1
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Aveta A, Iossa V, Spena G, Conforti P, Pagano G, Dinacci F, Verze P, Manfredi C, Ferro M, Lasorsa F, Spirito L, Napolitano L, Tufano A, Fiorenza A, Russo P, Crocerossa F, Lucarelli G, Perdonà S, Sanseverino R, Siracusano S, Cilio S, Pandolfo SD. Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review. Life (Basel) 2024; 14:450. [PMID: 38672721 PMCID: PMC11050889 DOI: 10.3390/life14040450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
This review focuses on ablative techniques for small renal masses (SRMs), including radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and irreversible electroporation (IRE), and discusses recurrence management. Through an extensive literature review, we outline the procedures, outcomes, and follow-up strategies associated with each ablative method. The review provides a detailed examination of these techniques-RFA, CA, MWA, and IRE-elucidating their respective outcomes. Recurrence rates vary among them, with RFA and CA showing comparable rates, MWA demonstrating favorable short-term results, and IRE exhibiting promise in experimental stages. For managing recurrences, various strategies are considered, including active surveillance, re-ablation, or salvage surgery. Surveillance is preferred post-RFA and post-CA, due to slow SRM growth, while re-ablation, particularly with RFA and CA, is deemed feasible without additional complications. Salvage surgery emerges as a viable option for larger or resistant tumors. While ablative techniques offer short-term results comparable to surgery, further research is essential to understand their long-term effects fully. Decisions concerning recurrence management should consider individual and tumor-specific factors. Imaging, notably contrast-enhanced ultrasounds, plays a pivotal role in assessing treatment success, emphasizing the necessity of a multidisciplinary approach for optimal outcomes. The lack of randomized trials highlights the need for further research.
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Affiliation(s)
- Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | - Vincenzo Iossa
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Gianluca Spena
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Paolo Conforti
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Giovanni Pagano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Fabrizio Dinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 71013 Milan, Italy;
| | - Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Alessandra Fiorenza
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Fabio Crocerossa
- Division of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | | | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
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2
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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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3
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Chaurasia A, Singh S, Homayounieh F, Gopal N, Jones EC, Linehan WM, Shyn PB, Ball MW, Malayeri AA. Complications after Nephron-sparing Interventions for Renal Tumors: Imaging Findings and Management. Radiographics 2023; 43:e220196. [PMID: 37384546 PMCID: PMC10323228 DOI: 10.1148/rg.220196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 07/01/2023]
Abstract
The two primary nephron-sparing interventions for treating renal masses such as renal cell carcinoma are surgical partial nephrectomy (PN) and image-guided percutaneous thermal ablation. Nephron-sparing surgery, such as PN, has been the standard of care for treating many localized renal masses. Although uncommon, complications resulting from PN can range from asymptomatic and mild to symptomatic and life-threatening. These complications include vascular injuries such as hematoma, pseudoaneurysm, arteriovenous fistula, and/or renal ischemia; injury to the collecting system causing urinary leak; infection; and tumor recurrence. The incidence of complications after any nephron-sparing surgery depends on many factors, such as the proximity of the tumor to blood vessels or the collecting system, the skill or experience of the surgeon, and patient-specific factors. More recently, image-guided percutaneous renal ablation has emerged as a safe and effective treatment option for small renal tumors, with comparable oncologic outcomes to those of PN and a low incidence of major complications. Radiologists must be familiar with the imaging findings encountered after these surgical and image-guided procedures, especially those indicative of complications. The authors review cross-sectional imaging characteristics of complications after PN and image-guided thermal ablation of kidney tumors and highlight the respective management strategies, ranging from clinical observation to interventions such as angioembolization or repeat surgery. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available in the Online Learning Center. See the invited commentary by Chung and Raman in this issue.
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Affiliation(s)
- Aditi Chaurasia
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Shiva Singh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Fatemeh Homayounieh
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Nikhil Gopal
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Elizabeth C. Jones
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - W. Marston Linehan
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Paul B. Shyn
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Mark W. Ball
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
| | - Ashkan A. Malayeri
- From the Urologic Oncology Branch, National Cancer Institute,
National Institutes of Health, Bethesda, Md (A.C., N.G., W.M.L., M.W.B.);
Department of Radiology and Imaging Sciences, Clinical Center, National
Institutes of Health, 10 Center Dr 1C352, Bethesda, MD 20892 (S.S., F.H.,
E.C.J., A.A.M.); and Division of Abdominal Imaging and Intervention, Department
of Radiology, Brigham and Women’s Hospital, Harvard Medical School,
Boston, Mass (P.B.S.)
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Purysko AS, Nikolaidis P, Khatri G, Auron M, De Leon AD, Ganeshan D, Gore JL, Gupta RT, Shek-Man Lo S, Lyshchik A, Savage SJ, Smith AD, Taffel MT, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Post-Treatment Follow-up and Active Surveillance of Clinically Localized Renal Cell Carcinoma: 2021 Update. J Am Coll Radiol 2022; 19:S156-S174. [PMID: 35550799 DOI: 10.1016/j.jacr.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Renal cell carcinoma (RCC) accounts for most malignant renal tumors and is considered the most lethal of all urologic cancers. For follow-up of patients with treated or untreated RCC and those with neoplasms suspected to represent RCC, radiologic imaging is the most valuable component of surveillance, as most relapses and cases of disease progression are identified when patients are asymptomatic. Understanding the strengths and limitations of the various imaging modalities for the detection of disease, recurrence, or progression is essential when planning follow-up regimens. This document addresses the appropriate imaging examinations for asymptomatic patients who have been treated for RCC with radical or partial nephrectomy or ablative therapies. It also discusses the appropriate imaging examinations for asymptomatic patients with localized biopsy-proven or suspected RCC undergoing active surveillance. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Paul Nikolaidis
- Panel Chair, Vice Chair, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Gaurav Khatri
- Panel Vice-Chair, Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging; Program Director, Body MRI Fellowship, UT Southwestern Medical Center, Dallas, Texas
| | - Moises Auron
- Medical Director Blood Management; Quality and Patient Safety Officer, Department of Hospital Medicine; Member, Board of Governors, Cleveland Clinic, Cleveland, Ohio; Primary care physician-Internal medicine
| | | | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina; and Chair, ACR Meetings Subcommittee, Commission on Publications and Lifelong Learning
| | - Simon Shek-Man Lo
- Vice Chair for Strategic Planning, Director of SBRT, and Co-chair of Appointment and Promotion Committee of Department of Radiation of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; and Immediate Past President of CARROS of ACR, Fellowship Committee Chair of CARROS of ACR, ACR Assistant Councilor (on behalf of American Radium Society), Chair of the Committee for ACR Practice Parameter for Radiation Oncology
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stephen J Savage
- Professor and Vice Chairman of Urology, Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Myles T Taffel
- Associate Section Head Abdominal Imaging, New York University Langone Medical Center, New York, New York
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama; and Chair, ACR Appropriateness Committee
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5
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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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6
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Abou Elkassem AM, Lo SS, Gunn AJ, Shuch BM, Dewitt-Foy ME, Abouassaly R, Vaidya SS, Clark JI, Louie AV, Siva S, Grosu AL, Smith AD. Role of Imaging in Renal Cell Carcinoma: A Multidisciplinary Perspective. Radiographics 2021; 41:1387-1407. [PMID: 34270355 DOI: 10.1148/rg.2021200202] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the expansion in cross-sectional imaging over the past few decades, there has been an increase in the number of incidentally detected renal masses and an increase in the incidence of renal cell carcinomas (RCCs). The complete characterization of an indeterminate renal mass on CT or MR images is challenging, and the authors provide a critical review of the best imaging methods and essential, important, and optional reporting elements used to describe the indeterminate renal mass. While surgical staging remains the standard of care for RCC, the role of renal mass CT or MRI in staging RCC is reviewed, specifically with reference to areas that may be overlooked at imaging such as detection of invasion through the renal capsule or perirenal (Gerota) fascia. Treatment options for localized RCC are expanding, and a multidisciplinary group of experts presents an overview of the role of advanced medical imaging in surgery, percutaneous ablation, transarterial embolization, active surveillance, and stereotactic body radiation therapy. Finally, the arsenal of treatments for advanced renal cancer continues to grow to improve response to therapy while limiting treatment side effects. Imaging findings are important in deciding the best treatment options and to monitor response to therapy. However, evaluating response has increased in complexity. The unique imaging findings associated with antiangiogenic targeted therapy and immunotherapy are discussed. An invited commentary by Remer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Asser M Abou Elkassem
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Simon S Lo
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew J Gunn
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Brian M Shuch
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Molly E Dewitt-Foy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Robert Abouassaly
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Sandeep S Vaidya
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Joseph I Clark
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Alexander V Louie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Shankar Siva
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Anca-Ligia Grosu
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew D Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
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7
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Xu SS, Hocking D, Cool DW, Wiseman D, Mujoomdar A. Nonmalignant Enhancement Following Percutaneous Renal Ablation Mimicking Viable Malignancy. Cardiovasc Intervent Radiol 2020; 44:176-178. [PMID: 33000318 DOI: 10.1007/s00270-020-02639-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Samuel S Xu
- Department of Medical Imaging, Western University, London Health Sciences, London, ON, Canada.
| | - David Hocking
- Division of Interventional Radiology, Department of Medical Imaging, Western University, London Health Sciences, London, ON, Canada
| | - Derek W Cool
- Division of Interventional Radiology, Department of Medical Imaging, Western University, London Health Sciences, London, ON, Canada
| | - Daniele Wiseman
- Division of Interventional Radiology, Department of Medical Imaging, Western University, London Health Sciences, London, ON, Canada
| | - Amol Mujoomdar
- Division of Interventional Radiology, Department of Medical Imaging, Western University, London Health Sciences, London, ON, Canada
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8
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Papa M, Suardi N, Losa A, Agostini G, Maga T, Ierardi AM, Carrafiello G, Gaboardi F, Cardone G. ABLATE: a score to predict complications and recurrence rate in percutaneous treatments of renal lesions. Med Oncol 2020; 37:26. [PMID: 32166542 DOI: 10.1007/s12032-020-01351-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 01/20/2023]
Abstract
RENAL score has been validated on predicting adverse events and relapses in percutaneous treatments of renal lesions. To better fit interventional issues a modified score (mRENAL) has been introduced, but the only difference from the RENAL score is on the dimensional parameter. However, it remains of surgical derivation while a specific interventional score is missing. This study aims to obtain a specific score (ABLATE) to better quantify the risk of complications and relapses in percutaneous kidney ablation procedures compared to the existing surgical scores. Taking inspiration from previous papers, a score was built to quantify the real difficulties faced in percutaneous treatment of renal lesions. The ABLATE score was used on 71 cryoablations to evaluate its predictivity of complications and relapses. Logistic regression was used to predict complication incidence; Cox-regression was used for relapses; ROC analysis was used to evaluate the accuracy of the different scores. Between January 2014 and November 2019, 71 lesions in 68 patients were treated. Overall, malignant histology was found in 62 lesions (87.3%). Mean and median RENAL, mRENAL, and ABLATE scores were 7.04 and 7, 7.19 and 7, and 5.11 and 4, respectively. Out of 71 treatments, we experienced 3 bleeding with anemia (4.2%), only 2 of which needed further treatment (2.82%). The mean and median RENAL, mRENAL, and ABLATE scores in those with complications were 7.66 and 7.01 (p = 0.69), 8.0 and 7.1 (p = 0.54), and 6.6 and 5.0 (p = 0.38), respectively. Out of 62 malignant lesions, we experienced 2 persistent and 6 recurrent lesions (3.2% and 8.4%, respectively). At Cox-regression analyses, mABLATE score outperformed both RENAL and mRENAL scores in predicting recurrences (HR 1.48; p < 0.001 vs. 1.41; p = 0.1 vs. 1.38: p = 0.07, respectively). The ABLATE score showed to be a better predictor of relapses than RENAL and mRENAL. The small number of complications conditioned a lack of statistic power on complications for all the scores. At the moment to quantify the risks in percutaneous kidney ablation procedures, surgical scores are used. A specific score better performs this task.
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Affiliation(s)
- Maurizio Papa
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy.
| | - Nazareno Suardi
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Andrea Losa
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Giulia Agostini
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy
| | - Tommaso Maga
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | | | | | - Franco Gaboardi
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Gianpiero Cardone
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy
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9
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Joe WB, Zarzour JG, Gunn AJ. Renal Cell Carcinoma Ablation: Preprocedural, Intraprocedural, and Postprocedural Imaging. Radiol Imaging Cancer 2019; 1:e190002. [PMID: 33778679 DOI: 10.1148/rycan.2019190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023]
Abstract
The rising incidence of renal cell carcinoma (RCC) in recent decades necessitates careful consideration of additional treatment options, especially for patients who may be poor surgical candidates. An emerging body of evidence suggests that ablation may be performed effectively and safely even in patients with multiple comorbidities. Accordingly, clinical guidelines now include thermal ablation as an alternative for such patients with localized tumors that are 4.0 cm or smaller. Recent experience with these minimally invasive techniques has led to a greater understanding of the imaging findings that merit close attention when ablation is anticipated, or after it is performed. These imaging findings may guide the interventionalist's perception of the risks, technical challenges, and likelihood of treatment success associated with RCC ablation. The present review provides an overview of clinically relevant radiologic findings during the preprocedural, intraprocedural, and postprocedural period in the context of image-guided renal ablation. Keywords: Interventional-Body, Kidney, Percutaneous, Urinary © RSNA, 2019.
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Affiliation(s)
- Winston B Joe
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Jessica G Zarzour
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Andrew J Gunn
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
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10
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Lum MA, Shah SB, Durack JC, Nikolovski I. Imaging of Small Renal Masses before and after Thermal Ablation. Radiographics 2019; 39:2134-2145. [PMID: 31560613 DOI: 10.1148/rg.2019190083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thermal ablation of small renal masses is increasingly accepted as an alternative to partial nephrectomy, particularly in patients with multiple comorbidities. Many professional societies support this alternate treatment with updated guidelines. Before performing thermal ablation, it is important to stratify risk and assess technical feasibility by evaluating tumor imaging features such as size, location, and centrality. Routine postablation imaging with CT or MRI is necessary for assessment of residual or recurrent tumor, evidence of complications, or new renal masses outside the ablation zone. The normal spectrum and evolution of findings at CT and MRI include a halo appearance of the ablation zone, ablation zone contraction, and ablation zone calcifications. Tumor recurrence frequently manifests at CT or MRI as new nodular enhancement at the periphery of an expanding ablation zone, although it is normal for the ablation zone to enlarge within the first few months. Recognizing early tumor recurrence is important, as small renal masses are often easily treated with repeat ablations. Potential complications of thermal ablation include vascular injury, urine leak, ureteral stricture, nerve injury, and bowel perforation. The risk of these complications may be related to tumor size and location.©RSNA, 2019.
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Affiliation(s)
- Mark A Lum
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
| | - Shreena B Shah
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
| | - Jeremy C Durack
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
| | - Ines Nikolovski
- From the Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065 (M.A.L., S.B.S.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.C.D., I.N.)
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