV and tumour volumes were segmented on the contrast-enhanced CT scans obtained 1 week after treatment. The AZV to applied energy R(AZV:E) ratios were calculated for each tumour treatment and compared between both MWA devices and tumour types. Results: R(AZV:E)EMPRINT was 0.41 and R(AZV:E)NEUWAVE was 0.81, p < 0.001. Moderate correlation between AZV and applied energy was found for Emprint (r = 0.57, R2 = 0.32, p < 0.001) and strong correlation was found for Neuwave (r = 0.78, R2 = 0.61, p < 0.001). R(AZV:E)CRLM was 0.45 and R(AZV:E)HCC was 0.52, p = 0.270. Conclusion: This study confirms the unpredictability of AZVs based on the applied output energy for HCC and CRLM. No significant differences in R(AZV:E) were observed between CRLM and HCC. Significantly lower R(AZV:E) was found for Emprint devices compared to Neuwave; however, reflected energy due to cable and antenna design remains unclear and might contribute to these differences.
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15
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Ierardi AM, Grillo P, Bonanno MC, Coppola A, Vespro V, Andrisani MC, Tosi D, Mendogni P, Franzi S, Venturini M, Carrafiello G. Prediction of Ablation Volume in Percutaneous Lung Microwave Ablation: A Single Centre Retrospective Study. Tomography 2022; 8:2475-2485. [PMID: 36287805 PMCID: PMC9607488 DOI: 10.3390/tomography8050206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Percutaneous Microwave Ablation (MWA) of lung malignancies is a procedure with many technical challenges, among them the risk of residual disease. Recently, dedicated software able to predict the volume of the ablated area was introduced. Cone-beam computed tomography (CBCT) is the imaging guidance of choice for pulmonary ablation in our institution. The volumetric prediction software (VPS) has been installed and used in combination with CBCT to check the correct position of the device. Our study aimed to compare the results of MWA of pulmonary tumours performed using CBCT with and without VPS. METHODS We retrospectively reviewed 1-month follow-up enhanced contrast-enhanced computed tomography (CECT) scans of 10 patients who underwent ablation with the assistance of VPS (group 1) and of 10 patients who were treated without the assistance of VPS (group 2). All patients were treated for curative purposes, the maximum axial diameter of lesions ranged between 5 and 22 mm in group 1 and between 5 and 25 mm in group 2. We compared the presence of residual disease between the two groups. RESULTS In group 1 residual disease was seen in only 1 patient (10%) in which VPS had ensured complete coverage of the tumour. In group 2 residual disease was found in 3 patients (30%). CONCLUSIONS Using this software during MWA of lung malignancies could improve the efficacy of the treatment compared to the conventional only CBCT guidance.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Pasquale Grillo
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Maria Chiara Bonanno
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, 21100 Varese, Italy
| | - Valentina Vespro
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Carmela Andrisani
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sara Franzi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, 21100 Varese, Italy
- Department of Health Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
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16
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Dou Z, Lu F, Ren L, Song X, Li B, Li X. Efficacy and safety of microwave ablation and radiofrequency ablation in the treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29321. [PMID: 35905207 PMCID: PMC9333547 DOI: 10.1097/md.0000000000029321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Surgical resection is often only possible in the early stages of HCC and among those with limited cirrhosis. Radiofrequency ablation and Microwave ablation are 2 main types of percutaneous thermal ablation for the treatment of HCC. The efficacy and safety between these 2 therapy methods are still under a debate. OBJECTIVE To compare the efficacy and safety of Radiofrequency ablation and Microwave ablation in treating HCC. METHODS PubMed, EMBASE, the Cochrane databases and Web of Science were systematically searched. We included randomized controlled trials and cohort studies comparing the efficacy and safety of Radiofrequency ablation and Microwave ablation in HCC patients. Outcome measures on local tumor progression, complete ablation, disease-free survival, overall survival, or major complications were compared between the 2 groups. The random effect model was used when there was significant heterogeneity between studies, otherwise the fixed effect model was used. RESULTS A total of 33 studies, involving a total of 4589 patients were identified, which included studies comprised 7 RCTs, 24 retrospective observational trials, and 2 prospective observational trial. Microwave ablation had a lower local tumor progression than Radiofrequency ablation in cohort studies (OR = 0.78, 95% CI 0.64-0.96, P = .02). Complete ablation rate of Microwave ablation was higher than that of Radiofrequency ablation in cohort studies (OR = 1.54, 95% CI 1.05-2.25, P = .03). There was no significant difference in overall survival and disease-free survival between the 2 groups. Meta-analysis showed that there was no significant difference in the main complications between Microwave ablation and Radiofrequency ablation. CONCLUSIONS Microwave ablation has higher complete ablation and lower local tumor progression than Radiofrequency ablation in the ablation treatment of HCC nodules. There was no significant difference in overall survival between the 2 therapy methods.
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Affiliation(s)
- Zhimin Dou
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- The Department of Critical Care Medicine of The First Hospital of Lanzhou University, Lanzhou, China
| | - Fei Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Longfei Ren
- The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaojing Song
- The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou, China
| | - Bin Li
- The Department of Critical Care Medicine of The First Hospital of Lanzhou University, Lanzhou, China
| | - Xun Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou, China
- *Correspondence: Xun Li, The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou 730000, China (e-mail: )
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17
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Zhang Z, Wang J, Hu Y, Wang L. Microwaves, a potential treatment for bacteria: A review. Front Microbiol 2022; 13:888266. [PMID: 35958124 PMCID: PMC9358438 DOI: 10.3389/fmicb.2022.888266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 02/03/2023] Open
Abstract
Bacteria have brought great harm to the public, especially after the emergence of multidrug-resistant bacteria. This has rendered traditional antibiotic therapy ineffective. In recent years, hyperthermia has offered new treatments to remove bacteria. Microwaves (MW) are a component of the electromagnetic spectrum and can rapidly heat materials. Taking advantage of this characteristic of MW, related studies have shown that both thermal and non-thermal effects of MW can inactivate various bacteria. Even though the understanding of MW in the field of bacteria is not sufficient for widespread use at present, MW has performed well in dealing with microorganisms and controlling infection. This review will focus on the application of MW in bacteria and discuss the advantages, prospects and challenges of using MW in the bacterial field.
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Affiliation(s)
- Zhen Zhang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Jiahao Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
| | - Yihe Hu
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedics, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Long Wang,
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18
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Alpers J, Hensen B, Rötzer M, Reimert DL, Gerlach T, Vick R, Gutberlet M, Wacker F, Hansen C. Comparison study of reconstruction algorithms for volumetric necrosis maps from 2D multi-slice GRE thermometry images. Sci Rep 2022; 12:11509. [PMID: 35799055 PMCID: PMC9263155 DOI: 10.1038/s41598-022-15712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer is a disease which requires a significant amount of careful medical attention. For minimally-invasive thermal ablation procedures, the monitoring of heat distribution is one of the biggest challenges. In this work, three approaches for volumetric heat map reconstruction (Delauney triangulation, minimum volume enclosing ellipsoids (MVEE) and splines) are presented based on uniformly distributed 2D MRI phase images rotated around the applicator’s main axis. We compare them with our previous temperature interpolation method with respect to accuracy, robustness and adaptability. All approaches are evaluated during MWA treatment on the same data sets consisting of 13 ex vivo bio protein phantoms, including six phantoms with simulated heat sink effects. Regarding accuracy, the DSC similarity results show a strong trend towards the MVEE (\documentclass[12pt]{minimal}
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\begin{document}$$0.80\pm 0.03$$\end{document}0.80±0.03) and the splines (\documentclass[12pt]{minimal}
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\begin{document}$$0.77\pm 0.04$$\end{document}0.77±0.04) method compared to the Delauney triangulation (\documentclass[12pt]{minimal}
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\begin{document}$$0.75\pm 0.02$$\end{document}0.75±0.02) or the temperature interpolation (\documentclass[12pt]{minimal}
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\begin{document}$$0.73\pm 0.07$$\end{document}0.73±0.07). Robustness is increased for all three approaches and the adaptability shows a significant trend towards the initial interpolation method and the splines. To overcome local inhomogeneities in the acquired data, the use of adaptive simulations should be considered in the future. In addition, the transfer to in vivo animal experiments should be considered to test for clinical applicability.
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Affiliation(s)
- Julian Alpers
- Faculty of Computer Science, Otto-von-Guericke University, 39106, Magdeburg, Germany. .,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany.
| | - Bennet Hensen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Maximilian Rötzer
- Faculty of Computer Science, Otto-von-Guericke University, 39106, Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Daniel L Reimert
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Thomas Gerlach
- Faculty of Electrical Engineering and Information Technologies, Otto-von-Guericke University, 39106, Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Ralf Vick
- Faculty of Electrical Engineering and Information Technologies, Otto-von-Guericke University, 39106, Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, 30625, Hannover, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Christian Hansen
- Faculty of Computer Science, Otto-von-Guericke University, 39106, Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke University, 39106, Magdeburg, Germany
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19
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Luo C, Lin J, Liu G, He G, Zuo Y, Dai L, Li T. Preliminary Exploration on the Value of Shear Wave Elastography in Evaluating the Effectiveness of Microwave Ablation on Hepatic Malignancies. Ultrasound Q 2022; 38:160-164. [PMID: 35394990 DOI: 10.1097/ruq.0000000000000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Shear wave elastography (SWE) is a new type of ultrasonic elastography that can quantitatively assess the elasticity and stiffness of tissues. This study aimed to investigate the value of SWE in evaluating the effectiveness of microwave ablation in hepatic malignancies. A total of 24 patients (including 30 lesions) with liver malignancies receiving microwave ablation treatment at the Cancer Hospital of Guangzhou Medical University from April 2018 to January 2019 were enrolled. The elastography was performed within 1 week before and after ablation. The SWE values in the central zone, the marginal zone of the lesion, and peripheral liver parenchyma were collected and analyzed. Before ablation, the mean of SWE value was 65.80 ± 13.37 kPa for the central zone of the tumor and 39.93 ± 7.87 kPa for the marginal zone, both of which were significantly greater than that for the perinatal liver parenchyma (12.85 ± 2.67 kPa, both P < 0.05). In the central and marginal zone of the lesions, the SWE value was significantly elevated after ablation (both P < 0.001) but not in the peripheral liver parenchyma (P = 0.444). Receiver operating characteristic curve analysis showed that the cutoff value for ablation in the marginal zone was 53.87 kPa, suggesting that an SWE exceeding 53.87 kPa is an index guaranteeing the ablation effectiveness. These results suggested that SWE has the potential to be used in evaluating the effectiveness of microwave ablation in liver cancers.
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Affiliation(s)
| | | | | | | | | | - Lu Dai
- Thoracic Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Tao Li
- Departments of Ultrasound Imaging
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Pfannenstiel A, Iannuccilli J, Cornelis FH, Dupuy DE, Beard WL, Prakash P. Shaping the future of microwave tumor ablation: a new direction in precision and control of device performance. Int J Hyperthermia 2022; 39:664-674. [DOI: 10.1080/02656736.2021.1991012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Austin Pfannenstiel
- Precision Microwave Inc, Manhattan, KS, USA
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
| | - Jason Iannuccilli
- Department of Diagnostic Imaging, Division of Interventional Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Francois H. Cornelis
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Damian E. Dupuy
- Diagnostic Imaging, Brown University, Radiology, Cape Cod Hospital, MA, USA
| | - Warren L. Beard
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
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21
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Paolucci I, Ruiter SJS, Freedman J, Candinas D, de Jong KP, Weber S, Tinguely P. Volumetric analyses of ablation dimensions in microwave ablation for colorectal liver metastases. Int J Hyperthermia 2022; 39:639-648. [DOI: 10.1080/02656736.2021.1965224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Iwan Paolucci
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Simeon J. S. Ruiter
- Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacob Freedman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Koert P. de Jong
- Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Pascale Tinguely
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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22
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Zhang S, Li C, Cao L, Moser MAJ, Zhang W, Qian Z, Zhang B. Modeling and ex vivo experimental validation of liver tissue carbonization with laser ablation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 217:106697. [PMID: 35180678 DOI: 10.1016/j.cmpb.2022.106697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to model the process of liver tissue carbonization with laser ablation (LA). METHODS A dynamic heat source model was proposed and combined with the light distribution model as well as bioheat transfer model to predict the development of tissue carbonization with laser ablation (LA) using an ex vivo porcine liver tissue model. An ex vivo laser ablation experiment with porcine liver tissues using a custom-made 1064 nm bare fiber was then used to verify the simulation results at 3, 5, and 7 W laser administrations for 5 min. The spatiotemporal temperature distribution was monitored by measuring the temperature changes at three points close the fiber during LA. Both the experiment and simulation of the temperature, tissue carbonization zone, and ablation zone were then compared. RESULTS Four stages were recognized in the development of liver tissue carbonization during LA. The growth of the carbonization zone along the fiber axial and radial directions were different in the four stages. The carbonization zone along the fiber axial direction (L2) grew in the four stages with a sharp increase in the initial period and a minor increase in Stage 4. However, the change in the carbonization zone along the fiber radial direction (D2) increased dramatically (Stage 1) to a long-time plateau (Stages 2 and 3) followed by a slow growth in Stage 4. An acceptable agreement between the computer simulation and ex vivo experiment in the temperature changes at the three points was found at all three testing laser administrations. A similar result was also obtained for the dimensions of coagulation zone and ablation zone between the computer simulation and ex vivo experiment (carbonization zone: 2.99± 0.10 vs. 2.78 mm2, 67.39± 0.09 vs. 63.53 mm2, and 90.53± 0.11 vs. 85.15 mm2; ablation zone: 68.95± 0.28 vs. 65.29 mm2, 182.11± 0.24 vs. 213.81 mm2, and 244.80± 0.06 vs. 251.79 mm2 at 3, 5, and 7 W, respectively). CONCLUSION This study demonstrates that the proposed dynamic heat source model combined with the light distribution model as well as bioheat transfer model can predict the development of liver tissue carbonization with an acceptable accuracy. This study contributes to an improved understanding of the LA process in the treatment of liver tumors.
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Affiliation(s)
- Shiguang Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, 200444, China; School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Chunlei Li
- Shanghai Advanced Research Institute, Chinese Academy of Science, Shanghai, 201024, China
| | - Lin Cao
- Department of Automatic Control and Systems Engineering, the University of Sheffield, Sheffield, UK
| | - Michael A J Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Wenjun Zhang
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Zhiqin Qian
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, 200237, China.
| | - Bing Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, 200444, China.
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Poch FGM, Eminger KJ, Neizert CA, Geyer B, Rieder C, Ballhausen H, Niehues SM, Vahldiek JL, Lehmann KS. Cooling Effects Occur in Hepatic Microwave Ablation At Low Vascular Flow Rates and in Close Proximity to Liver Vessels - Ex Vivo. Surg Innov 2022; 29:705-715. [PMID: 35227134 DOI: 10.1177/15533506221074619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The impact of vascular cooling effects in hepatic microwave ablation (MWA) is controversially discussed. The objective of this study was a systematic assessment of vascular cooling effects in hepatic MWA ex vivo. Methods. Microwave ablations were performed in fresh porcine liver ex vivo with a temperature-controlled MWA generator (902-928 MHz) and a non-cooled 14-G-antenna. Energy input was set to 9.0 kJ. Hepatic vessels were simulated by glass tubes. Three different vessel diameters (3.0, 5.0, 8.0 mm) and vessel to antenna distances (5, 10, 20 mm) were examined. Vessels were perfused with saline solution at nine different flow rates (0-500 mL/min). Vascular cooling effects were assessed at the largest cross-sectional ablation area. A quantitative and semi-quantitative/morphologic analysis was carried out. Results. 228 ablations were performed. Vascular cooling effects were observed at close (5 mm) and medium (10 mm) antenna to vessel distances (P < .05). Vascular cooling effects occurred around vessels with flow rates ≥1.0 mL/min (P < .05) and a vessel diameter ≥3 mm (P < .05). Higher flow rates did not result in more distinct cooling effects (P > .05). No cooling effects were measured at large (20 mm) antenna to vessel distances (P > .05). Conclusion. Vascular cooling effects occur in hepatic MWA and should be considered in treatment planning. The vascular cooling effect was mainly affected by antenna to vessel distance. Vessel diameter and vascular flow rate played a minor role in vascular cooling effects.
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Affiliation(s)
- Franz G M Poch
- Department of General and Visceral Surgery-Campus Benjamin Franklin, 9373Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katharina J Eminger
- Department of General and Visceral Surgery-Campus Benjamin Franklin, 9373Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christina A Neizert
- Department of General and Visceral Surgery-Campus Benjamin Franklin, 9373Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Beatrice Geyer
- Department of General and Visceral Surgery-Campus Benjamin Franklin, 9373Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian Rieder
- Institute for Digital Medicine, Fraunhofer MEVIS, Bremen, Germany
| | - Hanne Ballhausen
- Institute for Digital Medicine, Fraunhofer MEVIS, Bremen, Germany
| | - Stefan M Niehues
- Department of Radiology-Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Janis L Vahldiek
- Department of Radiology-Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kai S Lehmann
- Department of General and Visceral Surgery-Campus Benjamin Franklin, 9373Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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24
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Geoghegan R, Zhang L, Priester A, Wu HH, Marks L, Natarajan S. Interstitial Optical Monitoring of Focal Laser Ablation. IEEE Trans Biomed Eng 2022; 69:2545-2556. [PMID: 35148260 PMCID: PMC9371599 DOI: 10.1109/tbme.2022.3150279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Focal laser ablation is a minimally invasive method of treating cancerous lesions in organs such as prostate, liver and brain. Oncologic control is achieved by inducing hyperthermia throughout the target while minimizing damage to surrounding tissue. Consequently, successful clinical outcomes are contingent upon achieving desired ablation volumes. Magnetic resonance thermometry is frequently used to monitor the formation of the induced thermal damage zone and inform the decision to terminate energy delivery. However, due to the associated cost and complexity there is growing interest in the development of alternative approaches. Here we investigate the utility of real-time interstitial interrogation of laser-tissue interaction as an inexpensive alternative monitoring modality that provides direct assessment of tissue coagulation without the need for organ specific calibration. The optical contrast mechanism was determined using a Monte Carlo model. Subsequently, four interstitial probe designs were manufactured and assessed in a tissue mimicking phantom under simultaneous magnetic resonance imaging. Finally, the optimal probe design was evaluated in ex vivo bovine muscle. It was found to be capable of providing sufficient feedback to achieve pre-defined ablation radii in the range 4-7mm with a mean absolute error of 0.3mm. This approach provides an inexpensive monitoring modality that may facilitate widespread adoption of focal laser ablation.
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25
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Lee J, Rhim H, Lee MW, Kang TW, Song KD, Lee JK. Direction of Tissue Contraction after Microwave Ablation: A Comparative Experimental Study in Ex Vivo Bovine Liver. Korean J Radiol 2022; 23:42-51. [PMID: 34983092 PMCID: PMC8743151 DOI: 10.3348/kjr.2021.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/11/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the direction of tissue contraction after microwave ablation in ex vivo bovine liver models. Materials and Methods Ablation procedures were conducted in a total of 90 sites in ex vivo bovine liver models, including the surface (n = 60) and parenchyma (n = 30), to examine the direction of contraction of the tissue in the peripheral and central regions from the microwave antenna. Three commercially available 2.45-GHz microwave systems (Emprint, Neuwave, and Surblate) were used. For surface ablation, the lengths of two overlapped square markers were measured after 2.5- and 5-minutes ablations (n = 10 ablations for each system for each ablation time). For parenchyma ablation, seven predetermined distances between the markers were measured on the cutting plane after 5- and 10-minutes ablations (n = 5 ablations for each system for each ablation time). The contraction in the radial and longitudinal directions and the sphericity index (SI) of the ablation zones were compared between the three systems using analysis of variance. Results In the surface ablation experiment, the mean longitudinal contraction ratio and SI from a 5-minutes ablation using the Emprint, Neuwave, and Surblate systems were 28.92% and 1.04, 20.10% and 0.53, and 24.90% and 0.45, respectively (p < 0.001). A positive correlation between longitudinal contraction and SI was noted, and a similar radial contraction was observed. In the parenchyma ablation experiment, the mean longitudinal contraction ratio and SI from a 10-minutes ablation using the three pieces of equipment were 38.60% and 1.06, 32.45% and 0.61, and 28.50% and 0.50, respectively (p < 0.001). There was a significant difference in the longitudinal contraction properties, whereas there was no significant difference in the radial contraction properties. Conclusion The degree of longitudinal contraction showed significant differences depending on the microwave ablation equipment, which may affect the SI of the ablation zone.
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Affiliation(s)
- Junhyok Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hyunchul Rhim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Kyong Lee
- Department of Radiology, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Korea
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26
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Taheri-Ledari R, Fazeli A, Kashtiaray A, Salek Soltani S, Maleki A, Zhang W. Cefixime-Containing Silica Nanoseeds Coated by a Hybrid PVA-Gold Network with a Cys-Arg Dipeptide Conjugation: Enhanced Antimicrobial and Drug Release Properties. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2021; 38:132-146. [PMID: 34961315 DOI: 10.1021/acs.langmuir.1c02233] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Therapeutic nano-bioconjugates (TNBCs) as an advanced class of drug delivery systems have attracted much attention due to more efficacy than the individual medications. Hence, in this study, a novel anti-infection TNBC system is designed based on highly porous silica nanoparticles, gold nanoparticles (AuNPs), and hybridized polyvinyl alcohol (PVA) for the efficient delivery of cefixime (CFM). Furthermore, a conjugation of cysteine-arginine (CR) dipeptide is made onto the surfaces for the enhancement of cell adhesion. Concisely, the AuNPs incorporated inside the PVA network play the key role in the controlled release process triggered by localized surface plasmon resonance (LSPR) heating. The drug content of the CFM-containing cargo (named as CFM@SiO2/PVA/Au-CR) and related release profile have been precisely studied by the confirmed analytical methods. Eventually, confocal microscopy on the stained cells has revealed that the TNBC particles are capable of entering the Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) bacterial cells better than the individual CFM. Also, optical density experiments (OD600) have corroborated that the prepared CFM@SiO2/PVA/Au-CR TNBC includes a high antimicrobial effect on K. pneumoniae and E. coli cells with (93.0 ± 1.5) % and (86.8 ± 1.0) % success rates, respectively, whereas the same dosage of the individual CFM has shown a lower effect on the cell growth rate. Also, estimation of minimum inhibitory/bactericidal concentrations (MIC/MBC) confirmed the enhanced antibacterial property of the CFM through the presented delivery method. Overall, this product is suggested to be clinically administrated instead of the individual CFM due to its high efficacy and containing lower dosage of the antibiotic drug.
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Affiliation(s)
- Reza Taheri-Ledari
- Catalysts and Organic Synthesis Research Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - Atefeh Fazeli
- Catalysts and Organic Synthesis Research Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - Amir Kashtiaray
- Catalysts and Organic Synthesis Research Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - Siavash Salek Soltani
- Catalysts and Organic Synthesis Research Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - Ali Maleki
- Catalysts and Organic Synthesis Research Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran 16846-13114, Iran
| | - Wenjie Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, P. R. China
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Crocetti L, Amabile C, Scalise P, Tosoratti N, Bozzi E, Rossi P, Cervelli R, Cassarino S, Cioni R. Predicting the coagulation volume induced by microwave ablation of hepatocellular carcinoma: the role of deposited energy, ex-vivo bovine liver charts and central hyperdense area on post-treatment CT. Int J Hyperthermia 2021; 38:1486-1494. [PMID: 34927518 DOI: 10.1080/02656736.2021.1986642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To study the correlation between the overall coagulation zone (A) attained in percutaneous microwave ablation (MWA) of hepatocellular carcinomas (HCC) and: (1) the hyperdense zone (C) visible in the central part of zone A on post-treatment unenhanced CT scans; (2) the deposited energy; (3) the coagulation zones observed on ex-vivo bovine liver. MATERIALS AND METHODS The post-procedural computed tomography (CT) scans of HCCs treated with a single energy deployment through the same 2450 MHz MWA system were retrospectively analyzed, retrieving the dimensions of A and C zones and the deposited energy (E). Ex-vivo bovine liver MWA with the same system were performed and analyzed to determine the same quantities by gross-pathologic examination and CT imaging. RESULTS A total of 101 HCC treatments were analyzed. The average coagulation volumes increased linearly with deposited energy (1.11 cc/kJ, R2 = 0.90, 4.2 kJ ≤ E ≤ 48 kJ), similarly to ex-vivo findings (1.38 cc/kJ, R2 =0.97, 7.2 kJ ≤ E ≤ 144 kJ). The long axis (L) and short axis (D) of zones A and C held a fairly constant ratio both in-vivo (LC/LA=0.43 ± 0.13; DC/DA=0.42 ± 0.10) and ex-vivo (LC/LA = 0.49 ± 0.07; DC/DA = 0.28 ± 0.06). CONCLUSIONS The average dimensions of the ablation zone induced by the considered system on HCC increase linearly with the deposited energy and are fairly well predicted by the corresponding ex-vivo dimensions. The ratio between each linear dimension of A and C zones was found to be roughly constant over a large deposited energy span, both ex-vivo and in-vivo.
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Affiliation(s)
- Laura Crocetti
- Division of Interventional Radiology, University of Pisa, Pisa, Italy
| | | | - Paola Scalise
- Division of Interventional Radiology, University of Pisa, Pisa, Italy
| | | | - Elena Bozzi
- Division of Interventional Radiology, University of Pisa, Pisa, Italy
| | - Piercarlo Rossi
- Division of Interventional Radiology, University of Pisa, Pisa, Italy
| | - Rosa Cervelli
- Division of Interventional Radiology, University of Pisa, Pisa, Italy
| | | | - Roberto Cioni
- Division of Interventional Radiology, University of Pisa, Pisa, Italy
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Ridouani F, Tuttle RM, Ghosn M, Li D, Wong RJ, Fagin JA, Monette S, Solomon SB, Camacho JC. Ultrasound-Guided Percutaneous Laser Ablation of the Thyroid Gland in a Swine Model: Comparison of Ablation Parameters and Ablation Zone Dimensions. Cardiovasc Intervent Radiol 2021; 44:1798-1806. [PMID: 34254175 PMCID: PMC9578502 DOI: 10.1007/s00270-021-02915-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare laser ablation (LA) zone dimensions at two predetermined energy parameters to cover a theoretical 10 mm zone + 2 mm margin in a thyroid swine model. METHODS Approval of the Institutional Animal Care and Use Committee was obtained. After hydrodissection, an ultrasound-guided LA (Elesta Echolaser X4 with Orblaze technology, 1064 nm) was performed in the periphery of the thyroid in 10 swine. Two cohorts were established to ablate a region of 10mm diameter with 2mm margin based on manufacturer's ex vivo data (n= 5 at 3W/1400J and n= 5 at 3W/1800J). The ablation zone was measured on contrast-enhanced computed tomography (CT) and compared to the pathological specimen. Euthanasia was performed 48 hours following ablation. RESULTS All ablations in the 3W/1800J group achieved a diameter of 12 mm ± 1 mm in three dimensions. In the 3W/1400J group, 1 ablation reached 12 mm ± 1 mm in 2 dimensions and 4 ablations reached this size in one dimension. Maximum diameter was higher in the 3W/1800J compared to the 3W/1400J group, both on histology (1.46 cm ± 0.05 vs. 1.1 cm ± 0.0, p< 0.01) and CT (1.52 cm ± 0.04 vs. 1.18 cm ± 0.04, p< 0.01). Similar results were obtained regarding volumes, both on histology (1.12 mL ± 0.13 vs. 0.57 mL ± 0.06, p< 0.01) and CT (1.24 mL ± 0.13 vs. 0.59 mL ± 0.07, p< 0.01). Histology showed coagulation necrosis and correlated well with CT measurements. CONCLUSION Optimal parameters to obtain a LA zone of 10 mm with 2 mm margin utilizing a single needle are 3W/1800J.
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Affiliation(s)
- Fourat Ridouani
- Interventional Radiology Service, Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 118, New York 10065, T 212 639 2209, New York, NY, USA
| | - R Michael Tuttle
- Head and Neck Cancer and Endocrinology Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario Ghosn
- Interventional Radiology Service, Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 118, New York 10065, T 212 639 2209, New York, NY, USA
| | - Duan Li
- Interventional Radiology Service, Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 118, New York 10065, T 212 639 2209, New York, NY, USA
| | - Richard J Wong
- Head and Neck Cancer and Endocrinology Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A Fagin
- Head and Neck Cancer and Endocrinology Services, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sebastien Monette
- Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 118, New York 10065, T 212 639 2209, New York, NY, USA
| | - Juan C Camacho
- Interventional Radiology Service, Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 118, New York 10065, T 212 639 2209, New York, NY, USA.
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Tinguely P, Paolucci I, Ruiter SJS, Weber S, de Jong KP, Candinas D, Freedman J, Engstrand J. Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:713685. [PMID: 34631539 PMCID: PMC8495244 DOI: 10.3389/fonc.2021.713685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023] Open
Abstract
Background Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors. Methods A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed. Results Thirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1–6 weeks and 90% (87, 93) if assessed at 6–12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies). Conclusions Advances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.
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Affiliation(s)
- Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.,Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Simeon J S Ruiter
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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30
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Yan X, Ning ZY, Wang P, Zhuang LP, Xu LT, Zhu ZF, Sheng J, Shen YH, Hua YQ, Meng ZQ. Combined ablation-chemotherapy versus chemotherapy alone for pancreatic cancer with liver metastasis: a propensity score matching study. Expert Rev Gastroenterol Hepatol 2021; 15:1047-1056. [PMID: 33356652 DOI: 10.1080/17474124.2021.1869937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: To retrospectively assess the efficacy of combined ablation-chemotherapy in comparison to that of chemotherapy alone in patients with liver metastasized pancreatic ductal adenocarcinoma (lmPDAC).Methods: In total 104 patients with hepatic oligo metastasized PDAC were identified; among them, 74 patients underwent combined thermal ablation-chemotherapy, and 30 patients underwent chemotherapy alone. Through propensity score matching, 1:1 matching of the combined ablation-chemotherapy group and chemotherapy group was achieved. The primary endpoint of this study was overall survival (OS). Clinical and tumor-related factors affecting OS were also analyzed through univariate and multivariate analyses using the Cox risk model.Results: For patients treated with combined ablation-chemotherapy, the median OS was 10.77 months, while it was 5.77 months for patients treated with chemotherapy alone (P = 0.011). The survival benefit for patients treated with combined ablation-chemotherapy was still preserved in the matched cohort, with a median OS of 8.17 months compared to 5.77 months in the chemotherapy group. Univariate and multivariate analyses in the matched population also showed treatment with combined ablation-chemotherapy was an independent prognostic factor (P < 0.05).Conclusions: For patients with liver metastases from pancreatic cancer, the combined use of thermal ablation and systemic chemotherapy offers a chance for a better survival outcome.
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Affiliation(s)
- Xia Yan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhou-Yu Ning
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Peng Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li-Ping Zhuang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li-Tao Xu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen-Feng Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jie Sheng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ye-Hua Shen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yong-Qiang Hua
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhi-Qiang Meng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
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Liu M, Jin K, Sun J, Lou Z. Postoperative ethmoid sinus mucoceles: Late complication of endoscopic ethmoidectomy and MWA management in outpatient. Am J Otolaryngol 2021; 42:103120. [PMID: 34167833 DOI: 10.1016/j.amjoto.2021.103120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the feasibility of intranasal endoscopic microwave ablation (MWA) on the management of postoperative ethmoid sinus mucoceles. METHODS AND MATERIALS The patients with postoperative ethmoid sinus mucoceles were ablated through intranasal endoscopic MWA. Postoperative pain intensity was measured via visual analogue scale (VAS), post-operative complications were recorded. RESULTS Of the 26 patients with unilateral postoperative ethmoid sinus mucoceles, the mucoceles were diagnosed 3 to 11 years with average time of time of 6.9 ± 2.7 years after endoscopic ethmoidectomy. The ipsilateral middle turbinate was present and intact in 24 patients and partially resected during the original surgery in the remaining 2. There were adhesions in the middle meatus in one case. All 26 patients were successfully treated with the intranasal endoscopic ablation technique in outpatient. The ablation time was 6 to 11 min, with an average duration of 6.84 ± 1.27 min. The mean VAS pain score was 2.41 ± 1.22. There were no perioperative complications reported in this series. No evidence of recurrence was observed in any patients during follow-up periods. CONCLUSIONS The present study demonstrates the safety and efficacy of intranasal endoscopic MWA in the office. The procedure is well tolerated by patients with low complication rates. Thus, it is alternative to conventional endonasal endoscopic marsupialization for treatment of postsurgical ethmoid sinus mucoceles.
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Habert P, Di Bisceglie M, Hak JF, Brige P, Chopinet S, Mancini J, Bartoli A, Vidal V, Roux C, Tselikas L, De Baere T, Gaubert JY. Percutaneous lung and liver CT-guided ablation on swine model using microwave ablation to determine ablation size for clinical practice. Int J Hyperthermia 2021; 38:1140-1148. [PMID: 34353206 DOI: 10.1080/02656736.2021.1961883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Microwave ablation (MWA) provides an effective treatment of lung and liver tumors but suffers from a lack of reproducibility of ablation size among currently available technologies. In-vitro evaluations are far removed from clinical practices because of uninfused tissue. This study is in-vivo preclinical testing of a new MWA system on swine lungs and liver. MATERIALS AND METHODS All ablations were performed under CT guidance and multiple algorithms were tested with a power of 50, 75, and 100 W for durations of 3, 5, 8, 10, and 15 min. A 3 D-evaluation of the ablation zone was carried out using enhanced-CT. The sphericity index, coefficients of variation, and energy efficiency (which corresponds to the volume yield according to the power supplied) were calculated. RESULTS Fifty liver and 48 lung ablations were performed in 17 swine. The sphericity index varies from 0.50 to 0.80 for liver ablations and from 0.40 to 0.69 for lung ablations. The coefficient of variation was below 15% for 4/5 and 4/8 protocols for lung and liver ablations, respectively. The energy efficiency seems to decrease with the duration of the ablation from 0.60 × 10-3 cm3/J (75 W, 3 min) to 0.26 × 10-3 cm3/J (100 W, 15 min) in the liver and from 0.57 × 10-3 cm3/J (50 W, 10 min) to 0.42 × 10-3 cm3/J (100 W, 12 min) in the lungs. CONCLUSION A shorter treatment time provides the best energy efficiency, and the best reproducibility is obtained for a 10 min treatment duration. The system tested provides an interesting reproducibility in both lung and liver measurements. Our results may help interventional radiologists in the optimal selection of treatment parameters.
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Affiliation(s)
- Paul Habert
- Department of Interventional Imaging, Assistance Publique Hopitaux de Marseille, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Mathieu Di Bisceglie
- Department of Interventional Imaging, Assistance Publique Hopitaux de Marseille, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Jean-François Hak
- Department of Interventional Imaging, Assistance Publique Hopitaux de Marseille, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Pauline Brige
- Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Sophie Chopinet
- Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France.,Department of Visceral Surgery, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Julien Mancini
- Biostatistics Department, BIOSTIC, Aix Marseille University, APHM, INSERM, IRD, SESSTIM, ISSPAM, Hop Timone, Marseille, France
| | - Axel Bartoli
- Department of Interventional Imaging, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Vincent Vidal
- Department of Interventional Imaging, Assistance Publique Hopitaux de Marseille, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
| | - Charles Roux
- Departement d'Anesthesie, Chirurgie et Interventionel, Gustave Roussy, Paris, France.,Université Paris-Saclay, Paris, France
| | - Lambros Tselikas
- Departement d'Anesthesie, Chirurgie et Interventionel, Gustave Roussy, Paris, France.,Université Paris-Saclay, Paris, France
| | - Thierry De Baere
- Departement d'Anesthesie, Chirurgie et Interventionel, Gustave Roussy, Paris, France.,Université Paris-Saclay, Paris, France
| | - Jean-Yves Gaubert
- Department of Interventional Imaging, Assistance Publique Hopitaux de Marseille, Marseille, France.,Aix Marseille University, LIIE, Marseille, France.,Aix Marseille University, CERIMED, Marseille, France
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Heinrich A, Schenkl S, Buckreus D, Güttler FV, Teichgräber UKM. CT-based thermometry with virtual monoenergetic images by dual-energy of fat, muscle and bone using FBP, iterative and deep learning-based reconstruction. Eur Radiol 2021; 32:424-431. [PMID: 34327575 PMCID: PMC8660750 DOI: 10.1007/s00330-021-08206-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022]
Abstract
Objectives The aim of this study was to evaluate the sensitivity of CT-based thermometry for clinical applications regarding a three-component tissue phantom of fat, muscle and bone. Virtual monoenergetic images (VMI) by dual-energy measurements and conventional polychromatic 120-kVp images with modern reconstruction algorithms adaptive statistical iterative reconstruction-Volume (ASIR-V) and deep learning image reconstruction (DLIR) were compared. Methods A temperature-regulating water circuit system was developed for the systematic evaluation of the correlation between temperature and Hounsfield units (HU). The measurements were performed on a Revolution CT with gemstone spectral imaging technology (GSI). Complementary measurements were performed without GSI (voltage 120 kVp, current 130–545 mA). The measured object was a tissue equivalent phantom in a temperature range of 18 to 50°C. The evaluation was carried out for VMI at 40 to 140 keV and polychromatic 120-kVp images. Results The regression analysis showed a significant inverse linear dependency between temperature and average HU regardless of ASIR-V and DLIR. VMI show a higher temperature sensitivity compared to polychromatic images. The temperature sensitivities were 1.25 HU/°C (120 kVp) and 1.35 HU/°C (VMI at 140 keV) for fat, 0.38 HU/°C (120 kVp) and 0.47 HU/°C (VMI at 40 keV) for muscle and 1.15 HU/°C (120 kVp) and 3.58 HU/°C (VMI at 50 keV) for bone. Conclusions Dual-energy with VMI enables a higher temperature sensitivity for fat, muscle and bone. The reconstruction with ASIR-V and DLIR has no significant influence on CT-based thermometry, which opens up the potential of drastic dose reductions. Key Points • Virtual monoenergetic images (VMI) enable a higher temperature sensitivity for fat (8%), muscle (24%) and bone (211%) compared to conventional polychromatic 120-kVp images. • With VMI, there are parameters, e.g. monoenergy and reconstruction kernel, to modulate the temperature sensitivity. In contrast, there are no parameters to influence the temperature sensitivity for conventional polychromatic 120-kVp images. • The application of adaptive statistical iterative reconstruction-Volume (ASIR-V) and deep learning–based image reconstruction (DLIR) has no effect on CT-based thermometry, opening up the potential of drastic dose reductions in clinical applications.
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Affiliation(s)
- Andreas Heinrich
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
| | - Sebastian Schenkl
- Institute of Forensic Medicine, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - David Buckreus
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Felix V Güttler
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Ulf K-M Teichgräber
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
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Izaaryene J, Drai M, Deniel C, Bridge P, Rico G, Daidj N, Gilabert M, Ewald J, Turrini O, Piana G. Computed tomography-guided microwave ablation of perivascular liver metastases from colorectal cancer: a study of the ablation zone, feasibility, and safety. Int J Hyperthermia 2021; 38:887-899. [PMID: 34085891 DOI: 10.1080/02656736.2021.1912413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To compare the ablation margins and safety of microwave ablation (MWA) of perivascular versus non-perivascular liver metastases from colorectal cancer (CRC) and to determine the risk factors for local tumor progression (LTP) after perivascular MWA. METHODS Between June 2017 and June 2019, 84 metastases were treated: 39 perivascular (<5 mm from a vessel >3 mm), and 46 non-perivascular. Perivascular metastases were treated with either conventional or optimized protocols (maximum power and/or several heating cycles after repositioning the needle regardless of the initial tumor dimensions). The mean diameter of metastases was 15.4 mm (SD: 7.56). RESULTS Vascular proximity did not result in a significant difference in ablation margins. The technical success rate, primary efficacy, and secondary efficacy were 90%, 66%, and 83%, respectively. Perivascular location was not a risk factor for time to LTP (p = 0.49), RFS (p = 0.52), or OS (p = 0.54). LTP was statistically related to the presence of a colonic obstruction (p < 0.05), number of metastases at the time of diagnosis (p < 0.05), type of protocol (p < 0.05), ablation margins (p < 0.001) and LTP was proportional to the number of liver resections before MWA (p < 0.05). There was no LTP in tumors ablated with margins over 10 mm. Two grade 4 complications occurred. CONCLUSION MWA is an effective and safe treatment for perivascular liver metastases from CRC, provided that satisfactory margins are achieved. A maximalist attitude could be related to better local control.
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Affiliation(s)
- Jean Izaaryene
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Maxime Drai
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Cécile Deniel
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Pauline Bridge
- Laboratoire Imagerie Interventionnelle Experimentale CERIMED, Marseille, France
| | - Geoffrey Rico
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Nassima Daidj
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
| | - Marine Gilabert
- Department of Oncology, Institut Paoli Calmettes, Marseille, France
| | - Jacques Ewald
- Department of Surgery, Institut Paoli Calmettes, Marseille, France
| | - Olivier Turrini
- Department of Surgery, Institut Paoli Calmettes, Marseille, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli Calmettes, Aix Marseille University, Marseille, France
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Yu J, Wang H, Cheng ZG, Liu FY, Li QY, He GZ, Luo YC, Yu XL, Han ZY, Liang P. A multicenter 10-year oncologic outcome of ultrasound-guided percutaneous microwave ablation of clinical T1 renal cell carcinoma: will it stand the test of time? Eur Radiol 2021; 32:89-100. [PMID: 34195888 DOI: 10.1007/s00330-021-07900-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/11/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We updated the experience on percutaneous microwave ablation for renal cell carcinoma with five-center data and long-term follow-up. METHODS This retrospective study reviewed the T1N0M0 renal cell carcinoma patients who underwent microwave ablation between April 2006 and December 2019. Clinicopathological and procedural data were collected. Technical effectiveness and complications were assessed, and the Kaplan-Meier method was used for cancer-specific survival, disease-free survival, overall survival, and local neoplastic process analyses. RESULTS A total of 323 consecutive patients (mean age, 62.9 years ± 14.0) with 371 biopsy-proved tumors (mean diameter, 2.9 cm ± 1.2) were enrolled, and 42.6% of the tumors were located adjacent to collecting system/bowel and technical effectiveness was achieved in 360 (97.0%) tumors. For 275 cT1a patients, during median follow-up time of 66.0 months (IQR, 58.4-73.6), 10-year local neoplastic processes, cancer-specific survival, disease-free survival, and overall survival rates were 1.9%, 87.4%, 71.8, and 67.5%, respectively. For 48 cT1b patients, during the median follow-up time of 30.4 months (IQR, 17.7-44.8), 5-year local tumor progression, cancer-specific survival, disease-free survival, and overall survival rates were 11.3%, 91.4%, 69.1, and 89.2%, respectively. Major complications showed no differences between cT1a (3.5%) and cT1b (6.9%) patients (p = 0.28). A clinical risk stratification system was developed based on multivariable model to predict DFS and CSS with c-indexes of 0.78 (95% CI: 0.71-0.85) and 0.77 (95% CI: 0.65-0.90), respectively. CONCLUSIONS With matured follow-up at five institutions, ultrasound-guided percutaneous microwave ablation is a reliable treatment option for cT1a renal cell carcinoma even in dangerous location and appears to be promising for cT1b tumors. KEY POINTS • To our knowledge, this is the first multicenter cohort of long-term oncologic outcomes with percutaneous MWA of cT1 RCC. • The predicting model we developed is accurate to predict the long-term DFS and CSS, which can help to provide a better MWA prognostication over routinely available clinical information. • The available evidence shows that microwave ablation of clinical stage T1 RCC is safe and reliable with promising long-term oncologic outcomes, especially for cT1a RCC with excellent 10-year results.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Qin-Ying Li
- Department of Ultrasound, Puyang Hospital of Traditional Chinese Medicine of Henan Province, No. 135 Shengli East Road, Puyang, 457000, Henan Province, China
| | - Guang-Zhi He
- Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, 4253 Songbai Road, Matian Street, Guangming District, Shenzhen, Guangdong Province, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Prud'homme C, Teriitehau C, Adam J, Kyaw Tun J, Roux C, Hakime A, Delpla A, Deschamps F, de Baere T, Tselikas L. Lung microwave ablation - an in vivo swine tumor model experiment to evaluate ablation zones. Int J Hyperthermia 2021; 37:879-886. [PMID: 32689829 DOI: 10.1080/02656736.2020.1787530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate microwave ablation (MWA) algorithms, comparing pulsed and continuous mode in an in vivo lung tumor mimic model. MATERIALS AND METHODS A total of 43 lung tumor-mimic models of 1, 2 or 3 cm were created in 11 pigs through an intra-pulmonary injection of contrast-enriched minced muscle. Tumors were ablated under fluoroscopic and 3D-CBCT-guidance using a single microwave antenna. Continuous (CM) and pulsed mode (PM) were used. According to tumor size, 3 different algorithms for both continuous and pulsed mode were used. The ablation zones were measured using post-procedural 3D-CBCT and on pathologic specimens. RESULTS Two radiologists measured the ablation zones on CBCT and they significantly correlated with macroscopic and microscopic pathological findings: r = 0.75 and 0.74 respectively (p < 0.0001) (inter-observer correlation r = 0.9). For 1, 2 and 3 cm tumors mimics lesions (TMLs), mean maximal and transverse ablation diameters were 3.6 [Formula: see text] 0.3 × 2.2 [Formula: see text] 0.3 cm; 4.1 [Formula: see text] 0.5 × 2.6 [Formula: see text] 0.3 cm and 4.8 [Formula: see text] 0.3 × 3.2 [Formula: see text] 0.3 cm respectively using CM; And, 3.0 [Formula: see text] 0.2 × 2.1 [Formula: see text] 0.2 cm; 4.0 [Formula: see text] 0.4 × 2.7 [Formula: see text] 0.4 cm and 4.6 [Formula: see text] 0.4 × 3.2 [Formula: see text] 0.4 cm respectively for PM, without any significant difference except for 1 cm TMLs treated by PM ablation which were significantly smaller (p = 0.009) The sphericity index was 1.6, 1.6, 1.5 and 1.4, 1.5, 1.4 at 1, 2 and 3 cm for CM and PM respectively, p = 0.07, 0.14 and 0.13 for 1, 2 and 3 cm tumors mimics. CONCLUSION Microwave ablation for 1-3 cm lung tumors were successfully realized but with a moderate reproducibility rate, using either CM or PM. Immediate post ablation CBCT can accurately evaluate ablation zones.
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Affiliation(s)
- Clara Prud'homme
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Christophe Teriitehau
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Julien Adam
- Department of Pathology, Gustave Roussy, Villejuif, France
| | - Jimmy Kyaw Tun
- Interventional Radiology Department, Barts Health NHS Trust, London, UK
| | - Charles Roux
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Antoine Hakime
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Alexandre Delpla
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Fréderic Deschamps
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Thierry de Baere
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Saint-Aubin, France
| | - Lambros Tselikas
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
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Liu M, Lou Z, Jin K, Sun J, Chen Z. The feasibility of intranasal endoscopic microwave ablation on the removal of nasolabial cyst: Preliminary case series. Am J Otolaryngol 2021; 42:103018. [PMID: 33840513 DOI: 10.1016/j.amjoto.2021.103018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinical effect of the removal of nasolabial cyst via intranasal endoscopic microwave ablation (MWA). METHODS AND MATERIALS The patients with nasolabial cyst were ablated through intranasal endoscopic MWA. Postoperative pain intensity was measured via visual analogue scale (VAS), post-operative complications were recorded. RESULTS Of the 31 patients with unilateral nasolabial cyst, the main complaint was a gradually increasing mass in the nasal alar and upper lip, other complaint included nasal obstruction (11/31,35.5%), localized pain (21,67.7%), and erythema (13/31,41.9%). All 31 patients were successfully treated with the intranasal endoscopic ablation technique in outpatient. The mean ablation duration was 5.86 ± 0.71 min. The mean VAS pain score was 2.36 ± 1.08 on postoperative. None of infection occurred. All the patients complained of mild numbness in the upper lip with an average last duration of 28.5 ± 7.9 h in patients. In addition, 4 (12.9%) patients had facial/perinasal swelling, acid bilge of maxillary teeth in 7(22.6%), and toothache in one (3.2%). The patients were followed up for 12 months without recurrence and oronasal fistula. The nasolabial cyst had integrated into a part of the nasal cavity. CONCLUSIONS The intranasal endoscopic MWA is feasible and alternative to conventional transoral sublabial approach for removal of the nasolabial cysts in outpatient.
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Evaluation of the performance of designed coaxial antennas for hyperthermia using simulation and experimental methods. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2021. [DOI: 10.2478/pjmpe-2021-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Introduction: Antenna geometries and tissue properties affect microwave energy distributions during microwave ablation procedures. There is paucity information on the potential of antenna fabricated from a thick semi-rigid coaxial cable in the field of microwave thermal therapy. This study aimed at comparing the performance of two dual-slot antennas designed from different semi-rigid coaxial cables for the ablation of a liver tumour using numerical simulation and experimental validation methods.
Materials and Methods: COMSOL Multiphysics software was used for designing dual-slot antennas and as well as to evaluate microwave energy deposition and heat distribution in the liver tissue. Experimental validations were conducted on the ex-vivo bovine livers to validate the simulation results.
Results: Thick antenna developed in this study produced a higher sphericity index, larger ablation diameter and reduced backward heating along the antenna shaft than the existing one. The experimental validation results also indicate significant differences between the two antennas in terms of ablation diameters (p = 0.04), ablation lengths (p = 0.02) and aspect ratios (p = 0.02).
Conclusion: Based on the findings in this study, antenna fabricated from a thick coaxial cable has a higher potential of localizing microwave energy in the liver than conventional antennas.
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Role of Thermal Ablation in Colorectal Cancer Lung Metastases. Cancers (Basel) 2021; 13:cancers13040908. [PMID: 33671510 PMCID: PMC7927065 DOI: 10.3390/cancers13040908] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary For a long time, surgery has been the only local treatment for pulmonary metastases. Percutaneous thermal ablation appeared in the early 2000s as a minimally invasive alternative technique to surgery for patients who were not eligible for surgery or wanted to preserve quality of life. In this review, we discuss the role of thermal ablation in the management of lung metastases of colorectal cancer, and present the main results of the literature concerning oncological outcomes (local tumor control, survival) based on 12 relevant original studies each involving a minimum of 50 patients, with a minimal follow-up of 12 months. Abstract Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.
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Huber TC, Miller G, Patrie J, Angle JF. Relationship of Antenna Work and Ablation Cavity Volume Following Percutaneous Microwave Ablation of Hepatic Tumors. J Vasc Interv Radiol 2021; 32:536-543. [PMID: 33551303 DOI: 10.1016/j.jvir.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To formulate a statistical model relating ablation time, power, and work with posttreatment cavity volume following percutaneous microwave ablation of hepatic tumors in vivo. MATERIALS AND METHODS A retrospective review (October 2015 to October 2018) yielded 122 hepatic tumors treated with microwave ablation. Ablation cavity dimensions were measured at 1-month follow-up examination and calculated using an ellipsoid volume formula. The antenna manufacturer (Neuwave Medical, Madison, Wisconsin) provided the activation time and energy used to calculate the antenna work. Generalized estimating equations with ordinary least-squares regression models were obtained to relate tumor volume with cumulative antenna work. Coefficient of determination (R2) and mean square error were used as statistical measures of model prediction performance. RESULTS There is a logarithmic relationship between postablation cavity volume (cm3) and cumulative work (kJ), represented by the formula: log10 cm3 = -0.4583 + 0.9887 × cumulative work (log10 kJ) (R2 = 0.41, mean square error, 0.102). Ablation volumes were predicted as a function of antenna work, calculated using an antilog transformation. When a single antenna was used, ablation cavity volume was predicted using a generalized estimating equation ordinary least-squares regression model of power and time: log10cm3= -0.0546 + 0.0485 × total time (min) + 0.0107 × power (W) (R2 = 0.30; mean square error, 0.106). Using this model, a nomogram was developed to predict the postablation cavity volume based on total activation time and target power. CONCLUSION There is a logarithmic relationship between the ablation work and posttreatment ablation cavity volume, which can be expressed in a nomogram when using a single probe.
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Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239.
| | - Geoffery Miller
- Department of Vascular and Interventional Radiology, University of Virginia, Charlottesville, Virginia
| | - James Patrie
- Department of Statistics, University of Virginia, Charlottesville, Virginia
| | - John F Angle
- Department of Vascular and Interventional Radiology, University of Virginia, Charlottesville, Virginia
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A predictive model of incomplete response after transarterial chemoembolization for early or intermediate stage of hepatocellular carcinoma: consideration of hepatic angiographic and cross-sectional imaging. Abdom Radiol (NY) 2021; 46:581-589. [PMID: 32761406 DOI: 10.1007/s00261-020-02701-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The purpose of the present study is to develop a predictive model for incomplete response (IR) after conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) based on hepatic angiographic and cross-sectional imaging. METHODS Sixty patients with 139 target HCC lesions who underwent cTACE from February 2013 to March 2019 were included in this retrospective study. Hepatic angiographic features were identified: the number of feeding arteries, vascularity of the tumor, tumor staining on angiography, vascular lake phenomenon, and hepatic arterio-portal shunt. Cross-sectional imaging features were also identified: tumor extent, location, size, and enhancement pattern. Treatment response was assessed by the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Logistic regression analysis was performed to determine the potential predictive factors for treatment response. To validate the predictive value of potential factors, the means of a decision tree were also calculated by Classification and Regression Tree (CART). P < 0.05 was considered statistically significant. RESULTS The IR rate was 43.2% (60/139) in the entire study population. Logistic regression analysis showed that a tumor size > 50 mm (P = 0.005; odds ratio, 7.25; 95% CI 1.79-29.33), central location (P = 0.007; odds ratio, 0.14; 95% CI 0.03-0.59), and nondense tumor staining (P < 0.001; odds ratio, 0.08; 95% CI 0.02-0.28) were predictors of IR after cTACE. Decision tree analysis showed a good ability to classify treatment response with an accuracy of 78.4%. CONCLUSION Tumor size > 50 mm, central tumor location, and nondense tumor staining were predictors of IR after cTACE. These factors should be taken into consideration when performing cTACE.
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Ramalingam R, Mukund A, Anandpara KM, Patidar Y, Sarin SK. Comparative Analysis of Radiofrequency Ablation and Microwave Ablation for Critically Located Hepatocellular Carcinomas Smaller than 5 cm. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1723050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Abstract
Purpose To compare the safety and efficacy of radiofrequency ablation (RFA) versus microwave ablation (MWA) for hepatocellular carcinomas (HCC) smaller than 5 cm in critical locations.
Methods Single-center retrospective study of all patients who underwent RFA/MWA for HCC from July 2015 to Dec 2019. Critical location includes exophytic tumors, tumors ≤ 5 mm from the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, and ≤ 10 mm from large vessels with caliber of ≥ 3 mm. Treatment effectiveness, local tumor progression, and complication rates were evaluated.
Results Out of 119 patients with 147 HCC nodules in critical location, 65 (M:F = 49:16; mean age–61.7) were included in RFA group and 54 (M:F =43:11; mean age–60.5) in MWA group. Mean follow-up period was 16.5 and 14.8 months, respectively. At first follow-up imaging, 66/78 tumors in RFA group and 57/69 tumors in MWA group showed complete ablation with primary treatment effectiveness rates of 84.6% and 82.6%, respectively (p = 0.741). Local tumor progression (LTP) rate was 21.8% (17/78) and 20.3% (14/69), respectively (p = 0.826). Median time to LTP was 12 and 13.5 months, respectively. Fourteen tumors in RFA group and 12 in MWA group underwent reablation with a secondary treatment effectiveness rates of 78.6% (14/17) and 83.3% (12/14), respectively (p = 0.757). Mean LTP-free survival was 37.2 and 28.1 months, respectively. The total complication rate was 36.9% and 31.5%, respectively (p = 0.535) with no major complications in both the groups.
Conclusion Our data suggest that both MWA and RFA are equally safe and effective for treating HCCs < 5 cm in critical locations.
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Affiliation(s)
- Ravindran Ramalingam
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karan Manoj Anandpara
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Performance of the Emprint and Amica Microwave Ablation Systems in ex vivo Porcine Livers: Sphericity and Reproducibility Versus Size. Cardiovasc Intervent Radiol 2021; 44:952-958. [PMID: 33462682 PMCID: PMC8172387 DOI: 10.1007/s00270-020-02742-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/04/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the performance of two microwave ablation (MWA) systems regarding ablation volume, ablation shape and variability. MATERIALS AND METHODS In this ex vivo study, the Emprint and Amica MWA systems were used to ablate porcine livers at 4 different settings of time and power (3 and 5 minutes at 60 and 80 Watt). In total, 48 ablations were analysed for ablation size and shape using Vitrea Advanced Visualization software after acquisition of a 7T MRI scan. RESULTS Emprint ablations were smaller (11,1 vs. 21,1 mL p < 0.001), more spherical (sphericity index of 0.89 vs. 0.59 p < 0.001) and showed less variability than Amica ablations. In both systems, longer ablation time and higher power resulted in significantly larger ablation volumes. CONCLUSION Emprint ablations were more spherical, and the results showed a lower variability than those of Amica ablations. This comes at the price of smaller ablation volumes.
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Microwave Thermoablation of Colorectal Liver Metastases Close to Large Hepatic Vessels Under Pringle Maneuver Minimizes the "Heat Sink Effect". World J Surg 2021; 44:1595-1603. [PMID: 31965277 DOI: 10.1007/s00268-020-05379-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver resection and thermoablation are the mainstay of the surgical management of colorectal liver metastases (CRLM). The main limitation of thermoablation is the "heat-sink" effect for nodules next to large vessels. Herein, we report the preliminary results of microwave ablation (MWA) with associated Pringle maneuver to overcome this flaw. METHODS From November 2017, we performed intraoperative MWA with Pringle maneuver for nodules ≤3 cm with immediate proximity to large vessels (distance ≤ 5 mm, diameter ≥ 3 mm). We collected characteristics of nodules, surgical procedures and postoperative morbidity. Diameter of the ablation area, especially the ablative minimal margin, was calculated for each nodule. Recurrence was also evaluated. RESULTS Nineteen patients underwent MWA with Pringle maneuver for 23 nodules. Nineteen (83%) ablated nodules were located in segments VI, VII and VIII, and one nodule was in segment I. Median size of nodules was 15 mm (10-21). No deaths occurred. Six patients (38%) experienced complications, among them only one was subsequent to the thermal ablation. Ablative minimal margin was ≥5 mm for 19 (83%) nodules. Margin was not sufficient for four nodules, among them only 2/23 cases (8.7%) of in situ recurrence occurred after 12 months of median follow-up. CONCLUSIONS In this preliminary study, MWA with Pringle maneuver was associated with a low related morbidity rate and favorable oncological outcome, especially when the radiological minimal margin was sufficient.
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Ye J, Huang W, Huang G, Qiu Y, Peng W, Lan N, Xie X, Liu B. Efficacy and safety of US-guided thermal ablation for primary hyperparathyroidism: a systematic review and meta-analysis. Int J Hyperthermia 2020; 37:245-253. [PMID: 32138558 DOI: 10.1080/02656736.2020.1734673] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose: To summarize the published literature on thermal ablation for primary hyperparathyroidism (PHPT) and to evaluate the effectiveness and safety of thermal ablation as a novel treatment strategy.Materials and methods: Two authors carried out the literature search using four databases independently, including PubMed, Embase, Cochrane, and Web of Science. The meta-analysis included prospective and retrospective data that compared post-ablative outcomes to pre-ablative values. The primary outcomes were parathyroid hormone (PTH), serum calcium and volume of the parathyroid gland (VPG).Results: From the 184 original articles, five studies (4 retrospective studies and 1 prospective study) examining 84 patients met the inclusion criteria. The meta-analysis showed significant reduction of PTH at 3 (standardized mean difference (SMD) = -1.09, 95% confidence index (CI) = -1.42 to -0.76, p < 0.001) and 6 months (SMD = -1.13, 95% CI = -1.46 to -0.80, p < 0.001) after thermal ablation. Serum calcium level was significantly reduced at 3 (mean difference (MD) = -0.31, 95% CI = -0.50 to -0.12, p = 0.001) and 6 months (MD = -0.31, 95% CI = -0.46 to -0.17, p < 0.001) after thermal ablation. There was no significant difference between pre-ablative VPG and that of 6 months after ablation (MD = -0.30, 95% CI = -0.70 to 0.09, p = 0.13). The most common complications were transient dysphonia and subcutaneous edema. No major complications or death occurred.Conclusion: Thermal ablation is effective and safe for treatment of PHPT. PTH and calcium levels were reduced significantly at 3 and 6 months after thermal ablation.
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Affiliation(s)
- Jieyi Ye
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First Municipal People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), Foshan, China
| | - Weijun Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First Municipal People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), Foshan, China
| | - Guangliang Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yide Qiu
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First Municipal People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), Foshan, China
| | - Weiwei Peng
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First Municipal People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), Foshan, China
| | - Ninghui Lan
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First Municipal People's Hospital (The Affiliated Foshan Hospital of Sun Yat-sen University), Foshan, China
| | - Xiaoyan Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Baoxian Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Winkelmann MT, Gohla G, Kübler J, Weiß J, Clasen S, Nikolaou K, Hoffmann R. MR-Guided High-Power Microwave Ablation in Hepatic Malignancies: Initial Results in Clinical Routine. Cardiovasc Intervent Radiol 2020; 43:1631-1638. [PMID: 32699978 PMCID: PMC7591402 DOI: 10.1007/s00270-020-02584-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Evaluation of technique effectiveness, patient safety and ablation parameters of MR-guided microwave ablation in hepatic malignancies using an MR-conditional high-power microwave ablation system. MATERIALS AND METHODS Institutional review board approval and informed patient consent were obtained. Patients who underwent MR-guided microwave ablation of hepatic malignancies in a 1.5T wide-bore scanner using a perfusion-cooled high-power microwave ablation system with a maximum generator power of 150 W were included. Ablation parameters comprising procedure durations, net ablation duration, applicator positions and ablation zone dimensions were recorded. Adverse events were classified according to the CIRSE classification system. Technique effectiveness was assessed after 1 month. Follow-up was conducted with contrast-enhanced MRI and ranged from 1 to 20 months (mean: 6.1 ± 5.4 months). RESULTS Twenty-one consecutive patients (age: 63.4 ± 10.5 years; 5 female) underwent 22 procedures for 28 tumours (9 hepatocellular carcinomas, 19 metastases) with a mean tumour diameter of 14.6 ± 5.4 mm (range: 6-24 mm). Technique effectiveness was achieved in all lesions. Tumours were treated using 1.7 ± 0.7 applicator positions (range: 1-3). Mean energy and ablation duration per tumour were 75.3 ± 35.4 kJ and 13.3 ± 6.2 min, respectively. Coagulation zone short- and long-axis diameters were 29.1 ± 6.4 mm and 39.9 ± 7.4 mm, respectively. Average procedure duration was 146.4 ± 26.2 min (range: 98-187 min). One minor complication was reported. Five patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed during initial follow-up. CONCLUSION MR-guided high-power microwave ablation provides safe and effective treatment of hepatic malignancies with short ablation times and within acceptable procedure durations.
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Affiliation(s)
- Moritz T Winkelmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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Hui TCH, Brace CL, Hinshaw JL, Quek LHH, Huang IKH, Kwan J, Lim GHT, Lee FT, Pua U. Microwave ablation of the liver in a live porcine model: the impact of power, time and total energy on ablation zone size and shape. Int J Hyperthermia 2020; 37:668-676. [DOI: 10.1080/02656736.2020.1774083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Christopher Lee Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - J. Louis Hinshaw
- Department of Radiology and Urology, University of Wisconsin, Madison, WI, USA
| | | | | | - Justin Kwan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gavin Hock Tai Lim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Fred T. Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Radiology and Urology, University of Wisconsin, Madison, WI, USA
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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Deng H, Zhang T, Jiang X, Huang S, Jiang NN, Lau WY, Jinhua H. Comparison of hydrochloric acid infusion radiofrequency ablation with microwave ablation in an ex vivo liver model. Int J Hyperthermia 2020; 37:600-607. [PMID: 32484363 DOI: 10.1080/02656736.2020.1772995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objectives: To compare sizes and shapes of ablation zones resulting from hydrochloric acid infusion radiofrequency ablation (HRFA) and microwave ablation (MWA), using normal saline infusion radiofrequency ablation (NSRFA) as a control, at a variety of matched power settings and ablation durations, in an ex vivo bovine liver model.Methods: A total of 90 ablation procedures were performed, using each of three modalities: NSRFA, HRFA, and MWA. For each modality, five ablation procedures were performed for each combination of power (80 W, 100 W, or 120 W) and duration (5, 10, 20, 30, 45, or 60 min). The size of ablation zones were compared using ANOVA, the Kruskal-Wallis test, or generalized linear regression.Results: For ablation durations up to 30 min, mean transverse diameter (TD) after HRFA and MWA did not differ significantly (β = 0.13, p = .20). For ablation durations greater than 30 min, mean TD was significantly larger after HRFA than after MWA (β = 1.657, p < .001). The largest TD (9.46 cm) resulted from HRFA performed with 100 W power for 60 min.Conclusions: Compared to MWA, monopolar HRFA with power settings of 80 W-120 W and durations of less than 30 min showed no significant difference. When duration of more than 30 min, HRFA created larger ablation zones than MWA.
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Affiliation(s)
- Hanxia Deng
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tianqi Zhang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiongying Jiang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Senmiao Huang
- Department of Oncology, Panyu Central Hospital, Guangzhou, People's Republic of China
| | - Nan Nancy Jiang
- Department of Diagnostic Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Wan-Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong, PR China
| | - Huang Jinhua
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Commentary on "The efficacy of microwave ablation versus liver resection in the treatment of hepatocellular carcinoma and liver metastases". Int J Surg 2020; 78:87-88. [PMID: 32311519 DOI: 10.1016/j.ijsu.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/21/2022]
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Lachenmayer A, Tinguely P, Maurer MH, Frehner L, Knöpfli M, Peterhans M, Weber S, Dufour JF, Candinas D, Banz V. Stereotactic image-guided microwave ablation of hepatocellular carcinoma using a computer-assisted navigation system. Liver Int 2019; 39:1975-1985. [PMID: 31276296 DOI: 10.1111/liv.14187] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. METHODS Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. RESULTS In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). CONCLUSION Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.
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Affiliation(s)
- Anja Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascale Tinguely
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Frehner
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marina Knöpfli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Jean-François Dufour
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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