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de Ruiter QMB, Mauda-Havakuk MM, Starost MF, Bakhutashvili I, Esparza-Trujillo JA, Brown A, Natesan H, Kveen G, Lewis AL, Wood BJ, Pritchard WF, Karanian JW. Image-Guided Transbronchial Pulmonary Cryoablation with a Flexible Cryoprobe in Swine: Performance and Radiology-Pathology Correlation. J Vasc Interv Radiol 2024; 35:1022-1030.e4. [PMID: 38599280 PMCID: PMC11194150 DOI: 10.1016/j.jvir.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To evaluate the performance of a prototype flexible transbronchial cryoprobe compared with that of percutaneous transthoracic cryoablation and to define cone-beam computed tomography (CT) imaging and pathology cryolesion features in an in vivo swine model. MATERIALS AND METHODS Transbronchial cryoablation was performed with a prototype flexible cryoprobe (3 central and 3 peripheral lung ablations in 3 swine) and compared with transthoracic cryoablation performed with a commercially available rigid cryoprobe (2 peripheral lung ablations in 1 swine). Procedural time and cryoablation success rates for endobronchial navigation and cryoneedle deployment were measured. Intraoperative cone-beam CT imaging features of cryolesions were characterized and correlated with gross pathology and hematoxylin and eosin-stained sections of the explanted cryolesions. RESULTS The flexible cryoprobe was successfully navigated and delivered to each target through a steerable guiding sheath (6/6). At 4 minutes after ablation, 5 of 6 transbronchial and 2 of 2 transthoracic cryolesions were visible on cone-beam CT. The volumes on cone-beam CT images were 55.5 cm3 (SE ± 8.0) for central transbronchial ablations (n = 2), 72.5 cm3 (SE ± 8.1) for peripheral transbronchial ablations (n = 3), and 79.5 cm3 (SE ±11.6) for peripheral transthoracic ablations (n = 2). Pneumothorax developed in 1 animal after transbronchial ablation and during ablation in the transthoracic cryoablation. Images of cryoablation zones on cone-beam CT correlated well with the matched gross pathology and histopathology sections of the cryolesions. CONCLUSIONS Transbronchial cryoablation with a flexible cryoprobe, delivered through a steerable guiding sheath, is feasible. Transbronchial cryoablation zones are imageable with cone-beam CT, with gross pathology and histopathology similar to those of transthoracic cryoablation.
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Affiliation(s)
- Quirina M B de Ruiter
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Michal M Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland; Interventional Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Matthew F Starost
- Division of Veterinary Resources, National Institutes of Health, Bethesda, Maryland
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Juan A Esparza-Trujillo
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Andrew Brown
- Boston Scientific (formerly BTG), Arden Hills, Minnesota
| | | | - Graig Kveen
- Boston Scientific (formerly BTG), Arden Hills, Minnesota
| | - Andrew L Lewis
- Boston Scientific (formerly BTG), Arden Hills, Minnesota; Alchemed Bioscience Consulting Ltd, Farnham, Surrey, United Kingdom
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland; Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - William F Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - John W Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland.
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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Salas N, Castle SM, Leveillee RJ. Radiofrequency ablation for treatment of renal tumors: technological principles and outcomes. Expert Rev Med Devices 2014; 8:695-707. [DOI: 10.1586/erd.11.51] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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