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Du Q, Li X, Lin Z, Dong L, Liu F, Liang P. Value of the three-dimensional visualization ablation planning system in ultrasound-guided percutaneous microwave ablation for malignant adrenal tumors: A clinical comparative study. J Cancer Res Ther 2024:01363817-990000000-00092. [PMID: 38801760 DOI: 10.4103/jcrt.jcrt_2315_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/22/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE We aimed to assess the efficacy and safety of the three-dimensional visualization ablation planning system (3DVAPS) in ultrasound-guided percutaneous microwave ablation (US-PMWA) for malignant adrenal tumors (MATs). METHODS A retrospective analysis was conducted on a cohort of 62 unilateral MAT cases from March 2011 to November 2022. There were a total of 62 lesions, with a mean maximum diameter of 5.4 ± 2.7 cm (range, 1.4-15.7 cm). The patients were categorized into the following, based on the pre-operative planning method: 3D planning (n = 32) and 2D planning (n = 30) groups. A comparative analysis was performed on various parameters, including ablation techniques, tumor-related prognosis, and incidence of complications. This analysis encompassed indicators, such as overall survival (OS) rate and local tumor progression (LTP), among others. RESULTS The median follow-up period was 30 months (range, 3-84 months). Notably, compared with the 2D planning group, the 3D planning group exhibited significant disparities in the number of punctures (P = 0.035) and incidence of complications (P = 0.029) and had no significant difference in the OS (P > 0.05) but had a significantly lower LTP rate (6.2% vs. 23.3%, P = 0.033). In the 3D planning group, the sub-group with a tumor diameter of < 5 cm exhibited a significantly less number of punctures (P = 0.039), lower input energy (P = 0.002), and a shorter ablation time (P = 0.001), compared with the sub-group with a tumor diameter of ≥ 5 cm, but there was no significant difference in the LTP and OS rates between the two sub-groups (P > 0.05). CONCLUSIONS The use of 3DVAPS in US-PMWA of MATs was advantageous, especially in lesions with a diameter of ≥ 5 cm. It can help in developing more rational surgical plans, reducing the incidence of complications, and extending the local recurrence-free survival time of patients and can add a certain value for precise treatment and expand the indications for ablation.
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Affiliation(s)
- Qiaowei Du
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Xin Li
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
| | - Zheng Lin
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Linan Dong
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, the Fifth Center of Chinese PLA General Hospital, Beijing, China
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Timmerman SA, Mullen N, Taylor AE, Gilligan LC, Pyle M, Shrestha TB, Sebek J, Highland MA, Challapalli R, Arlt W, Bossmann SH, Dennedy MC, Prakash P, Basel MT. Characterization of a Biochemical Mouse Model of Primary Aldosteronism for Thermal Therapies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.07.592955. [PMID: 38766205 PMCID: PMC11100708 DOI: 10.1101/2024.05.07.592955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Aldosterone-producing adenoma (APA) is the most common cause of endocrine-related hypertension but surgery is not always feasible. Current medical interventions are associated with significant side effects and poor patient compliance. New APA animal models that replicate basic characteristics of APA and give physical and biochemical feedback are needed to test new non-surgical treatment methods, such as image-guided thermal ablation. Methods A model of APA was developed in nude mice using HAC15 cells, a human adrenal carcinoma cell line. Tumor growth, aldosterone production, and sensitivity to angiotensin II were characterized in the model. The utility of the model was validated via treatment with microwave ablation and characterization of the resulting physical and biochemical changes in the tumor. Results The APA model showed rapid and relatively homogeneous growth. The tumors produced aldosterone and steroid precursors in response to angiotensin II challenge, and plasma aldosterone levels were significantly higher in tumor bearing mice two hours after challenge verses non-tumor bearing mice. The model was useful for testing microwave ablation therapy, reducing aldosterone production by 80% in treated mice. Conclusion The HAC15 model is a useful tumor model to study and develop localized treatment methods for APA.
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Zhong H, Wang Z, Liu Y, Ke H, Liu P, Lian X, Xu Z. Efficacy and Safety of Ultrasound-Guided Percutaneous Ablation for Adrenal Metastases: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36840701 DOI: 10.1002/jum.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of ultrasound-guided percutaneous ablation (US-PA) for adrenal metastases (AMs) using a meta-analysis. METHODS A systematic search of PubMed, Cochrane, Web of Science, and Embase electronic databases was performed to identify studies on US-PA for AM. Seven studies published between January 2000 and August 2022 were analyzed, which resulted in a sample size of 140 patients. Both random effects and common effects meta-analysis models were used to analyze the following efficacy and safety outcomes: the first and secondary technical success rate, 1-year overall survival rates, 1-year local tumor control rate, incidence rate of intraoperative hypertensive crises, and major complications. The subgroup analysis was performed to explore the origin of heterogeneity. RESULTS Among 140 patients from 7 studies included in this meta-analysis: 51 (36.43%) underwent radiofrequency ablation (RFA), and 89 (63.57%) underwent microwave ablation (MWA). Pooled data analysis revealed that the first and secondary technical success rates were 85% (95% confidence interval [CI], 73-96) and 99% (95% CI, 96-100), the 1-year overall survival rate was 83% (95% CI, 71-93), the 1-year local tumor control rate was 83% (95% CI, 75-90), and the incidence rate of intraoperative hypertensive crises was 14% (95% CI, 8-20). The overall rate of major complications was 3.6%. In the subgroup analysis, lower heterogeneity was indicated to be associated with mean tumor size and ablation type. CONCLUSIONS This meta-analysis showed that US-PA can be both effective and safe for AM in terms of overall survival, technical success rate, and local control for AM.
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Affiliation(s)
- Huohu Zhong
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zecheng Wang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yingchao Liu
- Department of Anesthesiology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Helin Ke
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Piaopiao Liu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xihua Lian
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Zhenhong Xu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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4
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Zheng BW, Wu T, Yao ZC, Ma YP, Ren J. Perithyroidal hemorrhage caused by hydrodissection during radiofrequency ablation for benign thyroid nodules: Two case reports. World J Clin Cases 2022; 10:10755-10762. [PMID: 36312477 PMCID: PMC9602231 DOI: 10.12998/wjcc.v10.i29.10755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/08/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hydrodissection is a widely used technique during radiofrequency ablation (RFA) for benign thyroid nodules. Although it could effectively avoid thermal injury to the surrounding critical structures and achieve complete treatment, routine operation of the remaining needle could cause perithyroidal hemorrhage. In this report, we present 2 cases of perithyroidal hemorrhage during RFA caused by a hydrodissection needle, which have not been reported before.
CASE SUMMARY A 21-year-old female and a 45-year-old male were admitted for RFA for benign thyroid nodules. Considering that their nodules were adjacent to the recurrent laryngeal nerve, the needle used for hydrodissection was placed and remained between the dorsal capsule of the lateral lobe and the recurrent laryngeal nerve. During the procedure, active bleeding near the needle appeared on ultrasonography (US). Although moderate pressure was quickly applied to the neck for several minutes, contrast-enhanced US (CEUS) still showed an active hemorrhage. A radiofrequency electrode was placed at the bleeding point under the guidance of CEUS to stop the bleeding, and the procedure was finally confirmed to be successful by CEUS, without other complications.
CONCLUSION Hydrodissection during RFA of benign thyroid nodules was associated with a risk of perithyroidal hemorrhage. The timely recognition of this acute hemorrhage could help in the timely control of the bleeding, and CEUS-guided ablation of the bleeding point could be useful.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Zhi-Cheng Yao
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-sen university, Guangzhou 510530, Guangdong Province, China
| | - Yan-Ping Ma
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
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Laparoscopic Adrenalectomy Versus Percutaneous Ablation for Aldosterone‑Producing Adenoma: a Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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6
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Park BK, Shen SH, Fujimori M, Wang Y. Thermal Ablation for Renal Cell Carcinoma: Expert Consensus from the Asian Conference on Tumor Ablation. Korean J Radiol 2021; 22:1490-1496. [PMID: 34448380 PMCID: PMC8390817 DOI: 10.3348/kjr.2020.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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Donlon P, Dennedy MC. Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future. Curr Opin Endocrinol Diabetes Obes 2021; 28:291-302. [PMID: 33741778 PMCID: PMC8183491 DOI: 10.1097/med.0000000000000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. RECENT FINDINGS Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. SUMMARY Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
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Affiliation(s)
- Padraig Donlon
- Adrenal Research Laboratory, The Discipline of Pharmacology and Therapeutics, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Ireland
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Chen J, Wu J, Zhu R, Lu L, Ma XJ. Ablation versus laparoscopic adrenalectomy for the treatment of aldosterone‑producing adenoma: a meta-analysis. Abdom Radiol (NY) 2021; 46:2795-2804. [PMID: 33386911 DOI: 10.1007/s00261-020-02887-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the relative clinical efficacy and safety of ablation and laparoscopic adrenalectomy (LA) for the treatment of adrenal aldosterone-producing adenoma (APA). MATERIALS AND METHODS Pubmed, Embase, and Cochrane Library databases were searched for relevant studies, while the meta-analysis was performed with RevMan v5.3. RESULTS After initially identifying 496 potentially relevant studies, five were ultimately included in the final meta-analysis. In total, these studies contained 128 patients that underwent LA and 91 patients that underwent ablation to treat APA. Clinical success rates were comparable between these two groups (OR: 0.55, P = 0.20), whereas the pooled decreases of systolic and diastolic blood pressure were significantly larger in the ablation group (P = 0.01 and 0.002, respectively). Pooled changes in the aldosterone-to-renin ratio (ARR), serum potassium levels, and medication use were similar in both groups (P = 0.62, 0.24, and 0.96, respectively). The average operative duration in the ablation group was somewhat shorter, but the difference was not significant (MD: - 57.99; P = 0.05), whereas the average blood loss and postoperative hospital stay duration of patients in the ablation group were decreased for patients in the ablation group compared to the LA group (P < 0.00001 and 0.00001, respectively). Major complication, minor complication, and hypertension crisis rates were comparable between these groups (P = 0.35, 0.69, and 0.09, respectively). CONCLUSIONS Ablation offers comparable efficacy to LA when treating patients with APA, but is associated with a reduced operative duration, decreased intraoperative blood loss, and faster postoperative recovery.
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Affiliation(s)
- Jin Chen
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Juan Wu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Rui Zhu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China
| | - Lu Lu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, China.
| | - Xi-Juan Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, 221000, China.
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Park BK, Fujimori M, Shen SH, Pua U. Asian Conference on Tumor Ablation Guidelines for Adrenal Tumor Ablation. Endocrinol Metab (Seoul) 2021; 36:553-563. [PMID: 34107604 PMCID: PMC8258324 DOI: 10.3803/enm.2021.1008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Thermal ablation is a good alternative treatment in patients who are unable to undergo adrenalectomy. Even though the Asian Conference on Tumor Ablation (ACTA) has been held for many years, adrenal ablation guidelines have not been established. No guidelines for adrenal ablation are established in American and European countries, either. The aim of this review was to introduce the first version of ACTA guidelines for adrenal tumor ablation.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu,
Japan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei,
Taiwan
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital,
Singapore
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10
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Surgical approaches for retroperitoneal tumors. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Pan S, Baal JD, Chen WC, Baal U, Pai JS, Baal JH, Zagoria R. Image-Guided Percutaneous Ablation of Adrenal Metastases: A Meta-Analysis of Efficacy and Safety. J Vasc Interv Radiol 2021; 32:527-535.e1. [PMID: 33518369 DOI: 10.1016/j.jvir.2020.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of percutaneous ablation of adrenal metastases through a meta-analysis of various image-guided percutaneous ablation techniques. MATERIALS AND METHODS A comprehensive literature search of PubMed and Embase databases was performed for studies evaluating the efficacy and/or safety of image-guided percutaneous ablation of adrenal metastases. A total of 37 studies published between 2009 and 2020 were analyzed, comprising a sample size of 959 patients. Proportion estimates of overall survival, local control, and toxicity were analyzed in a pooled meta-analysis. The pooled prevalence of adverse events after ablation was calculated based on common terminology criteria for adverse events (CTCAE) grading. RESULTS Of the 959 included patients, 320 (33.3%) underwent radiofrequency ablation, 72 (7.5%) microwave ablation, 95 (9.9%) cryoablation, and 46 (4.8%) ethanol injections for treatment of adrenal metastases. The remaining 426 (44.4%) patients were from studies involving a mixture of the 4 listed percutaneous ablation techniques. The pooled 1-year local control rate was 80% (95% confidence interval [CI], 76%-83%). The pooled 1-year overall survival rate was 77% (95% CI, 70%-83%). The overall rate of severe adverse events after ablation (CTCAE grade 3 or higher) was 16.1%. The overall rate of low-grade adverse events after ablation (CTCAE grade 2 or lower) was 32.6%. Approximately 21.9% (n = 203) of patients experienced intraprocedural hypertensive crises, the majority of which were reversed with antihypertensive medications. CONCLUSIONS This study demonstrates that image-guided percutaneous ablation can be effective in achieving acceptable short- to mid-term local tumor control and overall survival with a moderate safety profile.
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Affiliation(s)
- Simon Pan
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California
| | - Joe D Baal
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California.
| | - William C Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Ulysis Baal
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California
| | - Jonathan S Pai
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Jed H Baal
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California
| | - Ronald Zagoria
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California; Department of Urology, University of California, San Francisco, California
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12
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Park BK, Shen SH, Fujimori M, Wang Y. Asian Conference on Tumor Ablation guidelines for renal cell carcinoma. Investig Clin Urol 2021; 62:378-388. [PMID: 34190433 PMCID: PMC8246015 DOI: 10.4111/icu.20210168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 01/20/2023] Open
Abstract
Thermal ablation has been established as an alternative treatment for renal cell carcinoma (RCC) in patients who are poor candidates for surgery. However, while American and European guidelines have been established for American and European patients, respectively, no ablation guidelines for Asian patients with RCCs have been established many years after the Asian Conference on Tumor Ablation (ACTA) had been held. Given that Western guidelines are difficult to apply to Asian patients due to differences in body habitus, economic status, and insurance systems, the current review sought to establish the first version of the ACTA guidelines for treating a RCC with thermal ablation.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Mie Prefecture, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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Park BK. Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists. Endocrinol Metab (Seoul) 2020; 35:750-755. [PMID: 33261308 PMCID: PMC7803608 DOI: 10.3803/enm.2020.880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
Image-guided radiofrequency ablation (RFA) has been accepted as a minimally invasive treatment for adrenal tumors in patients who are unable to undergo adrenalectomy. Accordingly, this treatment has become more readily available for treating functioning or non-functioning adrenal masses. Thus, endocrinologists need a better understanding of percutaneous RFA of adrenal tumors. The purpose of this review is to briefly describe the basic mechanism of RFA, indications and contraindications, patient preparation prior to RFA, type of complications, how to avoid complications, RFA procedures, and treatment outcomes.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Abstract
Incidentally discovered adrenal alterations should be separated into those without any clinical importance and adrenal diseases that have to be surgically or conservatively treated. Before operative treatment, in addition to the possible different functional activity of tumors, a differentiation must be made between sporadically arising singular or multiple adrenal tumors or nodular adrenal hyperplasia, adrenal tumors as part of a familial syndrome and metastases of other primary malignant tumors into the adrenal glands. Benign hormonally active adrenal tumors as well as questionable malignant tumors of the adrenal cortex are resected by minimally invasive techniques. For large malignant tumors infiltrating into surrounding tissues and tumors with proven lymph node metastases, the primarily open approach is indicated. Patients with adrenal diseases should always undergo an interdisciplinary assessment and in cases with clear indications for surgery, sometimes transferred to a center with experience in surgery and postoperative management of these patients.
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Affiliation(s)
- S Schimmack
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - P Knoell
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - L Kihm
- Klinik für Endokrinologie, Stoffwechsel und Klinische Chemie, Universität Heidelberg, Heidelberg, Deutschland
| | - O Strobel
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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15
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Rossi GP, Bisogni V, Bacca AV, Belfiore A, Cesari M, Concistrè A, Del Pinto R, Fabris B, Fallo F, Fava C, Ferri C, Giacchetti G, Grassi G, Letizia C, Maccario M, Mallamaci F, Maiolino G, Manfellotto D, Minuz P, Monticone S, Morganti A, Muiesan ML, Mulatero P, Negro A, Parati G, Pengo MF, Petramala L, Pizzolo F, Rizzoni D, Rossitto G, Veglio F, Seccia TM. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2020; 5:100029. [PMID: 33447758 PMCID: PMC7803025 DOI: 10.1016/j.ijchy.2020.100029] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Background and aim Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism. Methods To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered. Results Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review. Conclusions After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- Corresponding author. DIMED –Clinica dell’Ipertensione Arteriosa, University Hospital, via Giustiniani, 2; 35126, Padova, Italy.
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | | | - Anna Belfiore
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Rita Del Pinto
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | - Bruno Fabris
- Department of Medical Sciences, Università degli Studi di Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy
| | - Cristiano Fava
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | | | | | - Claudio Letizia
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Mallamaci
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Dario Manfellotto
- UO Medicina Interna, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Silvia Monticone
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Paolo Mulatero
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Aurelio Negro
- Department of Medicine, Center for Hypertension, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Martino F. Pengo
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Francesca Pizzolo
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Franco Veglio
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
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Liang KW, Jahangiri Y, Tsao TF, Tyan YS, Huang HH. Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters. J Vasc Interv Radiol 2019; 30:1335-1342.e1. [PMID: 31375447 DOI: 10.1016/j.jvir.2019.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/20/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma. MATERIALS AND METHODS A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated. RESULTS A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (-29.06 mm Hg; 95% confidence interval [CI], -33.93 to -24.19), DBP (-16.03 mm Hg; 95% CI, -18.33 to -13.73), and the number of antihypertensive medications used (-1.43; 95% CI, -1.97 to -0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration. CONCLUSIONS Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.
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Affiliation(s)
- Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Hsin-Hui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C.
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Liang P, Wu S, Li X, Yu J, Yu X, Cheng Z, Liu F, Han Z, Duan S. Ultrasound-guided percutaneous microwave ablation assisted by a three-dimensional visualization preoperative treatment planning system for larger adrenal metastasis (D ≥ 4 cm): Preliminary results. J Cancer Res Ther 2019; 15:1477-1483. [DOI: 10.4103/jcrt.jcrt_39_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Xu Y, Wang Z, Bi Y, Duan Z, Yue X. Correlation between CT features of adrenocortical and adrenal medullary tumors and expression of miR-96 in serum. Oncol Lett 2018; 16:2053-2057. [PMID: 30008900 PMCID: PMC6036421 DOI: 10.3892/ol.2018.8863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022] Open
Abstract
Correlation between CT features of adrenocortical and adrenal medullary tumors and the expression of miR-96 in serum were investigated. A total of 230 patients with adrenocortical tumors and 194 patients with adrenal medullary tumors were selected in Dongying People's Hospital from August 2013 to August 2017. The two groups of patients underwent CT examination, and the signs and symptoms were recorded. The expression of miR-96 in the serum of the two groups was detected by RT-PCR, and the correlation between the expression of serum miR-96 and CT features was analyzed. In patients with adrenocortical tumor, serum miR-96 expression levels were significantly higher in patients with tumor diameter ≥5 cm than those with tumor diameter <5 cm (p<0.001). In patients with adrenal medullary tumor, serum miR-96 expression levels were significantly higher in patients with tumor diameter ≥3 cm than those with tumor diameter <3 cm (p<0.001). In patients with adrenocortical or adrenal medullary tumor, serum miR-96 expression levels were significantly higher in patients with peripheral infiltration than those without peripheral infiltration (p<0.001), and serum miR-96 expression levels were also significantly higher in patients with distant metastasis than those without distant metastasis (p<0.001). Serum levels of miR-96 in patients with benign adrenocortical and adrenal medullary tumors were significantly lower than those with malignant tumors in the same group (p<0.001). miR-96 may have oncogenic functions in patients with adrenocortical or adrenal medullary tumors. Increased expression level of miR-96 may promote proliferation, invasion and metastasis of tumors, and serum levels of miR-96 provide references for the diagnosis of adrenocortical and adrenal medullary tumors.
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Affiliation(s)
- Yongyun Xu
- CT Room, Dongying People's Hospital, The Second People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Zhenfang Wang
- CT Room, Dongying People's Hospital, The Second People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Yangang Bi
- CT Room, Dongying People's Hospital, The Second People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Zuyun Duan
- Department of Imaging, The Second People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
| | - Xuewang Yue
- CT Room, Dongying People's Hospital, The Second People's Hospital of Dongying, Dongying, Shandong 257091, P.R. China
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Ierardi AM, Petrillo M, Patella F, Biondetti P, Fumarola EM, Angileri SA, Pesapane F, Pinto A, Dionigi G, Carrafiello G. Interventional radiology of the adrenal glands: current status. Gland Surg 2018; 7:147-165. [PMID: 29770310 DOI: 10.21037/gs.2018.01.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As more and more adrenal neoplasms are found incidentally or symptomatically, the need for interventional procedures has being increasing. In recent years these procedures registered continued steady expansion. Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. They may be applied both in benign and in malignant pathologies. The present review reports the current status of indications, techniques results and complications of the image-guided procedures.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mario Petrillo
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Filippo Pesapane
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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20
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Zener R, Zaleski A, Van Uum SH, Gray DK, Mujoomdar A. Successful percutaneous CT-guided microwave ablation of adrenal gland for ectopic Cushing syndrome. Clin Imaging 2016; 42:93-95. [PMID: 27919009 DOI: 10.1016/j.clinimag.2016.11.021] [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] [Received: 08/30/2016] [Revised: 11/16/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023]
Abstract
Adrenocorticotropic hormone production by pancreatic neuroendocrine tumor (PNET) is rare and results in hyperstimulation of the adrenal gland to produce ectopic Cushing syndrome. Our case showcases the safety and effectiveness of percutaneous CT-guided microwave ablation of the adrenal gland in a 49-year-old female with PNET and hepatic metastases who presented with ectopic Cushing syndrome despite surgical resection of the primary pancreatic tumor and left adrenal gland. Prior to ablation, the right adrenal gland measured 4.3×1.6×2.0cm and the patient had malignant hypertension with elevated morning serum cortisol level (1976nmol/L). After microwave ablation of the right adrenal gland, the hypertension resolved and the cortisol level decreased dramatically (74nmol/L). As expected after successful treatment, the patient developed adrenal insufficiency and was placed on glucocorticoid and mineralocorticoid supplementation.
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Affiliation(s)
- Rebecca Zener
- London Health Sciences Centre - Victoria Hospital, Western University - Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.
| | - Andrew Zaleski
- London Health Sciences Centre - Victoria Hospital, Western University - Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Stan H Van Uum
- St. Joseph's Health Care, Western University - Division of Endocrinology, 286 Grosvenor Street, London, Ontario N6A 4V2, Canada
| | - Daryl K Gray
- London Health Sciences Centre - Victoria Hospital, Western University - Department of Surgery, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
| | - Amol Mujoomdar
- London Health Sciences Centre - Victoria Hospital, Western University - Department of Medical Imaging, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada
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Men M, Ye X, Fan W, Zhang K, Bi J, Yang X, Zheng A, Huang G, Wei Z. Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study. Korean J Radiol 2016; 17:864-873. [PMID: 27833402 PMCID: PMC5102914 DOI: 10.3348/kjr.2016.17.6.864] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/09/2016] [Indexed: 12/22/2022] Open
Abstract
Objective To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. Materials and Methods From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Results Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). Conclusion CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.
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Affiliation(s)
- Min Men
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province 510060, China
| | - Kaixian Zhang
- Department of Oncology, Teng Zhou Central People's Hospital Affiliated with Jining Medical College, Tengzhou, Shandong Province 277500, China
| | - Jingwang Bi
- Department of Oncology, Jinan Military General Hospital of Chinese People's Liberation Army, Jinan, Shandong Province 250021, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Aimin Zheng
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
| | - Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan, Shandong Province 250021, China
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22
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Yang MH, Tyan YS, Huang YH, Wang SC, Chen SL. Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma. Radiol Med 2016; 121:811-9. [PMID: 27300650 DOI: 10.1007/s11547-016-0662-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/01/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE To retrospectively compare the safety and efficacy of radiofrequency ablation (RFA) with laparoscopic adrenalectomy (LA) in treating aldosterone-producing adenoma (APA) of the adrenal gland. MATERIALS AND METHODS From September 2009 to September 2013, seven patients, diagnosed with unilateral adrenal APA and underwent computed tomography (CT)-guided percutaneous RFA, were recruited in this retrospective study. Eighteen unilateral adrenal APA with the same tumor size (<25 mm) who underwent LA during the same interval were enrolled as control group. Treatment success was defined as complete tumor ablation on follow-up CT scan and normalization of serum aldosterone-to-renin ratio. We also compared "normalization ability" between RFA group and LA group. Normalization ability was defined as reduction in blood pressure, decrease in number of antihypertensive medicine use, reduction in serum aldosterone, and increase in serum potassium level. RESULTS There was no statistically significant demographic difference in both groups. The mean tumor size was 18 (8-25) mm in RFA and 19 (11-25) mm in LA groups, respectively. There was only one intra-procedure hypertensive crisis in the RFA group. No other complications needed further management in both groups. During an interval of 3-6 months of follow-up, the treatment success rate reached 100 % in the RFA group versus 94.4 % in the LA group. Normalization ability was statistically equivalent in the RFA and the LA group. Comparing with LA group, RFA group demonstrated with less post-operative pain (visual analog scale, 2.0 ± 1.16 vs. 4.22 ± 1.44, p < 0.001) and shorter operative time (105 ± 34 vs. 194 ± 58 min, p < 0.001). CONCLUSIONS CT-guided percutaneous RFA is effective, safe and is a justifiable alternative for patients who are reluctant or unfit for laparoscopic surgery for the treatment of APA.
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Affiliation(s)
- Min-Hsin Yang
- Department of Urology, Chung Shan Medical University Hospital, No. 110, Chien-Kuo North Rd., Section 1, Taichung, 402, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hui Huang
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shao-Chuan Wang
- Department of Urology, Chung Shan Medical University Hospital, No. 110, Chien-Kuo North Rd., Section 1, Taichung, 402, Taiwan
| | - Sung-Lang Chen
- Department of Urology, Chung Shan Medical University Hospital, No. 110, Chien-Kuo North Rd., Section 1, Taichung, 402, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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23
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Catecholamine Surge during Image-Guided Ablation of Adrenal Gland Metastases: Predictors, Consequences, and Recommendations for Management. J Vasc Interv Radiol 2015; 27:395-402. [PMID: 26724964 DOI: 10.1016/j.jvir.2015.11.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/12/2015] [Accepted: 11/10/2015] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland. MATERIALS AND METHODS Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y ± 10; age range, 41-81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7). Tumors measured 0.7-11.3 cm (mean, 4 cm ± 2.5). Modalities included cryoablation (n = 38), radiofrequency (RF) ablation (n = 20), RF ablation with injection of dehydrated ethanol (n = 10), and microwave ablation (n = 4). Fisher exact test, univariate, and multivariate logistical regression analysis was used to evaluate factors predicting hypertensive crisis (HC). RESULTS HC occurred in 31 sessions (43%). Ventricular tachycardia (n = 1), atrial fibrillation (n = 2), and troponin leak (n = 4) developed during HC episodes. HC was significantly associated with maximum tumor diameter ≤ 4.5 cm (odds ratio [OR], 26.36; 95% confidence interval [CI], 5.26-131.99; P < .0001) and visualization of normal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67-25.33; P < .0001). No HC occurred during ablation of metastases in previously irradiated or ablated adrenal glands. CONCLUSIONS Patients at high risk of catecholamine surge during ablation of non-hormonally active adrenal metastases can be identified by the presence of normal adrenal tissue and tumor diameter ≤ 4.5 cm on pre-procedure CT or MR imaging.
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Park JJ, Park BK, Kim JH, Jeong BC, Kim CK. Salvage computed tomography-guided transhepatic radiofrequency ablation for unresected aldosteronoma of adrenohepatic fusion after adrenalectomy. Int J Urol 2015; 23:102-4. [PMID: 26415990 DOI: 10.1111/iju.12956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
Adrenalectomy is a treatment of choice for functioning adrenocortical adenoma. We experienced a case of unresected aldosteronoma after right adrenalectomy. Computed tomography-guided transhepatic radiofrequency ablation was carried out to treat the unresected functioning adenoma. The purpose of our case report was to show the clinical findings, computed tomography imaging features and computed tomography-guided transhepatic ablation techniques for adrenocortical adenoma arising from adrenohepatic fusion.
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Affiliation(s)
- Jung Jae Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hasegawa T, Yamakado K, Nakatsuka A, Uraki J, Yamanaka T, Fujimori M, Miki M, Sasaki T, Sakuma H, Sugimura Y. Unresectable Adrenal Metastases: Clinical Outcomes of Radiofrequency Ablation. Radiology 2015; 277:584-93. [PMID: 25997031 DOI: 10.1148/radiol.2015142029] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To retrospectively evaluate the clinical outcomes of radiofrequency (RF) ablation for the treatment of unresectable adrenal metastasis. MATERIALS AND METHODS The institutional review board approved this retrospective study, and informed consent to perform adrenal RF ablation was obtained from all patients. From February 2005 through May 2014, 35 patients (25 men and 10 women; mean age, 64.7 years ± 9.6; age range, 39-82 years) underwent RF ablation to treat 41 metastatic adrenal tumors from lung cancer (n = 15), renal cell carcinoma (n = 9), colorectal cancer (n = 5), hepatocellular carcinoma (n = 4), and other tumors (n = 2). Tumors ranged in size from 1.2 to 8.2 cm (mean, 3.3 cm ± 1.6). The diagnosis was established mainly on the basis of radiologic findings. Adrenal arterial embolization was combined with RF ablation in 12 of the 35 patients (34%). Technical success, safety, local tumor progression, and survival were evaluated. The Kaplan-Meier method and Cox proportional hazard model were used to evaluate prognostic factors. RESULTS There were 48 completed sessions with planned procedures and treatment protocols with no mortality and a major complication rate of 8.3% (four of 48 sessions). Tumor enhancement disappeared after initial adrenal RF ablation in 33 of the 35 patients (94%). Local tumor progression developed in eight of the 35 patients (23%); two patients received repeated RF ablation, resulting in adrenal tumor control in 27 of the 35 patients (77%) at the last follow-up (mean, 30.1 months ± 27.5; range 1.2-96.8 months). The 1-, 3-, and 5-year overall survival rates were 75% (95% confidence interval [CI], 61%, 90%), 34% (95% CI: 17%, 52%), and 30% (95% CI: 13%, 48%), respectively, with a median survival time of 26.0 months. Existence of extra-adrenal tumors (P = .005) and age of 65 years or older (P = .04) were significant indicators of a poor prognosis. CONCLUSION Adrenal RF ablation is a feasible and useful method for controlling adrenal metastases and offers patients opportunities for improved survival.
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Affiliation(s)
- Takaaki Hasegawa
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Koichiro Yamakado
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsuhiro Nakatsuka
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Junji Uraki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takashi Yamanaka
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masashi Fujimori
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Manabu Miki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takeshi Sasaki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yoshiki Sugimura
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome. Cardiovasc Intervent Radiol 2015; 38:1335-8. [PMID: 25762486 DOI: 10.1007/s00270-015-1056-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
Abstract
Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: O ne was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.
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Abstract
Although laparoscopic adrenalectomy has remained the standard of care for the treatment for adrenal tumors, percutaneous image-guided ablation therapy, such as chemical ablation, radiofrequency ablation, cryoablation, and microwave ablation, has been shown to be clinically useful in many nonsurgical candidates. Ablation therapy has been used to treat both functioning adenomas and malignant tumors, including primary adrenal carcinoma and metastasis. For patients with functioning adenomas, biochemical and symptomatic improvement is achieved in 96 to 100% after ablation; for patients with malignant adrenal neoplasms, however, the survival benefit from ablation therapy remains unclear, though good initial results have been reported. This article outlines the current role of ablation therapy for adrenal lesions, as well as identifying some of the technical considerations for this procedure.
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Affiliation(s)
- Koichiro Yamakado
- Department of Interventional Radiology, Mie University School of Medicine, Mie, Japan
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Welch BT, Callstrom MR, Carpenter PC, Wass CT, Welch TL, Boorjian SA, Nichols DA, Thompson GB, Lohse CM, Erickson D, Leibovich BC, Atwell TD. A single-institution experience in image-guided thermal ablation of adrenal gland metastases. J Vasc Interv Radiol 2014; 25:593-8. [PMID: 24507995 DOI: 10.1016/j.jvir.2013.12.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 12/14/2013] [Accepted: 12/15/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To assess safety, technical success, local control, and survival associated with percutaneous image-guided adrenal ablation. MATERIALS AND METHODS Adult patients with adrenal metastases who underwent percutaneous image-guided adrenal ablation during the years 2003-2012 were identified. There were 32 patients with 37 adrenal tumors identified. Technical success, safety, local control, and survival were analyzed according to standard criteria. RESULTS In 32 patients (25 men and 7 women; mean age, 66 y; age range, 44-88 y) with 37 adrenal tumors, 35 ablation procedures were performed. One patient with an 8.2-cm tumor underwent planned cryoablation debulking fully anticipating untreated margins owing to close proximity of the pancreas (ie, the intent was to diminish tumor burden rather than a curative intervention). Of the 36 patients treated with curative intent, technical success was achieved in 35 (97%) tumors. Follow-up imaging was performed on 34 of 37 tumors (excluding patients with intentional debulking [n = 1], technical failure [n = 1], and absence of follow-up [n = 1]). Local recurrence developed in 3 (8.8%) of 34 tumors. Local tumor control was achieved in 31 lesions at a mean of 22.7 months of follow-up. Recurrence-free survival and overall survival at 36 months were 88% and 52%, respectively, with a median survival of 34.5 months. A Common Terminology Criteria for Adverse Events version 4 grade 3 or 4 complication was observed in three (8.6%) ablation procedures. CONCLUSIONS Image-guided ablation is safe and effective for local control of metastatic adrenal tumors and provides a minimally invasive alternative to surgical resection in appropriately selected patients.
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Affiliation(s)
- Brian T Welch
- Departments of Radiology (B.T.W., M.R.C., D.A.N., T.D.A.).
| | | | | | | | | | | | | | | | - Christine M Lohse
- Biostatistics (C.M.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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