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Park BK. Assessment of Local Tumor Progression After Image-Guided Thermal Ablation for Renal Cell Carcinoma. Korean J Radiol 2024; 25:33-42. [PMID: 38184767 PMCID: PMC10788605 DOI: 10.3348/kjr.2023.0676] [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: 07/18/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 01/08/2024] Open
Abstract
Focal enhancement typically suggests local tumor progression (LTP) after renal cell carcinoma is percutaneously ablated. However, evaluating findings that are false positive or negative of LTP is less familiar to radiologists who have little experience with renal ablation. Various imaging features are encountered during and after thermal ablation. Ablation procedures and previous follow-up imaging should be reviewed before determining if there is LTP. Previous studies have focused on detecting the presence or absence of focal enhancement within the ablation zone. Therefore, various diagnostic pitfalls can be experienced using computed tomography or magnetic resonance imaging examinations. This review aimed to assess how to read images during or after ablation procedures, recognize imaging features of LTP and determine factors that influence LTP.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Panhelleux M, Balssa L, David A, Thiery-Vuillemin A, Kleinclauss F, Frontczak A. Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: A propensity score matched study. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102534. [PMID: 37798161 DOI: 10.1016/j.purol.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The incidence of small renal tumors (≤4cm) is on the rise. The gold standard treatment is partial nephrectomy (PN) but focal therapy can be a good alternative. We evaluated oncological control after treatment of T1a renal tumors by microwave ablation (MWA) compared to PN. METHODS This is a retrospective, single-center study of all patients treated for TNM stage T1a renal tumors by either PN or MWA between 2010 and 2020. A propensity score was calculated and patients were matched 2:1 to compare recurrence-free survival, metastasis-free survival and overall survival between groups. We also compared postoperative complications using the Clavien-Dindo classification. RESULTS After matching and propensity score, the two groups (41 MWA and 82 PN) were comparable. The median follow-up was 23 months (interquartiles, 9-48 months). Recurrence-free survival was higher in the PN group compared to MWA, with a recurrence rate of 17.1% in the MWA group vs 4.9% in the PN group (P=0.003). MWA treatment was a risk factor for tumor recurrence (P=0.002), but there was no significant difference in terms of metastasis-free survival (P=0.549) or overall survival (P=0.539). MWA was associated with fewer postoperative complications (P=0.0005). CONCLUSION This study shows that MWA was associated with higher risk of recurrence but similar metastasis-free survival and overall survival compared to PN. Recurrence was treated with new MWA or active surveillance. MWA may be an interesting alternative to PN for small renal tumors. LEVEL OF EVIDENCE Grade C.
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Affiliation(s)
- M Panhelleux
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France.
| | - L Balssa
- Urology Department, University Hospital Center, Besançon, France
| | - A David
- Radiology Department, University Hospital Center, Besançon, France
| | - A Thiery-Vuillemin
- University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France; Oncology Department, University Hospital Center, Besançon, France
| | - F Kleinclauss
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
| | - A Frontczak
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
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3
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Obellianne J, De Marini P, Cazzato RL, Dalili D, Garnon J, Koch G, Weiss J, Autrusseau PA, Lang H, Gangi A. Role of MRI at 1- and 3-Month Follow-up in Predicting the Likelihood of Tumor Recurrence Following Percutaneous Cryoablation of Renal Tumors. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03452-8. [PMID: 37191935 DOI: 10.1007/s00270-023-03452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/22/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To evaluate whether ablation volume difference relatively to tumoral volume, minimal distance between ablation area and necrotic tumor, or apparent diffusion coefficient (ADC) within the ablation area, measured on 1- and 3-month follow-up MRI following cryoablation of renal tumors, are associated with tumor recurrence. MATERIALS AND METHODS 136 renal tumors were retrospectively identified. Patients, tumor characteristics and follow-up MRI (1-, 3-, 6-month, and thereafter annually) were collected. Uni- and multivariate analyses were performed to assess the association between the investigated parameters and tumor recurrence. RESULTS Over the follow-up period (27.7 ± 21.9 months), 13 recurrences were identified at 20.5 ± 19.4 months. At 1- and 3-month, the mean volume difference between the ablation zone and the tumor volume were + 577.5 ± 511.3% vs + 251.4 ± 209.8% (p = 0.003), and + 268.8 ± 291.1% vs + 103.8 ± 94.6% (p = 0.023) in patients without and with tumor recurrence, respectively. At 1- and 3-month, the minimum distance between the necrotic tumor and the edge of the ablation area was 3.4 ± 2.5 vs 1.8 ± 1.9 mm (p = 0.019), and 2.4 ± 2.3 vs 1.4 ± 1.8 mm (p = 0.13) in patients without and with tumor recurrence, respectively. Analysis of ADC values was not associated with tumor recurrence. After performing the multivariate analysis, only volume difference of the ablation area compared to tumor volume was associated with absence of tumor recurrence at 1- (OR = 14.1; p = 0.001) and 3-month (OR = 8.2; p = 0.01). CONCLUSIONS Evaluation of volume difference between the ablation area and tumor volume on early (≤ 3 months) MRI follow-up identifies patients at risk of tumor recurrence.
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Affiliation(s)
- Jules Obellianne
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, , London, KT18 7EG, UK
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
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Umakoshi N, Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Kajita S, Araki M, Mitsuhashi T, Gobara H, Kanazawa S. Correlation between renal ablation zone in contrast-enhanced CT and non-enhanced MRI during the early period following percutaneous cryoablation. Jpn J Radiol 2022; 40:1087-1095. [PMID: 35556212 PMCID: PMC9529705 DOI: 10.1007/s11604-022-01285-y] [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: 10/22/2021] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Purpose To retrospectively evaluate and correlate the contrast-enhanced computed tomography (CECT) and non-enhanced magnetic resonance imaging (MRI) during the early period following renal cryoablation. Materials and methods Both dynamic CECT and non-enhanced MRI were performed within 4 days following cryoablation in 34 renal tumors in 33 patients. The renal volumes of the unenhanced regions on dynamic CECT (nephrogenic phase, 4 mm thickness) and the regions with signal intensity changes on non-enhanced MRI (fat-suppressed T2-weighted image, 4 mm thickness) were evaluated. Fusion images of the axial, coronal, and sagittal sections of CECT and MRI images were created from the maximum cross-section of the renal tumor, and the match score of each image was visually evaluated on a 5-point scale. Results The mean renal volume of the unenhanced regions on CECT and those with signal intensity changes on non-enhanced MRI following cryoablation were 29.5 ± 19.9 cm3 (range, 4.3–97.4 cm3) and 30.7 ± 19.8 cm3 (range, 6.7–94.0 cm3), respectively; the difference between them was –1.17 cm3 (95% confidence interval [CI] –2.74, 0.40, P = 0.139). The Pearson’s product-moment correlation coefficient (r = 0.975; 95% CI, 0.951, 0.988; P < 0.0001) showed a strong correlation between the volumes. The average match score between CECT and non-enhanced MRI was as high as 4.5 ± 0.5 points (radiologist 1, 4.3 ± 0.5; radiologist 2, 4.7 ± 0.5). Local tumor control rate was 94.1% (32/34 tumors) and recurrence-free survival rate was 82.0% (95% CI: 64.2%, 91.5%) at 5 years. Conclusions The region with signal intensity changes on non-enhanced MRI was strongly correlated with the unenhanced region on CECT during the early period following renal cryoablation.
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Affiliation(s)
- Noriyuki Umakoshi
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan. .,Deptartment of Radiological Technology, Okayama University Graduate School of Health Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Soichiro Kajita
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Motoo Araki
- Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [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: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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Yong C, Mott SL, Laroia S, Tracy CR. Outcomes of Microwave Ablation for Small Renal Masses: A Single Center Experience. J Endourol 2020; 34:1134-1140. [PMID: 32611205 DOI: 10.1089/end.2020.0348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To investigate the safety of microwave ablation (MWA) as an emerging technology for treating small renal masses. Materials and Methods: Patients with renal masses treated at a high-volume center with MWA between March 2015 and June 2019 were retrospectively identified. Safety, changes in renal function, primary treatment efficacy, and the natural history of imaging characteristics of masses postablation were examined. Results: Forty-five patients underwent MWA during the study period. Median age was 71 years (range 31-87). Median RENAL nephrometry score was 6 (range 4-9) with mean tumor size 2.6 ± 0.7 cm. Thirty-three percent of tumors were within 4 mm of the collecting system. Median total microwave energy applied was 400 W (range 105-2600 W). There was no significant change in creatinine (p = 0.21) or glomerular filtration rate (GFR) (p = 0.09) from preoperative to postoperative day 1 (POD#1) levels. There was a statistically but not clinically significant decrease in hemoglobin from preoperative to POD#1 levels (estimated -0.06 from 7 days before procedure to POD#1, p = 0.02). There was no durable change in creatinine (p = 0.16) or GFR (p = 0.72) at median follow-up of 7.5 months. There were 4 (9%) complications: three Clavien grade 1 and one Clavien grade 3 that led to loss of the kidney. Tumor size decreased postoperatively by an estimated -0.03 cm/month (range 0-1.9 cm, p < 0.01). Initial technical success was 100%. Primary treatment efficacy was 94%. Conclusion: MWA shows promise as an alternative thermal ablative technique with excellent short-term outcomes.
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Affiliation(s)
- Courtney Yong
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Sarah L Mott
- Biostatistics Core, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
| | - Sandeep Laroia
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Chad R Tracy
- Department of Urology, University of Iowa, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa, Iowa City, Iowa, USA
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Gupta A, Musaddaq B, von Stempel C, Ilyas S. Percutaneous Renal Ablation. Semin Ultrasound CT MR 2020; 41:351-356. [PMID: 32620225 DOI: 10.1053/j.sult.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Incidental small renal cell cancers are increasingly being diagnosed on cross-sectional imaging. This review article describes the indications for percutaneous ablation of small renal cell cancers, choice of ablation technologies and imaging follow-up.
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Affiliation(s)
- Amit Gupta
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Besma Musaddaq
- Department of Radiology, Royal Free Hospital, London, UK
| | - Conrad von Stempel
- Department of Radiology, Royal Free Hospital, London, UK; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shahzad Ilyas
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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De Filippo M, Ziglioli F, Russo U, Pagano P, Brunese L, Bertelli E, Pagnini F, Maestroni U. Radiofrequency ablation (RFA) of T1a renal cancer with externally cooled multitined expandable electrodes. Radiol Med 2020; 125:790-797. [PMID: 32206984 DOI: 10.1007/s11547-020-01175-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To retrospectively evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) with multitined expandable electrodes externally cooled with saline solution in patients with T1a renal cell carcinoma (RCC). MATERIALS AND METHODS In this retrospective study, we evaluated 39 RCC in 35 patients treated with CT-guided RFA in 41 procedures (2011-2017). All patients were staged T1a, N0, M0 prior to RFA. Mean tumor size was 24.48 mm. A 4-tined expandable RFA electrode cooled with pump-circulating saline was used. Efficacy was evaluated verifying complete tumor necrosis (no contrast enhancement on imaging) at the end of the procedure and on subsequent controls. Follow-up observation period was 5 years. Minor/major complications, hospitalization days, serum creatinine and GFR pre- and post-RFA (compared using paired t test) and post-operative pain (evaluated with NRS after treatment) were considered as safety indicators. Overall survival was also calculated (Kaplan-Meier method). RESULTS Of 35 patients, 30/35 had 1 treatment (primary effectiveness rate 86%), 4/35 had 2 treatments and 1/35 had 3 treatments for residual disease. There were no relapses and no mid-long-term complications; 3 minor (8%) and 1 major (2.7%) complications during perioperative period were reported. Mean before and after RFA serum creatinine rates were, respectively, 1.08 mg/dl and 1.11 mg/dl (p value: 0.4117). NRS median value is 0.8. Hospitalization days median value is [2.8 ± 1.9] days. 91.4% of all patients survived, with a median overall survival time of 65 months. CONCLUSIONS Mid-term results show that CT-guided RFA with multitined expandable electrodes externally cooled with saline solution is an effective and safe treatment in patients with RCC-staged T1aN0M0. Data reported in our study are in line with data reported in the literature from patients treated with other devices.
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Affiliation(s)
- Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesco Ziglioli
- Department of Surgery, Unit of Urology, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Umberto Russo
- Department of Medicine and Surgery, Unit of Radiologic Sciences, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Paolo Pagano
- Department of Medicine and Surgery, Unit of Radiologic Sciences, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Luca Brunese
- Department of Medicine and Health Science, University of Molise, Via Francesco De Santis 86, Campobasso, Italy
| | - Elena Bertelli
- Department of Radiology, University-Hospital of Careggi, Largo Brambilla 3, Florence, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Via Gramsci 14, Parma, Italy
| | - Umberto Maestroni
- Department of Surgery, Unit of Urology, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
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Wasnik AP, Higgins EJ, Fox GA, Caoili EM, Davenport MS. Yield of Routine Image-Guided Biopsy of Renal Mass Thermal Ablation Zones: 11-Year Experience. Acad Radiol 2019; 26:232-238. [PMID: 29934021 DOI: 10.1016/j.acra.2018.05.016] [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: 04/11/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the yield of routine image-guided core biopsy of renal cell carcinoma (RCC) thermal ablation zones. METHODS Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant quality improvement effort. Routine core biopsy of RCC ablation zones was performed 2 months postablation from July 2003 to December 2014. Routine nicotinamide adenine dinucleotide staining was performed by specialized genitourinary pathologists to assess cell viability. The original purpose of performing routine postablation biopsy was to verify, in addition to imaging, whether the mass was completely treated. Imaging was stratified as negative, indeterminate, or positive for viable malignancy. Histology was stratified as negative, indeterminate, positive, or nondiagnostic for viable malignancy. Histology results were compared to prebiopsy imaging findings. RESULTS Routine ablation zone biopsy was performed after 50% (146/292) of index ablations (24 cryoablations, 122 radiofrequency ablations), and postablation imaging was performed more often with multiphasic computed tomography than magnetic resonance imaging (100 vs 46, p < 0.0001). When imaging was negative (n = 117), biopsy added no additional information (92% [n = 108] negative, 0.9% [n = 1] indeterminate, 7% [n = 8] nondiagnostic). When imaging was indeterminate (n = 19), 11% (n = 2) of biopsies had viable RCC and 89% (n = 17) were negative. When imaging was positive, biopsy detected viable neoplasm in only 10% (1/10) of cases; 80% (8/10) were negative and 10% (1/10) were nondiagnostic. CONCLUSION Routine biopsy of renal ablation zones to validate postablation imaging results was not value-added and therefore was discontinued at the study institution.
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Renal cryoablation: Multidisciplinary, collaborative and perspective approach. Cryobiology 2018; 83:90-94. [DOI: 10.1016/j.cryobiol.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
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Kassouf W, Monteiro LL, Drachenberg DE, Fairey AS, Finelli A, Kapoor A, Lattouf JB, Leveridge MJ, Power NE, Pouliot F, Rendon RA, Sabbagh R, So AI, Tanguay S, Breau RH. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J 2018; 12:231-238. [PMID: 30139427 DOI: 10.5489/cuaj.5462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Robert Sabbagh
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
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Ali O, Fishman EK, Kawamoto S. Recurrent renal cell carcinoma following nephrectomy and ablation therapy: Radiology perspective. Eur J Radiol 2018; 107:134-142. [PMID: 30292257 DOI: 10.1016/j.ejrad.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/28/2018] [Accepted: 05/02/2018] [Indexed: 01/14/2023]
Abstract
Renal cell carcinoma (RCC) is the most common renal malignancy, accounting for approximately 2% of adult malignancies and 4% of new cancer cases in the United States every year. Imaging guided ablative therapy, including radiofrequency (RF) ablation, cryotherapy and microwave has gained popularity over the last decade in treatment of small tumors. Antiangiogenic therapy has set itself to be the standard of care for many patients with metastasis these days. With hope for more research, survival rates of metastatic RCC may increase from a current 2-year survival rate of approximately 20%. Variation in imaging surveillance protocol in terms of frequency, modality, and duration is noted among guidelines developed by several organizations. In this review article, we will discuss follow-up imaging protocols, patterns of RCC recurrence following different modalities of treatment, imaging appearance, as well as usual and unusual sites of metastatic disease.
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Affiliation(s)
- Osama Ali
- The Johns Hopkins Hospital, Department of Radiology and Radiological Science, 601 N. Caroline St, JHOC 3235A, Baltimore, MD 21287, United States.
| | - Elliot K Fishman
- The Johns Hopkins Hospital, Department of Radiology and Radiological Science, 601 N. Caroline St, JHOC 3235A, Baltimore, MD 21287, United States.
| | - Satomi Kawamoto
- The Johns Hopkins Hospital, Department of Radiology and Radiological Science, 601 N. Caroline St, JHOC 3235A, Baltimore, MD 21287, United States.
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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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14
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Chan P, Vélasco S, Vesselle G, Boucebci S, Herpe G, Debaene B, Ingrand P, Irani J, Tasu JP. Percutaneous microwave ablation of renal cancers under CT guidance: safety and efficacy with a 2-year follow-up. Clin Radiol 2017; 72:786-792. [PMID: 28545682 DOI: 10.1016/j.crad.2017.03.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the safety and efficiency of percutaneous microwave ablation (MWA) of renal cell carcinomas (RCC) carried out under computed tomography (CT) guidance. MATERIALS AND METHODS A retrospective study was performed on RCC that was either histologically proven or diagnosed at imaging (Bosniak IV cyst) and treated by MWA under general anaesthesia with CT guidance. Indications for percutaneous ablation were based on the American Urological Association recommendations. Twenty-four months post-procedure follow-up was performed. RESULTS Sixty-two patients presenting one or more RCC (84 tumours ranging from 10-48 mm in diameter; mean diameter: 25.6 mm) were included. Technical success was achieved for 78 tumours (58 patients). For four patients, the treatment was stopped due to gas dissection failure. At 3 months, six residual tumours were observed (8%). At 6 months, two recurrences and one residual tumour (3.8%) were observed; all were retreated with complete success. At 12 months, local control of the disease was achieved in 94% of cases (100% in cases where treatment was performed). Two cases of distal metastasis were observed after 12 and 24 months. At 24 months, one patient presented with a contralateral tumour. The complication rate was 4.8% including one grade III complication and two grade II complications according to the Clavien-Dindo classification. At 2 years, the cumulative disease-free survival rate and overall survival were 95% and 97%, respectively. CONCLUSION MWA ablation under CT guidance to treat RCC is safe and provides a high rate of effectiveness at 24 months.
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Affiliation(s)
- P Chan
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - S Vélasco
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - G Vesselle
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - S Boucebci
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - G Herpe
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - B Debaene
- Anesthesiology Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - P Ingrand
- Inserm U619, CHU de Poitiers et University of Poitiers, rue de la milétrie, 86000 CHU de Poitiers, France
| | - J Irani
- Inserm U619, CHU de Poitiers et University of Poitiers, rue de la milétrie, 86000 CHU de Poitiers, France; Urology Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France
| | - J-P Tasu
- Imaging Department, CHU de Poitiers, 2 rue de la milétrie, 86000 CHU de Poitiers, France.
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15
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Martin JW, Patel RM, Okhunov Z, Vyas A, Vajgrt D, Clayman RV. Multipoint Thermal Sensors Associated with Improved Oncologic Outcomes Following Cryoablation. J Endourol 2017; 31:355-360. [PMID: 28114787 DOI: 10.1089/end.2016.0864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Cryoablation (CA) is a minimally invasive modality for the management of small renal cortical neoplasms (RCN). Effective ablation is dependent on achieving target temperatures during CA that result in tumor cell death. We investigated long-term oncologic outcomes following CA using multipoint thermal sensors (MTS), which allow precise temperature determination at four points along the needle. METHODS We performed a retrospective review of 20 patients with <4 cm RCN who underwent de novo CA from 2005 to 2009. In 11 procedures, MTS needles were deployed with the goal of obtaining -20°C at the tumor margin, while 9 were done without MTS. Patient demographics, tumor characteristics, and CA procedure data were retrieved and analyzed. Follow-up CT or MRI was used to assess recurrence status. RESULTS With a mean follow-up of 45 months, none of the 11 patients experienced a recurrence in the MTS group, compared with 4 of 9 (44.4%) patients in the non-MTS group (p = 0.026). Of the biopsy-confirmed renal cancers, none of the 6 in the MTS group, compared with 3 of 6 (50%) in the non-MTS group, recurred (p = 0.182). Age, tumor size, surgical approach, tumor histopathology, grade, follow-up time, and skin-to-tumor distance were similar between the MTS and non-MTS groups. The MTS group was also associated with increased total length of freeze (p = 0.041), procedure time (p = 0.020), cryoprobe utilization (p = 0.049), and a greater ratio of cryoprobes used per cm diameter of tumor (p = 0.003). CONCLUSIONS In this small renal mass pilot study, the use of MTS needles to monitor temperature and guide cryoneedle deployment was associated with improved oncologic outcomes.
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Affiliation(s)
- Jeremy W Martin
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Roshan M Patel
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Aashay Vyas
- 1 Department of Urology, University of California , Irvine, Irvine, California
| | - Duane Vajgrt
- 2 Department of Radiology, University of California , Irvine, Irvine, California
| | - Ralph V Clayman
- 1 Department of Urology, University of California , Irvine, Irvine, California
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Nonboe LL, Nielsen TK, Høyer S, Graumann O, Frøkiær J, Borre M. Arterial Clamping Increases Central Renal Cryoablation Efficacy: An Animal Study. Technol Cancer Res Treat 2016; 16:414-420. [PMID: 27566799 DOI: 10.1177/1533034616663365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The minimally invasive treatment of small renal masses with cryoablation has become increasingly widespread during the past 15 years. Studies with long-term follow-up are beginning to emerge, showing good oncological control, however, tumors with a central and endophytic location seem to possess an increased risk of treatment failure. Such tumors are likely to be subjected to a high volume of blood giving thermal protection to the cancerous cells. Arterial clamping during freezing might reduce this effect but at the same time subject the kidney to ischemia. The aim of this study was to evaluate the effect of renal artery clamping during cryoablation in a porcine survival model. METHODS Ten Danish Landrace pigs (approximately 40 kg) underwent bilateral laparoscopic cryoablation with clamping of the right renal artery during freezing. The cryoablation consisted of a standard double-freeze cycle of 10-minute freeze followed by 8 minutes of thaw. Arterial clamping subjected the right kidney to 2 cycles of ischemia (10 minutes) with perfusion in between. After surgery, the animals were housed for 14 days prior to computed tomography perfusions scans, radioisotope renography, and bilateral nephrectomy. RESULTS No perioperative or postoperative complications were experienced. Mean differential renal function was 44% (95% confidence interval: 42-46) in the clamped right kidney group and 56% (95% confidence interval: 54-58) in the nonclamped left kidney group, P < .05. The ±5% technical inaccuracy is not accounted for in the results. Mean maximum temperature between freeze cycles was 5.13°C (95% confidence interval: -0.1 to 10.3) in the clamped right kidney group and 22.7°C (95% confidence interval: -16.6 to 28.8) in the nonclamped left kidney group, P < .05. Mean cryolesion volume, estimated on computed tomography perfusion, was 12.4 mL (95% confidence interval: 10.35-14.4) in the clamped right kidney group and 6.85 mL (95% confidence interval: 5.57-8.14) in the nonclamped left kidney group, P < .05. Pathological examination shows a higher degree of vital cells in the intermediate zone of the cryolesions in the nonclamped left kidneys when compared with the clamped right kidneys. CONCLUSION Arterial clamping increases cryolesion size by approximately 80%, and pathologic examinations suggest a decreased risk of vital cells in the intermediate zone. The clamped kidneys showed no sign of injury from the limited ischemic insult. This study was limited by being a nontumor model.
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Affiliation(s)
- Lasse L Nonboe
- 1 Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Tommy K Nielsen
- 1 Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Høyer
- 2 Department of Pathology, Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Graumann
- 3 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Frøkiær
- 4 Deparment of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- 1 Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Chen JX, Maass D, Guzzo TJ, Bruce Malkowicz S, Wein AJ, Soulen MC, Clark TWI, Nadolski GJ, William Stavropoulos S. Tumor Growth Kinetics and Oncologic Outcomes of Patients Undergoing Active Surveillance for Residual Renal Tumor following Percutaneous Thermal Ablation. J Vasc Interv Radiol 2016; 27:1397-1406. [PMID: 27234485 DOI: 10.1016/j.jvir.2016.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate growth kinetics and oncologic outcomes of patients with renal tumors undergoing active surveillance (AS) for residual viable tumor following percutaneous ablation. MATERIALS AND METHODS Following percutaneous thermal ablation, residual tumor was detected in 21/133 (16%) patients on initial follow-up imaging, and AS was undertaken in 17/21 (81%) patients. Initial tumor volumes and volumes after ablation were assessed from cross-sectional imaging to calculate volumetric growth rate (VGR) and volume doubling time (VDT) of residual tumor. The rate of metastasis, overall survival, and renal cell carcinoma (RCC)-specific survival were compared between patients in the AS group and in the routine follow up group of patients who did not have residual tumor. RESULTS Median tumor volume prior to ablation, after first ablation, and at final follow-up were 25 cm(3), 6 cm(3), and 6 cm(3), respectively, in patients with residual tumor. Stable, mild, and moderate VGR occurred in 8/17 (47%), 4/17 (24%), and 5/17 (29%) cases, respectively. The 4 cases with fastest VDT underwent delayed intervention with ablation (n = 1) and nephrectomy (n = 3) without subsequent residual, recurrence, or metastasis. There was no significant difference in the rates of RCC metastasis, overall survival, or RCC-specific survival between AS and routine follow-up groups. Metastatic RCC and subsequent death occurred in 1 patient in the AS group, after the patient had refused offers for retreatment for local progression over 60.7 months of follow-up. CONCLUSIONS In cases when patients are not amenable to further intervention, AS of residual tumor may be an acceptable alternative and allows for successful delayed intervention when needed.
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Affiliation(s)
- James X Chen
- Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Daniel Maass
- Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - S Bruce Malkowicz
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Alan J Wein
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Michael C Soulen
- Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Timothy W I Clark
- Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - S William Stavropoulos
- Division of Interventional Radiology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104.
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Lagerveld BW, Sivro F, van der Zee JA, Baars PC. 18F-FDG PET-CT Findings Before and After Laparoscopic Cryoablation of Small Renal Mass: An Initial Report. J Kidney Cancer VHL 2015; 2:174-186. [PMID: 28326272 PMCID: PMC5345520 DOI: 10.15586/jkcvhl.2015.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/07/2015] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to describe the characteristics of positron emission tomography (PET) molecular imaging combined with low-dose computed tomography (CT) in small renal mass (SRM) treated with cryoablation (CA). Currently, treatment success is defined by the absence of contrast enhancement at CT. However, the use of contrast is relatively contraindicated in patients with renal function impairment, mandating alternative follow-up strategies. Several reasons were identified as criteria for performing PET-CT before and/or after SRM-CA in 9 patients, and the results were retrospectively studied. The histology revealed renal cell carcinoma in 7 patients and oncocytoma in 2 patients. In 6 patients, a PET-CT was performed before and after CA. In one patient, the PET-CT was performed only before CA and in 2 patients only after CA. Before CA, clearly there was metabolic uptake of fluorine-18 fluorodeoxyglucose (18F-FDG) in the SRM in all patients. Following CA, the absence of 18F-FDG uptakes in the SRM could clearly be noticed. However, the tracer cannot always be distinguished from focal recurrence or reactive inflammatory tissue. In one patient, asymptomatic metastatic bone lesions were noticed when performing PET-CT at follow-up. This pilot study with 18F-FDG PET-CT for the follow-up of SRM cryosurgery showed that 18F-FDG PET-CT imaging could be used to characterize cryoablative tissue injury at different times after CA.
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Affiliation(s)
- Brunolf W. Lagerveld
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ferida Sivro
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Johan A. van der Zee
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Phillippe C. Baars
- Department of Urology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Nuclear Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Abstract
This article illustrates the imaging characteristics of cystic and solid renal masses, along with a summary of identified imaging criteria that may be of use to differentiate masses that are more likely to be benign from those that are more likely to be malignant. In addition, important features of known or suspected renal cancers that should be identified before treatment are summarized, including staging of renal cancer and RENAL nephrometry. Finally, the imaging appearance of patients following treatment of renal cancer, including after partial or total nephrectomy, thermal ablation, or chemotherapy for metastatic disease, is reviewed.
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Affiliation(s)
- Richard H Cohan
- Department of Radiology, University of Michigan Hospital, University of Michigan Health System, Room B1-D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5030, USA.
| | - James H Ellis
- Department of Radiology, University of Michigan Hospital, University of Michigan Health System, Room B1-D502, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5030, USA
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20
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Minimally Invasive Percutaneous Treatment of Small Renal Tumors with Irreversible Electroporation: A Single-Center Experience. J Vasc Interv Radiol 2015; 26:1465-71. [PMID: 26250855 DOI: 10.1016/j.jvir.2015.06.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate whether irreversible electroporation (IRE) can be used as an ablation technique for small renal tumors (T1a cancers or small benign tumors) and to describe features after ablation on computed tomography (CT) or magnetic resonance (MR) imaging. MATERIALS AND METHODS In this retrospective study, 20 patients (mean age, 65 y ± 12.8 y) underwent CT-guided IRE of T1a renal carcinoma (n = 13) or small benign or indeterminate renal masses < 4 cm in size (n = 7). Mean tumor size was 2.2 cm ± 0.7. The ablation area was verified with contrast-enhanced imaging performed immediately after the procedure to determine technical success. Imaging was performed 6 weeks (20 of 20 patients), 6 months (15 of 20), and 12 months (6 of 20) after ablation. Medical records and CT/MR imaging features of all patients were reviewed for recurrence, symptoms, and complications after treatment. RESULTS Technical success was achieved in all patients (100%); there were no major procedure-related complications. Minor complications occurred in 7 patients, including self-limiting perinephric hematomas, pain difficult to control, and urinary retention. Mean procedure time was 2.0 hours ± 0.7. At 6 weeks, 2 patients required salvage therapy because of incomplete ablation. At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 6) was noted to have experienced recurrence. CT/MR imaging after IRE ablation demonstrated an area of nonenhancement in the treatment zone that involuted over ~6 months. CONCLUSIONS Renal IRE appears to be a safe treatment for small renal tumors. Tumors treated with IRE demonstrated nonenhancement in the treatment zone with involution on follow-up CT/MR imaging.
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21
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Nicolau C, Aldecoa I, Bunesch L, Mallofre C, Sebastia C. The Role of Contrast Agents in the Diagnosis of Renal Diseases. Curr Probl Diagn Radiol 2015; 44:346-59. [DOI: 10.1067/j.cpradiol.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/03/2015] [Indexed: 12/19/2022]
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22
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CT Dose Reduction Workshop: An Active Educational Experience. J Am Coll Radiol 2015; 12:610-6.e1. [DOI: 10.1016/j.jacr.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/15/2014] [Indexed: 11/18/2022]
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23
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Iannuccilli JD, Grand DJ, Dupuy DE, Mayo-Smith WW. Percutaneous ablation for small renal masses-imaging follow-up. Semin Intervent Radiol 2014; 31:50-63. [PMID: 24596440 DOI: 10.1055/s-0033-1363843] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Image-guided percutaneous thermal ablation is a safe and effective nephron-sparing alternative to surgical resection for the treatment of small renal tumors. Assessment of treatment efficacy relies heavily on interval follow-up imaging after treatment. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) both play a pivotal role in evaluating the treatment zone, identifying residual tumor, and detecting early and delayed procedure-related complications. This article discusses a surveillance imaging protocol for patients who undergo percutaneous thermal ablation of renal tumors, and also illustrates the typical appearances of both successfully treated tumors and residual disease on contrast-enhanced CT or MRI. In addition, it discusses the imaging appearance of potential early and delayed treatment-related complications to facilitate their prompt detection and management.
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Affiliation(s)
- Jason D Iannuccilli
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - David J Grand
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Damian E Dupuy
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
| | - William W Mayo-Smith
- Department of Diagnostic Imaging, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island
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Forauer AR, Dewey BJ, Seigne JD. Cancer-free survival and local tumor control after impendence-based radiofrequency ablation of biopsy-proven renal cell carcinomas with a minimum of 1-year follow-up. Urol Oncol 2014; 32:869-76. [PMID: 24946958 DOI: 10.1016/j.urolonc.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES There are numerous reports describing the use of radiofrequency ablation (RFA) to treat renal cell carcinoma. Many series, however, describe heterogeneous populations, lack histologic descriptions, use various RFA systems, and indicate tumor destruction by different ablation end points. This study examined the outcomes of computed tomography-guided, impedance-based RFA of biopsy-proven renal cell carcinoma clinically staged as T1a with a minimum of 1 year of postablation follow-up. METHODS AND MATERIALS This retrospective study identified all consecutive patients who had undergone renal RFA since May 2005 at our institution. Patients without biopsy-proven renal cell carcinoma (RCCa) were excluded. Of the patients who met these criteria, evaluation was limited to patients with a minimum of 12 months of follow-up. Data collected from the patients' electronic medical and radiologic records included demographic data, tumor-related data, procedural details, and clinical follow-up visits. RESULTS A total of 39 patients (46 lesions) met the inclusion criteria. The mean tumor diameter was 2.6 cm (range: 1.2-4.0 cm). The most common histologies were clear cell (n = 27) and papillary (n = 16) renal cancer. The lesion location was equally divided between upper pole (n = 16), middle pole (n = 16), and lower pole (n = 14). Overall, 83% of the tumors were exophytic. No residual or recurrent enhancing mass was identified in the ablation bed on post-RFA imaging during the mean follow-up period of 35.3 months (range: 12-83). All patients were treated in a single encounter and no lesion required a second ablation; technical success (absence of residual tumor) on the initial post-RFA imaging study was 46 of 46 (100%). Clinical success was achieved in 45 of 46 lesions (98%); residual, viable tumor was found in a pretransplant nephrectomy specimen on postprocedure day 127. The mean cancer-free survival was 36.2 months. Comparison of preablation and postablation renal function found no statistically significant change. CONCLUSIONS The consistent outcomes in our post-RFA imaging and clinical surveillance allow us to offer image-guided ablation to patients with T1a RCCa as a valid treatment option offering long-term cancer-free survival. Impedance-based RFA in a carefully selected patient population with T1a RCCa is a reliable treatment option, with disease-free survival rates that are comparable to partial nephrectomy.
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Affiliation(s)
- Andrew R Forauer
- Division of Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Benjamin J Dewey
- Geisel School of Medicine at Dartmouth College, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John D Seigne
- Division of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014; 273:241-60. [PMID: 24927329 DOI: 10.1148/radiol.14132958] [Citation(s) in RCA: 822] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article .
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215 (M.A.); Department of Radiology, Ospedale Generale, Busto Arsizio, Italy (L.S.); Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.L.B.); Department of Radiology, Southampton University Hospitals, Southampton, England (D.J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.R.C., J.W.C.); Department of Ultrasound, School of Oncology, Peking University, Beijing, China (M.H.C.); Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea (B.I.C.); Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France (T.d.B.); Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (G.D.D.); Department of Diagnostic Radiology, Rhode Island Hospital, Providence, RI (D.E.D.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.A.G.); Medical Imaging, University Health Network, Laval, Quebec, Canada (D.G.); Imaging Department, the London Clinic, London, England (A.R.G.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (F.T.L.); Department of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy (R.L.); Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Mich (P.J.L.); Busto Arsizio, Italy (T.L.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.S.L.); Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, Calif (J.P.M.); Department of Radiology, Ospedale Valduce, Como, Italy (M.F.M.); Department of Radiology, Albert Einstein Medical Center, Phil
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Percutaneous Renal Cryoablation: Prospective Experience Treating 120 Consecutive Tumors. AJR Am J Roentgenol 2013; 201:1353-61. [DOI: 10.2214/ajr.13.11084] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sommer CM, Lemm G, Hohenstein E, Stampfl U, Bellemann N, Teber D, Rassweiler J, Kauczor HU, Radeleff BA, Pereira PL. Bipolar versus multipolar radiofrequency (RF) ablation for the treatment of renal cell carcinoma: differences in technical and clinical parameters. Int J Hyperthermia 2013; 29:21-9. [PMID: 23311376 DOI: 10.3109/02656736.2012.750015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study aimed to compare retrospectively bipolar RF ablation with multipolar RF ablation for the treatment of renal cell carcinoma. MATERIALS AND METHODS Between March 2009 and June 2012, 12 tumours (nine patients) treated with bipolar RF ablation (one applicator) and 14 tumours (11 patients) treated with multipolar RF ablation (two applicators) were compared systematically. Selection between bipolar RF ablation and multipolar RF ablation was operator choice considering tumour size. Study goals included differences in tumour and coagulation extent, and technical parameters (total RF energy delivery and RF ablation time per coagulation volume). RESULTS Tumour maximum diameter was significantly larger for multipolar RF ablation compared with bipolar RF ablation (27.0 mm versus 19.4 mm; p < 0.01). This difference is partially dependent on operator choice. Coagulation length, width and volume were significantly larger for multipolar RF ablation compared with bipolar RF ablation (35.0 mm versus 26.5 mm, 27.5 mm versus 23.0 mm and 14.3 cm(3) versus 8.1 cm(3); p < 0.01, p < 0.05 and p < 0.05, respectively). Coagulation circularity was not significantly different between both study groups (0.8 versus 0.8; not significant). Total RF energy delivery was significantly higher and RF ablation time per coagulation volume was significantly shorter for multipolar RF ablation compared with bipolar RF ablation (52.0 kJ versus 28.6 kJ and 2.4 min/cm(3) versus 4.1 min/cm(3); p < 0.05 and p < 0.05, respectively). CONCLUSIONS Multipolar RF ablation creates a significantly larger coagulation width, but identical coagulation shape, compared with bipolar RF ablation. Additionally, multipolar RF ablation coagulates faster according to the shorter RF ablation time per coagulation volume.
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Affiliation(s)
- Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.
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29
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Abstract
Although nephron-sparing surgery remains the gold standard treatment for small renal tumors, minimally invasive image-guided percutaneous ablation is becoming a viable alternative to operative resection. Percutaneous radiofrequency ablation (RFA) and cryoablation show high technical success rates, a relatively low incidence of residual or recurrent tumor, and competitive rates of patient survival. In this review, an overview of the current status of image-guided percutaneous ablation of renal tumors is presented, with a focus on procedure indications and patient selection, technical aspects of ablation procedures, and treatment outcomes and patient follow-up.
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Affiliation(s)
- Majid Maybody
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
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30
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Krajewski KM, Giardino AA, Zukotynski K, Van den Abbeele AD, Pedrosa I. Imaging in renal cell carcinoma. Hematol Oncol Clin North Am 2011; 25:687-715. [PMID: 21763963 DOI: 10.1016/j.hoc.2011.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Imaging plays a central role in the detection, diagnosis, staging, and follow-up of renal cell carcinoma (RCC). Most renal masses are incidentally detected with modern, high-resolution imaging techniques and a variety of management options exist for the renal masses encountered today. This article discusses the role of multiple imaging modalities in the diagnosis of RCC and the imaging features of specific pathologic subtypes and staging techniques. Future directions in RCC imaging are presented, including dynamic contrast-enhanced and unenhanced techniques, as well as the development of novel tracers for positron emission tomography.
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Affiliation(s)
- Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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31
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Buy X, Lang H, Garnon J, Gangi A. Thermoablation percutanée des cancers rénaux : radiofréquence ou cryoablation ? ACTA ACUST UNITED AC 2011; 92:774-88. [DOI: 10.1016/j.jradio.2011.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 11/25/2022]
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32
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Georgiades CS, Rodriguez R, Littrup PJ, Frangakis CE, Leveille R, Ahrar K, Atwell TD, Cadeddu J, Trimmer C, Durack JC, Hammers HJ, Meng MV, Raman S, Solomon SB, Zagoria RJ, McLennan G, LaBerge JM, Gervais DA, Kee ST. Development of a Research Agenda for Percutaneous Renal Tumor Ablation: Proceedings from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2010; 21:1807-16. [DOI: 10.1016/j.jvir.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/28/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022] Open
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Thumar AB, Trabulsi EJ, Lallas CD, Brown DB. Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol 2010; 21:S233-41. [PMID: 20656233 DOI: 10.1016/j.jvir.2010.01.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/06/2010] [Accepted: 01/19/2010] [Indexed: 11/19/2022] Open
Abstract
The incidence of renal cell carcinoma (RCC) is increasing. With the increasing emphasis on minimally invasive nephron-sparing surgery, thermal ablation is playing a larger role in the management of patients with this disease. This review outlines imaging management, intraoperative and percutaneous ablation, and postprocedural follow-up of RCC.
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Affiliation(s)
- Adeep B Thumar
- Department of Urology, Thomas Jefferson University, 132 South 10th St, Suite 766 Main Building, Philadelphia, PA 19107, USA
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