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To determine the pathologic response of computed tomography-guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant, and its subsequent effect on survival. A single-center retrospective analysis was conducted on 62 patients (M:F = 50:12) with mean age of 59.6 years ± 7.2 months (SD). Sixty-four total MWA procedures were performed for hepatocellular carcinomas within Milan criteria as bridging therapy to subsequent orthotopic liver transplant between August 2014 and September 2018. The pathology reports of the explanted livers were reviewed to assess for residual disease. Residual disease was categorized as complete or incomplete necrosis. Patient demographics, tumor/procedural characteristics, and laboratory values were evaluated. Survival from time of ablation and time of transplantation were recorded and compared between cohorts using log rank tests. The mean tumor size was 2.4 cm ± 0.7 cm (SD), (range = 1–4.6 cm). 32 (50%) cases required hydrodissection. Histopathologic necrosis was seen in 66% of cases at time of liver transplantation. Median time to liver transplant post-MWA was 12.6 months. [IQR = 8.6–14.8 months]. The median survival from ablation was 60.8 months [IQR = 45.5–73.7 months], and the median survival from transplant was 49.3 months [IQR = 33.7–60.1 months]. There was no significant difference in survival for patients with complete versus incomplete necrosis from ablation or liver transplant (p = 0.49, p = 0.46, respectively). Computed tomography-guided percutaneous microwave ablation is an effective bridge to orthotopic liver transplantation for patients with hepatocellular carcinoma. Level 3, non-randomized controlled cohort study/follow-up study.

Thermal ablation of central renal cell carcinoma has been associated with increased risk of incomplete tumor necrosis and adverse events due to the proximity of tumors to the central collecting system and hilar vessels. The purpose of this study was to compare the safety and efficacy of computed tomography-guided percutaneous microwave ablation of central versus peripheral renal cell carcinoma. An institutional database was used to retrospectively identify 114 patients with renal cell carcinoma who were treated with computed tomography-guided percutaneous microwave ablation between January 2015 and December 2019. Patients were divided into two cohorts based on tumor location: central versus peripheral. Central renal tumors were defined as being within 4 mm of renal pelvis and/or ureter and peripheral tumors were defined as tumors beyond 4 mm the renal pelvis and/or ureter. Patient demographics, tumor type, technical success, primary technique efficacy and adverse events were recorded from the medical record. Technical success, primary technique efficacy and adverse events were compared between the two cohorts. There were 44 patients in the central group and 70 patients in the peripheral group. Technical success was 100% for both groups. There was no significant difference in primary technique efficacy rates for peripheral compared to central tumors (93% vs. 89%, p = 0.49). There was no significant difference in overall adverse event rate (17.7% vs. 11.7%, p = 0.34) or Grade II or higher adverse event rate (7.8% vs. 2.6%, p = 0.17) following microwave ablation of central versus peripheral lesions. Adjunctive maneuvers of hydrodissection and/or pyeloperfusion were performed significantly more frequently for treatment for central tumors compared to peripheral tumors (53% vs. 29%, p = 0.006). When adjunctive procedures were utilized more frequently for central compared to peripheral tumors, there was no significant difference in primary technique efficacy or adverse event rate following CT-guided percutaneous microwave ablation of central compared to peripheral renal cell carcinoma. The data suggest that MWA can be successfully applied to select central renal masses and adjunctive maneuvers such as pyeloperfusion should be strongly considered for patient safety. Non-randomized controlled cohort study/follow-up study.

To assess the performance of pre-ablation computed tomography texture features of adrenal metastases to predict post-treatment local progression and survival in patients who underwent ablation using machine learning as a prediction tool. This is a pilot retrospective study of patients with adrenal metastases undergoing ablation. Clinical variables were collected. Thirty-two texture features were extracted from manually segmented adrenal tumors. A univariate cox proportional hazard model was used for prediction of local progression and survival. A linear support vector machine (SVM) learning technique was applied to the texture features and clinical variables, with leave-one-out cross-validation. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess performance between using clinical variables only versus clinical variables and texture features. Twenty-one patients (61% male, age 64.1 ± 10.3 years) were included. Mean time to local progression was 29.8 months. Five texture features exhibited association with progression (p

To determine the pathologic response of computed tomography-guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant, and its subsequent effect on survival.A single-center retrospective analysis was conducted on 62 patients (M:F = 50:12) with mean age of 59.6 years ± 7.2 months (SD). Sixty-four total MWA procedures were performed for hepatocellular carcinomas within Milan criteria as bridging therapy to subsequent orthotopic liver transplant between August 2014 and September 2018. The pathology reports of the explanted livers were reviewed to assess for residual disease. Residual disease was categorized as complete or incomplete necrosis. Patient demographics, tumor/procedural characteristics, and laboratory values were evaluated. Survival from time of ablation and time of transplantation were recorded and compared between cohorts using log rank tests.The mean tumor size was 2.4 cm ± 0.7 cm (SD), (range = 1-4.6 cm). 32 (50%) cases required hydrodissection. Histopathologic necrosis was seen in 66% of cases at time of liver transplantation. Median time to liver transplant post-MWA was 12.6 months. [IQR = 8.6-14.8 months]. The median survival from ablation was 60.8 months [IQR = 45.5-73.7 months], and the median survival from transplant was 49.3 months [IQR = 33.7-60.1 months]. There was no significant difference in survival for patients with complete versus incomplete necrosis from ablation or liver transplant (p = 0.49, p = 0.46, respectively).Computed tomography-guided percutaneous microwave ablation is an effective bridge to orthotopic liver transplantation for patients with hepatocellular carcinoma.Level 3, non-randomized controlled cohort study/follow-up study.

Thermal ablation of central renal cell carcinoma has been associated with increased risk of incomplete tumor necrosis and adverse events due to the proximity of tumors to the central collecting system and hilar vessels. The purpose of this study was to compare the safety and efficacy of computed tomography-guided percutaneous microwave ablation of central versus peripheral renal cell carcinoma.An institutional database was used to retrospectively identify 114 patients with renal cell carcinoma who were treated with computed tomography-guided percutaneous microwave ablation between January 2015 and December 2019. Patients were divided into two cohorts based on tumor location: central versus peripheral. Central renal tumors were defined as being within 4 mm of renal pelvis and/or ureter and peripheral tumors were defined as tumors beyond 4 mm the renal pelvis and/or ureter. Patient demographics, tumor type, technical success, primary technique efficacy and adverse events were recorded from the medical record. Technical success, primary technique efficacy and adverse events were compared between the two cohorts.There were 44 patients in the central group and 70 patients in the peripheral group. Technical success was 100% for both groups. There was no significant difference in primary technique efficacy rates for peripheral compared to central tumors (93% vs. 89%, p = 0.49). There was no significant difference in overall adverse event rate (17.7% vs. 11.7%, p = 0.34) or Grade II or higher adverse event rate (7.8% vs. 2.6%, p = 0.17) following microwave ablation of central versus peripheral lesions. Adjunctive maneuvers of hydrodissection and/or pyeloperfusion were performed significantly more frequently for treatment for central tumors compared to peripheral tumors (53% vs. 29%, p = 0.006).When adjunctive procedures were utilized more frequently for central compared to peripheral tumors, there was no significant difference in primary technique efficacy or adverse event rate following CT-guided percutaneous microwave ablation of central compared to peripheral renal cell carcinoma. The data suggest that MWA can be successfully applied to select central renal masses and adjunctive maneuvers such as pyeloperfusion should be strongly considered for patient safety.Non-randomized controlled cohort study/follow-up study.

To assess the feasibility, safety and clinical outcomes of image-guided percutaneous thermal ablation as salvage therapy for local recurrence of renal cell carcinoma (RCC) in patients initially treated surgically with curative intent. A retrospective review of 11 consecutive patients (M/F = 8:3, mean age = 76 years) who underwent computed tomography (CT)-guided thermal ablation for locally recurrent RCC after partial (72%, 8/11) or radical nephrectomy (28%, 3/11) with a mean time to recurrence of 48 months (range 2–156). Assessment of technical success, complication (peri- and post-procedural), oncological outcome and survival analysis were performed. Patient baseline and follow-up renal function surrogates including creatinine level (Cr) and estimated glomerular filtration rate (eGFR) were statistically compared. Eleven biopsy-proven recurrent RCC measuring 1.4–3.9 cm (mean = 2.8 cm) were treated with CT-guided thermal ablation. Technical success was achieved in 100% (11/11) of the cases. There were no major complications except for one (9%) asymptomatic hemorrhage (Clavien–Dindo grade I complication). Complete response, local progression-free and overall survival rate were 91, 91 and 82% during the mean follow-up time of 2.5 years (range 0.1–7.1). Renal function was overall stable without significant change at 1 month and last follow-up (p = 0.21; GFR, p = 0.10; creatinine). Image-guided percutaneous thermal ablation is a feasible, safe and effective for local recurrence after nephrectomy, representing a non-surgical alternative for unresectable disease.

To determine the radiation dose associated with CT-guided percutaneous liver ablations and identify potential risk factors that result in higher radiation doses. Between June 2011 and June 2015, 245 consecutive patients underwent 304 CT-guided liver ablation treatments. Patient demographics, tumor characteristics and procedural parameters were identified and analyzed. The peak skin dose and effective dose were assessed for each procedure. Excess relative risk related to radiation effects was calculated. A logistic regression model was prepared by means of stepwise logistic regression to identify variables predictive of increased radiation exposure. Tumor ablations were performed with microwave (n = 220), radiofrequency (n = 74) or irreversible electroporation (IRE) (n = 10). The mean peak skin dose for ablations was 239.2 ± 136.4 mGy, and the mean effective dose was 36.6 ± 22.3 mSv. Of the patient and procedural parameters that were analyzed, increasing weight, use of intravenous contrast and/or hydrodissection during the procedure, together with treatment of multiple lesions in the same sitting were all associated with higher radiation exposure. The mean increase in the absolute risk of fatal malignancy from a single procedure was 0.18% (range 0.02–0.9%). No deterministic skin changes were identified in the patient cohort. The overall risk of stochastic and deterministic effects from radiation associated with CT-guided ablations is low compared with other inherent procedural complications. This study identifies several factors that are associated with higher radiation dose in percutaneous liver ablation procedures.

We report our experience with percutaneous image-guided radiofrequency (RF) ablation to treat isolated nodal metastases. Four patients underwent image-guided percutaneous RF ablation of metastatic disease involving retrocrural nodes, retroperitoneal nodes, or pelvic nodes. Coagulation necrosis was achieved in all cases.

Reconstruction of isolated biliary segments can be achieved using a combination of radiologic and endoscopic interventions.