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Mir M, Chen J, Patel A, Pinezich MR, Guenthart BA, Vunjak-Novakovic G, Kim J. A Minimally Invasive Robotic Tissue Palpation Device. IEEE Trans Biomed Eng 2024; 71:1958-1968. [PMID: 38261510 DOI: 10.1109/tbme.2024.3357293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Robot-assisted minimally invasive surgery remains limited by the absence of haptic feedback, which surgeons routinely rely on to assess tissue stiffness. This limitation hinders surgeons' ability to identify and treat abnormal tissues, such as tumors, during robotic surgery. METHODS To address this challenge, we developed a robotic tissue palpation device capable of rapidly and non-invasively quantifying the stiffness of soft tissues, allowing surgeons to make objective and data-driven decisions during minimally invasive procedures. We evaluated the effectiveness of our device by measuring the stiffness of phantoms as well as lung, heart, liver, and skin tissues obtained from both rats and swine. RESULTS Results demonstrated that our device can accurately determine tissue stiffness and identify tumor mimics. Specifically, in swine lung, we determined elastic modulus (E) values of 9.1 ± 2.3, 16.8 ± 1.8, and 26.0 ± 3.6 kPa under different internal pressure of the lungs (PIP) of 2, 25, and 45 cmH2O, respectively. Using our device, we successfully located a 2-cm tumor mimic embedded at a depth of 5 mm in the lung subpleural region. Additionally, we measured E values of 33.0 ± 5.4, 19.2 ± 2.2, 33.5 ± 8.2, and 22.6 ± 6.0 kPa for swine heart, liver, abdominal skin, and muscle, respectively, which closely matched existing literature data. CONCLUSION/SIGNIFICANCE Results suggest that our robotic palpation device can be utilized during surgery, either as a stand-alone or additional tool integrated into existing robotic surgical systems, to enhance treatment outcomes by enabling accurate intraoperative identification of abnormal tissue.
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Nasner D, Mejía-Quiñones V, Velásquez-Galvis M, Toro-Gutiérrez JS. CT-guided harpoon marking a ground-glass infiltrate: A case report. Radiol Case Rep 2023; 18:4479-4484. [PMID: 37868013 PMCID: PMC10585181 DOI: 10.1016/j.radcr.2023.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Physicians are facing a growing challenge in characterizing suspicious pulmonary lesions through biopsy. Video thoracoscopic surgery is crucial for conducting surgical biopsies of these nodules. However, accurately identifying small pulmonary nodules, tiny, subsolid, and deep ones, remains a significant challenge due to the absence of digital palpation. One proposed technique for localization involves using a harpoon, initially designed for mammary nodules but also applied to pulmonary nodules. In cases involving solitary pulmonary nodules, histologic characterization is often necessary also accurate descriptions through computed tomography and the patient's clinical and epidemiologic context allow for a presumptive diagnosis. In this case, during an abdominal CT scan, a 49-year-old female patient was serendipitously found to have a ground-glass infiltrate in the anteromedial segment of the lower lobe of her left lung. Despite presenting with normal lung auscultation on physical examination, the increasing prevalence of subsolid lung nodules, combined with the contemporary era of minimally invasive surgery, prompted the medical team to employ CT-guided harpoon marking for precise lesion localization. Subsequent pathology analysis confirmed the presence of lepidic pattern adenocarcinoma. This case underscores the efficacy of the CT-guided harpoon marking approach, which significantly enhances surgical precision. Such precision is paramount in formulating individualized treatment strategies and follow-up plans for patients with similar clinical presentations.
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Affiliation(s)
- Daniela Nasner
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | - Valentina Mejía-Quiñones
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
- Faculty of Health Sciences, School of Medicine, Universidad Icesi, Cali, Colombia
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Key BM, Callstrom MR, Filippiadis D. Musculoskeletal Interventional Oncology: A Contemporary Review. AJR Am J Roentgenol 2023; 221:503-516. [PMID: 37222277 DOI: 10.2214/ajr.23.29110] [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] [Indexed: 05/25/2023]
Abstract
Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Matthew R Callstrom
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Dimitrios Filippiadis
- Department of Diagnostic and Interventional Radiology, University General Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Al-Sharydah AM, BinShaiq FK, Aloraifi RI, Almefleh AA, Alessa SA, Alobud AS, AlSharidah AM, Bin Dahmash A, Al-Aftan MS, Al-Dhaferi BF. Procedural Software Toolkit in the Armamentarium of Interventional Therapies: A Review of Additive Usefulness and Current Evidence. Diagnostics (Basel) 2023; 13:diagnostics13040765. [PMID: 36832254 PMCID: PMC9955934 DOI: 10.3390/diagnostics13040765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Interventional radiology is a fast-paced specialty that uses many advanced and emerging technological solutions. Several procedural hardware and software products are available commercially. Image-guided procedural software helps save time and effort in interventionist practice and adds precision to the intraoperative decisions made by the end user. Interventional radiologists, including interventional oncologists, have access to a wide range of commercially available procedural software that can be integrated into their workflow. However, the resources and real-world evidence related to such software are limited. Thus, we performed a detailed review of the current resources available, such as software-related publications, vendors' multimedia materials (e.g., user guides), and each software's functions and features, to compile a resource for interventional therapies. We also reviewed previous studies that have verified the use of such software in angiographic suites. Procedural software products will continue to increase in number and usage; these will likely be advanced further with deep learning, artificial intelligence, and new add-ins. Therefore, classifying procedural product software can improve our understanding of these entities. This review significantly contributes to the existing literature because it highlights the lack of studies on procedural product software.
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Affiliation(s)
- Abdulaziz M. Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
- Correspondence:
| | - Faisal Khalid BinShaiq
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Rayan Ibrahim Aloraifi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Abdulrahman Abdulaziz Almefleh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Saud Abdulaziz Alessa
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Adi Saud Alobud
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Riyadh Province, Saudi Arabia
| | - Abdulmonem Mohammed AlSharidah
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
| | | | - Mohammad S. Al-Aftan
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
| | - Bander Fuhaid Al-Dhaferi
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, AlKhobar City 36277, Eastern Province, Saudi Arabia
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Milot L, L'Huillier R, Dumortier J, Gérard L, Valette PJ. Robotic-assisted percutaneous microwave ablation of hepatocellular carcinoma. Diagn Interv Imaging 2023; 104:258-260. [PMID: 36792426 DOI: 10.1016/j.diii.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Laurent Milot
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France; Interventional Radiology Oncology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Romain L'Huillier
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France; Interventional Radiology Oncology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Jérôme Dumortier
- Department of Hepatology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Laura Gérard
- Interventional Radiology Oncology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
| | - Pierre-Jean Valette
- Department of Diagnostic and Interventional Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, University of Lyon, 69003 Lyon, France
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Toman D, Sengul I, Kubala O, Jonszta T, Prokop J, Tulinský L, Ihnát P, Guňková P, Pelikán A, Sengul D. A novel labeling modality of intra-abdominal lesions with Magseed magnetic marker and extirpation by Sentimag probe navigation. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:159-163. [PMID: 36629655 PMCID: PMC9937617 DOI: 10.1590/1806-9282.20221129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aimed to evaluate our experience with the use of Magseed, the magnetic metallic marker, as a localization technique followed by Sentimag probe detection in patients with solitary intra-abdominal local metastases with subsequent resection of the lesions. METHODS Five patients underwent resection after the lesion was marked with the Magseed magnetic marker. Prior to the surgery, a computed tomography scan of the chest and abdomen and/or positron emission tomography was performed to rule out the dissemination of the disease. The indication for surgery was evaluated in a meeting of a multidisciplinary team, and the placement of the magnetic marker under computed tomography control had been performed the day before the planned procedure. RESULTS The present preliminary outcomes have revealed that Magseed might be a promising technique that is feasible and safe, particularly when the postsurgical anatomic conditions in the abdominal cavity are altered and the lesions are not visible or palpable. Surgical extirpation of lesions occurred without complications in each case. In all the cases, the resection was complete and curative, and one wound infection in all (20%), without any major complications, had occurred. The mean hospital stay was 6.6 days. CONCLUSION Magseed utilization, as a localization technique, followed by Sentimag probe detection in intra-abdominal tumors has not been reported before. Improving the visualization and, consequently, the precise marking of the lesion with subsequent radical removal can prevent insufficient or excessive removal of healthy tissue, leading to a faster diagnosis and better overall clinical outcomes.
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Affiliation(s)
- Daniel Toman
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Ilker Sengul
- Giresun University, Faculty of Medicine, Division of Endocrine Surgery – Giresun, Turkey.,Giresun University, Faculty of Medicine, Department of Surgery – Giresun, Turkey
| | - Otakar Kubala
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Tomáš Jonszta
- University Hospital Ostrava, Department of Imaging Methods – Ostrava, Czech Republic,University of Ostrava, Faculty of Medicine, Department of Imaging Methods – Ostrava, Czech Republic
| | - Jiří Prokop
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Lubomír Tulinský
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Peter Ihnát
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Petra Guňková
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic
| | - Anton Pelikán
- University Hospital Ostrava, Department of General Surgery – Ostrava, Czech Republic.,University of Ostrava, Faculty of Medicine, Department of Surgical Studies – Ostrava, Czech Republic.,Tomas Bata University in Zlin, Faculty of Humanities – Zlin, Czech Republic
| | - Demet Sengul
- Giresun University, Faculty of Medicine, Department of Pathology – Giresun, Turkey.,Corresponding author:
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Tasu JP, Tougeron D, Rols MP. Irreversible electroporation and electrochemotherapy in oncology: State of the art. Diagn Interv Imaging 2022; 103:499-509. [DOI: 10.1016/j.diii.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/10/2023]
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Gondim Teixeira PA, Lombard C, Moustache-Espinola P, Germain E, Gillet R, Hossu G, Jaquet Ribeiro G, Blum A. Initial Characterization of Focal Bone Lesions with Conventional Radiographs or Computed Tomography: Diagnostic Performance and Interobserver Agreement Assessment. Can Assoc Radiol J 2022; 74:404-414. [PMID: 36207066 DOI: 10.1177/08465371221131755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To ascertain the role of CT and conventional radiographs for the initial characterization of focal bone lesions.Methods: Images from 184 patients with confirmed bone tumors included in an ethics committee-approved study were retrospectively evaluated. The reference for benign-malignant distribution was based on histological analysis and long-term follow-up. Radiographs and CT features were analyzed by 2 independent musculoskeletal radiologists blinded to the final diagnosis. Lesion margins, periosteal reaction, cortical lysis, endosteal scalloping, presence of pathologic fracture, and lesion mineralization were evaluated. Results: The benign-malignant distribution in the study population was 68.5-31.5% (126 benign and 58 malignant). In the lesions that could be seen in both radiographs and CT, the performance of these methods for the benign-malignant differentiation was similar (accuracy varying from 72.8% to 76.5%). The interobserver agreement for the overall evaluation of lesion aggressiveness was considerably increased on CT compared to radiographs (Kappa of .63 vs .22). With conventional radiographs, 18 (9.7%) and 20 (10.8%) of the lesions evaluated were not seen respectively by readers 1 and 2. Among these unseen lesions, 50%-61.1% were located in the axial skeleton. Compared to radiographs, the number of lesions with cortical lysis and endosteal scalloping was 26-34% higher with CT. Conclusion: Although radiographs remain the primary imaging tool for lesions in the peripheral skeleton, CT should be performed for axial lesions. CT imaging can assess the extent of perilesional bone lysis more precisely than radiographs with a better evaluation of lesion fracture risk.
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Affiliation(s)
| | - Charles Lombard
- Guilloz imaging Department, Central Hospital, 26920University Hospital Center of Nancy, Nancy, France
| | | | - Edouard Germain
- Guilloz imaging Department, Central Hospital, 26920University Hospital Center of Nancy, Nancy, France
| | - Romain Gillet
- Guilloz imaging Department, Central Hospital, 26920University Hospital Center of Nancy, Nancy, France
| | - Gabriela Hossu
- Guilloz imaging Department, Central Hospital, 26920University Hospital Center of Nancy, Nancy, France
| | | | - Alain Blum
- Guilloz imaging Department, Central Hospital, 26920University Hospital Center of Nancy, Nancy, France
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Peng W, Wu W, Zhang J, Xie H, Zhang S, Gu L. An automatic framework for estimating the pose of the catheter distal section using a coarse-to-fine network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107036. [PMID: 35905696 DOI: 10.1016/j.cmpb.2022.107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE During percutaneous coronary intervention procedures, generally only 2D X-ray images are provided. The consequent lack of depth perception makes it difficult for interventionists to visually estimate the pose of medical tools inside the vasculature, especially for novices. Although some automatic methods have been developed to aid interventionists, it is still a challenging task to obtain stable and accurate pose estimation. In this paper, we describe a learning-based framework for estimating the pose of the catheter distal section (CDS). The main innovation of this framework is the proposal of a coarse-to-fine fusion network (CFF-Net) which can achieve the shape and orientation estimation for the CDS. METHODS By adopting a two-step fusion, CFF-Net progressively solves the shape and orientation ambiguities. The first step is the early fusion where the 2D projection image fuses with the shape prior before input, which makes the estimated result own a specific catheter distal shape. The second step is the late fusion where CFF-Net fuse feature maps and the orientation data from Electromagnetic (EM) sensors to confirm the overall orientation of the CDS. Finally, the estimated pose in the EM space will be obtained after we combine the estimated shape and orientation from CFF-Net with the position information from the EM sensor. RESULTS The effectiveness of CFF-Net has been verified in a simulated environment where RMSE of CFF-Net is 0.706 ± 0.121 mm. This approach was further transferred from simulation to reality using the real-world data, where RMSE of CFF-Net is 1.121 ± 0.124 mm and RMSE of the whole proposed framework is 1.577 ± 0.144 mm. CONCLUSION In simulated and real-world experiments, our proposed approach has been proven to achieve high accuracy while ensuring real-time processing for estimating the pose of the CDS.
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Affiliation(s)
- Wenjia Peng
- School of Biomedical Engineering and Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wu
- School of Biomedical Engineering and Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyang Zhang
- School of Biomedical Engineering and Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Hongzhi Xie
- Department of Cardiology, Peking Union Medical College Hospital, Peking, China.
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking, China
| | - Lixu Gu
- School of Biomedical Engineering and Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
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Zhang H, Li Y, Chen X, He Z. Comparison of hook-wire and medical glue for CT-guided preoperative localization of pulmonary nodules. Front Oncol 2022; 12:922573. [PMID: 36003778 PMCID: PMC9393881 DOI: 10.3389/fonc.2022.922573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/13/2022] [Indexed: 12/09/2022] Open
Abstract
BackgroundPreoperative localization is challenging due to the small diameter of pulmonary nodules or their deep location in the lung parenchyma during VATS surgery. The purpose of this study was to compare the efficacy and safety of both hook-wire and medical glue for pre-operative localization of pulmonary nodules.MethodsIn the current study, 158 patients were retrospectively analyzed (January 2019 and January 2020). The patients underwent hook-wire or medical glue for pre-operative localization of pulmonary nodules. Among them, 74 patients in the hook-wire group and 84 patients in the medical glue group underwent VATS anatomic segmentectomy or wedge resection after localization of pulmonary nodules. Pre-operative localization data from all patients were compiled. Moreover, the efficacy and safety of the two methods were evaluated according to localization success rates and localization-related complications.ResultsThe success rate of localization in the medical glue group was 100% while 97.3% in the hook-wire group. After localization of the pulmonary nodules, the incidence of minor pneumothorax in the medical glue group (11.9%) was lower than that in the hook-wire group (37.8%) (p=0.01). The incidence of mild pulmonary parenchymal hemorrhage in the medical glue group (13.1%) was also lower than that in the hook-wire group (24.3%) (p=0.000). The mean time from the completion of localization to the start of surgery was also longer in the medical glue group than in the hook-wire group (p=0.000). The mean visual analog scale (VAS) scores after localization were higher in the hook-wire group than in the medical glue group (p=0.02). In both groups, parenchymal hemorrhage was significantly associated with the needle length in hook-wire localization and the depth of the medical glue in the lung parenchyma (p = 0.009 and 0.001, respectively).ConclusionThese two localization methods are safe and effective in pre-operative pulmonary nodule localization. The medical glue localization method had a lower risk of complications, a higher localization success rate, less pain after localization and more flexibility in the arrangement of operation time.
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Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| | - Ying Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Yangpu, Shanghai, China
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| | - Zelai He
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
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Kobe A, Tselikas L, Deschamps F, Roux C, Delpla A, Varin E, Hakime A, De Baère T. Single-session transarterial chemoembolization combined with percutaneous thermal ablation in liver metastases 3 cm or larger. Diagn Interv Imaging 2022; 103:516-523. [PMID: 35715327 DOI: 10.1016/j.diii.2022.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of transarterial chemoembolization (TACE) combined with percutaneous thermal ablation in patients with liver metastases 3 cm in diameter or larger. MATERIALS AND METHODS This retrospective study included 39 patients with a total of 46 liver metastases treated. There were 14 men and 25 women, with a mean age of 55 ± 13.3 (SD) (age range: 28-77 years). All patients were treated with a combination of TACE and thermal ablation in a single session. Primary outcome was local tumor progression. Secondary outcomes were procedure related complications and systemic disease progression. RESULTS Mean tumor size was 3.6 ± 0.6 (SD) cm (range: 3-5 cm). Conventional TACE was performed in 32 liver metastases (32/46; 70%) and drug-eluting beads-TACE in 14 liver metastases (14/46; 30%) followed by radiofrequency ablation in 34 (34/46; 74%), microwave ablation in 11 (11/46; 24%) and cryoablation in one (1/46; 2%) metastasis. Four grade 2 (4/39; 10%) complications were observed. After a mean follow up of 31.9 ± 26.1 (SD) months (range: 2-113 months) overall local tumor progression rate was 15% (7/46). Local tumor progression rate at 12 months was 13% (6/46). Overall systemic disease progression was seen in 29 patients (29/39; 74%) with a systemic disease progression rate at 12 months of 59% (23/39). CONCLUSION Treatment of large liver metastases with TACE and thermal ablation in a single session is safe and achieves high local control rate.
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Affiliation(s)
- Adrian Kobe
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France.
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France
| | - Frédéric Deschamps
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France
| | - Charles Roux
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France
| | - Alexandre Delpla
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France
| | - Eloi Varin
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France
| | - Antoine Hakime
- Centre Imagerie Medicale Bachaumont Paris Centre, 75002 Paris, France
| | - Thierry De Baère
- Department of Interventional Radiology, Gustave Roussy-Cancer Center, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France
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Granata V, Fusco R, De Muzio F, Cutolo C, Setola SV, Simonetti I, Dell’Aversana F, Grassi F, Bruno F, Belli A, Patrone R, Pilone V, Petrillo A, Izzo F. Complications Risk Assessment and Imaging Findings of Thermal Ablation Treatment in Liver Cancers: What the Radiologist Should Expect. J Clin Med 2022; 11:jcm11102766. [PMID: 35628893 PMCID: PMC9147303 DOI: 10.3390/jcm11102766] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
One of the major fields of application of ablation treatment is liver tumors. With respect to HCC, ablation treatments are considered as upfront treatments in patients with early-stage disease, while in colorectal liver metastases (CLM), they can be employed as an upfront treatment or in association with surgical resection. The main prognostic feature of ablation is the tumor size, since the goal of the treatment is the necrosis of all viable tumor tissue with an adequate tumor-free margin. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most employed ablation techniques. Ablation therapies in HCC and liver metastases have presented a challenge to radiologists, who need to assess response to determine complication-related treatment. Complications, defined as any unexpected variation from a procedural course, and adverse events, defined as any actual or potential injury related to the treatment, could occur either during the procedure or afterwards. To date, RFA and MWA have shown no statistically significant differences in mortality rates or major or minor complications. To reduce the rate of major complications, patient selection and risk assessment are essential. To determine the right cost-benefit ratio for the ablation method to be used, it is necessary to identify patients at high risk of infections, coagulation disorders and previous abdominal surgery interventions. Based on risk assessment, during the procedure as part of surveillance, the radiologists should pay attention to several complications, such as vascular, biliary, mechanical and infectious. Multiphase CT is an imaging tool chosen in emergency settings. The radiologist should report technical success, treatment efficacy, and complications. The complications should be assessed according to well-defined classification systems, and these complications should be categorized consistently according to severity and time of occurrence.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
- Correspondence:
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy;
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy;
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.C.); (V.P.)
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
| | - Federica Dell’Aversana
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.); (F.G.)
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy; (F.D.); (F.G.)
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy;
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Belli
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (A.B.); (R.P.); (F.I.)
| | - Renato Patrone
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (A.B.); (R.P.); (F.I.)
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.C.); (V.P.)
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (S.V.S.); (I.S.); (A.P.)
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (A.B.); (R.P.); (F.I.)
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Minier C, Hermida M, Allimant C, Escal L, Pierredon-Foulongne MA, Belgour A, Piron L, Taourel P, Cassinotto C, Guiu B. Software-based assessment of tumor margins after percutaneous thermal ablation of liver tumors: A systematic review. Diagn Interv Imaging 2022; 103:240-250. [PMID: 35246412 DOI: 10.1016/j.diii.2022.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to make a systematic review of clinical studies evaluating software-based tumor margin assessment after percutaneous thermoablation (PTA) of liver tumors. MATERIALS AND METHODS A systematic literature search was performed through Pubmed/MEDLINE, Embase and the Cochrane Library. Original studies published in English that reported on software-based assessment of ablation margins (AM) following PTA of liver tumors were selected. Studies were analyzed with respect to design, number of patients and tumors, tumor type, PTA technique, tumor size, target registration error, study outcome(s) (subtypes: feasibility, comparative, clinical impact, predictive or survival), and follow-up period. RESULTS Twenty-nine articles (one multi-center and two prospective studies) were included. The majority were feasibility (26/29, 89.7%) or predictive (23/29, 79.3%) studies. AM was a risk factor of local tumor progression (LTP) in 25 studies (25/29, 86.2%). In nine studies (9/29, 31%) visual assessment overestimated AM compared with software-aided assessment. LTP occurred at the location of the thinnest margin in nine studies (9/29, 31%). Time for registration and analysis was heterogeneously reported, ranging between 5-30 min. Mean target registration error was reported in seven studies (7/29, 24.1%) at 1.62 mm (range: 1.20-2.23 mm). Inter-operator reproducibility was high (kappa range: 0.686-1). Ascites, liver deformation and inconspicuous tumor were major factors of co-registration error. CONCLUSION Available studies present a low level of evidence overall, since most of them are feasibility, retrospective and single-center studies.
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Affiliation(s)
- Chloé Minier
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Margaux Hermida
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Carole Allimant
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Laure Escal
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | | | - Ali Belgour
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Patrice Taourel
- Department of Radiology, Lapeyronie University Hospital, 34090, Montpellier, France
| | | | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France.
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