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Rationale and Objectives To evaluate the efficacy of microwave ablation (MWA) for benign thyroid nodules (BTNs) and compare trauma and complication rates between MWA and traditional thyroidectomy for BTNs. Materials and Methods 84 patients with BTNs were recruited and followed up at 1, 3, 6, and 12months. 56 and 28 patients chose to undergo MWA (group A) and traditional thyroidectomy (group B), respectively. Efficacy was assessed by volume reduction rate (VRR) and therapeutic success rate (TSR) at each follow-up. Trauma was compared using inflammation response parameters, visual analog scale (VAS) scores, quality of life (QOL) and thyroid function measures at 1, 3, and 6 months. Complications rates were also compared. Results The VRR was 80.70 ± 18.60%, and TSR was 91.70% at 6-months. Furthermore, the VRR increased to 90.45 ± 11.51%, and TSR increased to 100% at 12-months. C-reactive protein levels were significantly higher in group B on the first postoperative day (POD) (3.89 ± 0.86 mg/mL vs 3.39 ± 0.56 mg/mL, p = 0.002). Visual analog scale scores were significantly lower in group A on the first and second POD. Thyroid stimulating hormone levels were significantly lower in group A at three (1.71 ± 1.12uIU/mL vs 2.37 ± 1.24uIU/mL, p = 0.013) and 6-months (1.34 ± 0.70uIU/mL vs 1.97 ± 0.94uIU/mL, p = 0.002). There were no significant between-group differences in QOL and complication rates. Conclusion Microwave ablation shows acceptable and promising efficacy. Compared with thyroidectomy, MWA was associated with less trauma and comparable complication rates.

An increasing number of patients are being diagnosed with multiple ground glass opacities (GGOs), but a consensus on the treatment of these patients is still lacking. The aim of this study was to investigate the safety and feasibility of a novel technique, electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery in patients with multiple GGOs.The clinical, radiographic, surgical, and pathologic data of patients with multiple GGOs who underwent ENB-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery from October 2018 to December 2019 were reviewed.Eleven patients with multiple GGOs underwent ENB-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery; they included 6 men and 5 women with a mean age of 61.3 ± 5.1 years (range, 53 to 68). Thirty-seven lesions were observed in the 11 patients, 21 of which were microwave ablated and 16 of which were surgically resected. Only 1 patient had postoperative pneumothorax and subcutaneous emphysema and was successfully discharged from the hospital after symptomatic treatment. The success rate and the efficiency of microwave ablation under ENB guidance were both 100%, with no other serious complications or procedure-related deaths occurring. No local metastasis or recurrence occurred in any patients during the follow-up period.Electromagnetic navigation bronchoscopy-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery is safe and feasible in patients with multiple GGOs suspected of having multiple primary lung cancers, and may represent an alternative approach for more patients, particularly patients who cannot tolerate the simultaneous resection of multiple tumors.

Background: This study investigated the efficacy and complications of microwave ablation in combination with chemotherapy in treating peripheral IIIB-IV nonsmall cell lung cancer (NSCLC). Materials...

Background Both microwave ablation and robot-assisted hepatectomy are representative minimally invasive treatments for early hepatocellular carcinoma. Our study compares the practicability and medium-term therapeutic efficacy between them. Methods Patients with early HCC treated by MWA or RH from 2013 to 2019 were included. Propensity score matching (PSM) and inverse probability of treatment weight (IPTW) were used to minimize baseline imbalance. Operation trauma, postoperative recovery, complications, cost and oncological efficacy were compared. Results 401 patients with a median follow-up of 28 months were included (MWA n = 240; RH n = 161). After PSM, 3-year recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) of MWA group and RH group were 52.2% vs 65.8%, 91.5% vs 91.3% and 91.5% vs 91.3%, respectively. OS and CSS were comparable (p = 0.44 and 0.96), while RFS of MWA was slightly lower but not significant (p = 0.097). The above results after IPTW followed the same trend. After PSM, MWA showed advantages in operation time and blood loss, while RH performed better in postoperative liver function. There was no significant difference in incidence of severe complications between two groups. Conclusions For early HCC parents, both treatments can achieve good, safe and comparable medium-term therapeutic effects. MWA is more minimally invasive, while RH has better accuracy and causes less damage to liver parenchyma.

Background: The prognostic nutritional index (PNI) is used to assess immune and nutritional status, and is a prognostic factor for several malignant tumors. However, little evidence exists regarding the predictive impact of prognostic nutritional index (PNI) after local ablation therapy for hepatocellular carcinoma (HCC). The aim of this study was to evaluate the value of PNI to predict recurrence and survival after operative microwave ablation in patients with early-stage HCC. Methods: This retrospective study included 341 patients who underwent operative microwave ablation for HCC in Barcelona Clinic Liver Cancer (BCLC) stage 0-A at our institute between 2007 and 2015. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis in multivariate Cox regression analyses. Results: The OS rates at 1, 3, 5, and 10 years after microwave ablation were 100%, 92.7%, 85.1%, and 57.5% in patients with high-PNI levels, and 96.5%, 78.2%, 59.7%, and 20.7% in patients with low-PNI levels, respectively (P

We present single-and dual-frequency antennas based on the shorted helical slot in hepatic microwave ablation. The single-frequency antenna is designed by lathing a helical slot on shorted traditional semi-rigid coaxial cable, which is expected to be operated at the frequency of 2450 MHz, and the dual-frequency antenna is designed with the combination of an annular slot and a helical slot, which can be operated at 915 and 2450 MHz. We use full-wave electromagnetic simulation and transient thermal simulation to analyze the performance of proposed ablation antennas. Both proposed antennas are fabricated, and used in ex vivo ablation experiments at different frequencies with a power level of 23 W for 2 or 5 minutes. We observe that proposed single-frequency antenna with helical slot has more concentrated specific absorption rate (SAR) pattern than those antennas with conventional slots does at 2450 MHz, and the dual-frequency one has the capability to control the roundness of ablation zone from 0.34 to 0.63, under the different combination of frequencies and operation times. Proposed microwave ablation antennas are expected to lead to a potential solution of curing the liver cancers with various characteristic.

Hyperthyroidism is a common disease mainly manifested by hyperexcitability of multiple systems and hypermetabolism. Currently, antithyroid drugs (ATDs), radioiodine therapy (RIT), and surgery are mainly used in the clinical treatment for primary hyperthyroidism. We reported a case of a 28-year-old female who received a novel treatment for primary hyperthyroidism. This patient had poor control of thyroid function while taking ATD, and her oral Methimazole (MMI) dose varied repeatedly between 20 mg qd and 15 mg qd, failing to maintain a stable status. To minimize the possible complication and to achieve drug reduction or withdrawal, she refused RIT and surgery and showed up in our department. The patient, diagnosed with Graves’ disease (GD) and met the surgical indication after systematic clinical evaluation, was subject to ultrasound-guided percutaneous microwave ablation (MWA) of the partial thyroid gland with continuous oral administration of 20 mg qd MMI. The post-ablation condition was stable and the patient was discharged 2 days after the operation. Thyroid ultrasound and serum thyroid function test were examined regularly after ablation and the MMI dosage was gradually reduced according to the results of the biochemical examination. Five weeks after the operation, the patient completely discontinued the medication. Ultrasound-guided percutaneous microwave ablation is minimally invasive, safe, and effective, and has potential to be an alternative treatment besides the 3 classical treatments of hyperthyroidism.

Background Computed tomography (CT)‐guided percutaneous microwave ablation (MWA) is a very common ablation method that shows a good local tumor control rate in primary and secondary lung tumors. At present, few reports have explored the safety and efficacy of MWA for lung metastases from breast cancer. Methods From January 2012 to January 2018, 32 breast cancer patients with 46 pulmonary metastases received CT‐guided percutaneous MWA. The study was approved by the local institutional review board. The clinical efficacy and complications of MWA were investigated. Results The median follow‐up time was 32 months and the main effective rate was 97.8% (45/46). Five of 46 lesions had local progression (10.9%), with a median progression time of 10 months. The 1‐, 3‐, and 5‐year overall survival (OS) rates were 96.9%, 53.3%, and 17.8%, respectively. The median OS time was 36 months. Among 46 MWA treatments, 11 (23.9%) had massive pneumothorax, two (4.3%) had massive pleural effusion, and two (4.3%) had a pulmonary infection. Conclusion CT‐guided percutaneous MWA may be safe and effective for treating lung metastases from breast cancer., Most patients with lung metastases from breast cancer, especially those with multiple metastases, are ineligible for operation. Thirty‐two patients who underwent microwave ablation (MWA) for lung metastases from breast cancer over a 6‐year period were examined. Computed tomography‐guided percutaneous MWA may be safe and effective for treating lung metastases from breast cancer.

The goal of this study was to optimize a lung-tuned monopole antenna to deliver microwave energy at 2.45 GHz into a novel ventilator-controlled ex vivo lung model. An analytic\approach was utilized to create an optimized monopole antenna that was impedance-matched to aerated lung tissue. This lung-tuned antenna was then fabricated using a copper 0.085” semi-rigid copper coaxial cable. For validation, the lung-tuned antenna was inserted centrally into lobes of a ex vivo porcine lung that was fully inflated to physiologically appropriate volumes. Microwave ablations were then created at 50 and 100 W for 1 minute and 5 minutes. Reflected power, cross sectional ablation sizes and spherical shape of the lung-tuned antenna were compared against a liver-tuned antenna in the ventilator-controlled ex vivo lung tissue. The study showed that the lung-tuned antennas delivered energy significantly more efficiently, with less reflected power, compared to the conventionally-used liver-tuned antennas at 50 W at 1 minute (11.8 ${\pm }$ 3.0 vs 16.3 ${\pm }$ 3.1 W; p value = 0.03) and 5 minutes (16.2 ${\pm }$ 2.8 vs 19.4 ${\pm }$ 2.9 W; p value = 0.04), although this was only true using 100 W at the 1 min time point (29.0 ${\pm }$ 3.5 vs 38.0 ${\pm }$ 5.3 W; p value = 0.02). While overall ablation zone sizes were comparable between the two types of antenna, the lung-tuned antenna did create a significantly more spherical ablation zone compared to the liver-tuned antenna at the 1 minute, 50 W setting (aspect ratio: 0.43 ${\pm }$ 0.07 vs 0.38 ${\pm }$ 0.04; p value = 0.04). In both antenna groups, there was a significant rise in the ablation zone aspect ratio between 1 and 5 minutes, indicating that higher power and time settings can increase the spherical shape of ablation zones when using tuned antennas. Adapting this combined analytic and parametric approach to antenna design can be implemented in adaptive tissue-tuning for real-time microwave ablation optimization in lung tissue.

BACKGROUND: Thermal ablation is an effective treatment for patients with metastatic colon and rectal cancer and allows surgeons to offer curative intent therapy to patients who are otherwise not candidates for resection. We aimed to report outcomes of a single institution experience using microwave ablation (MWA) with or without resection to treat five or more liver metastases. METHODS: In this retrospective cohort study, the University of Minnesota Division of Surgical Oncology liver surgery database was queried to identify all patients who underwent thermal ablation of five or more colorectal liver metastases (CRLM) between 2012–2018. We reviewed patient, disease, and tumor characteristics and measured local, intrahepatic, and extrahepatic recurrence (EHR) rates. We also calculated median overall survival (OS) and disease-free survival (DFS). RESULTS: Ten patients identified had five or more (range, 5–18) tumors ablated with or without combined liver and bowel resection. Median age was 50, and most patients were male (70%) and Caucasian (90%). Four patients received ablation alone (5–12 lesions), while six had combined resection and ablation (5–18 lesions). Ablation was performed laparoscopically in six patients, and four had ablations without resection. All patients received pre- and post-operative chemotherapy. A median of 7 tumors were ablated per patient. Median follow-up was 2.3 years. Among 75 tumors ablated, ablation site recurrence (ASR) (within 1 cm of ablation site) was seen in three with a per-lesion recurrence rate of 4%. Intrahepatic recurrence (IHR) occurred in 6 (60%) patients and EHR in 1 (10%). Five patients underwent retreatment of IHR during follow-up. Median OS was 3 years and DFS was 7.1 months. At the time of last follow up, 6 patients were disease-free. CONCLUSIONS: Thermal ablation can provide acceptable DFS and OS, even with high volume metastatic colorectal cancers. Future efforts should be focused on defining selection criteria for those most likely to benefit from this aggressive approach.

Women with early-stage breast cancer have an excellent prognosis with current therapy, but could presumably be treated less invasively, without the need for surgery. The primary goal of this meta-analysis was to examine whether thermal ablation is an effective method to treat early-stage breast cancer. Studies reporting on complete ablation rate after thermal ablation as a treatment of small breast cancers (≤ 2 cm) were included. Methodologic quality of included studies was assessed using MINORS criteria. Complete ablation rates are given as proportions, and meta-regression and subgroup analyses were performed. The overall complete ablation rate in 1266 patients was 86% and was highest after radiofrequency ablation (RFA) (92%). Local recurrence rates varied from 0% to 3%, with a median follow-up of 15 to 61 months. Overall, complication rates were low (5%-18% across techniques) and were highest after high-intensity focused ultrasound ablation and lowest after cryoablation. Cosmetic outcome was good to excellent in at least 85% of patients but was reported infrequently and long-term results of cosmetic outcome after thermal ablation and radiotherapy are still lacking. Thermal ablation techniques treating early-stage breast cancer (≤ 2 cm) are safe and effective based on complete ablation rate and short-term local recurrence rates. Especially, RFA, microwave ablation, and cryoablation are promising techniques as an alternative to surgical resection without jeopardizing current treatment effectiveness or safety. Owing to great heterogeneity in the included studies, a formal recommendation on the best technique is not possible. These findings warrant the design of large randomized controlled trials comparing thermal ablation and breast-conserving surgery in the treatment of T1 breast cancer.

To evaluate the efficacy and safety of radiofrequency ablation (RFA) for the treatment of primary hyperparathyroidism (pHPT).Our study enrolled 25 patients who were treated with RFA for pHPT from September 2015 to January 2020. The serum intact parathyroid hormone (iPTH), calcium, and phosphate levels were tested within 1 week before RFA and at 1 day, 1 month, 3 months, 6 months, and 12 months after ablation. The ablation areas were evaluated using ultrasound at 1, 3, 6, and 12 months after RFA. Postoperative complications, including voice hoarseness, hematoma, postoperative pain, incision infections, hypoparathyroidism, and hypocalcemia, were recorded.A total of 25 patients with pHPT (mean age, 53.9 ± 10.9 years; 22 women and 3 men) with 29 enlarged parathyroid glands were treated with RFA. Of the 25 patients, 22 were treated in 1 session and 3 were treated in 2 sessions. Serum iPTH and calcium levels decreased significantly on day 1 after RFA (all P.05). A total of 21 patients had normal levels of serum iPTH and calcium after RFA, with a cure rate of 84%. At the 12-month follow-up, 26 treated parathyroid glands exhibited a volume reduction rate of70%. There were only a few minor complications, including 4 cases of postoperative pain (in 4 of the 25 patients [16%]) and 1 case of mild postoperative transient hypocalcemia (in 1 of the 25 patients [4%]).Ultrasound-guided RFA is an effective and safe technique for the treatment of carefully selected patients with pHPT. However, larger sample size and longer follow-up are still needed to further confirm its clinical value.

Objective To determine the early treatment response after microwave ablation (MWA) of inoperable lung neoplasms using the apparent diffusion coefficient (ADC) value calculated 24 h after the ablation. Materials and methods This retrospective study included 47 patients with 68 lung lesions, who underwent percutaneous MWA from January 2008 to December 2017. Evaluation of the lesions was done using MRI including DWI sequence with ADC value calculation pre-ablation and 24 h post-ablation. DWI-MR was performed with b values (50, 400, 800 mm2/s). The post-ablation follow-up was performed using chest CT and/or MRI within 24 h following the procedure; after 3, 6, 9, and 12 months; and every 6 months onwards to determine the local tumor response. The post-ablation ADC value changes were compared to the end response of the lesions. Results Forty-seven patients (mean age: 63.8 ± 14.2 years, 25 women) with 68 lesions having a mean tumor size of 1.5 ± 0.9 cm (range: 0.7–5 cm) were evaluated. Sixty-one lesions (89.7%) showed a complete treatment response, and the remaining 7 lesions (10.3%) showed a local progression (residual activity). There was a statistically significant difference regarding the ADC value measured 24 h after the ablation between the responding (1.7 ± 0.3 × 10−3 mm2/s) and non-responding groups (1.4 ± 0.3 × 10−3 mm2/s) with significantly higher values in the responding group (p = 0.001). A suggested ADC cut-off value of 1.42 could be used as a reference point for the post-ablation response prediction (sensitivity: 66.67%, specificity: 84.21%, PPV: 66.7%, and NPV: 84.2%). No significant difference was reported regarding the ADC value performed before the ablation as a factor for the prognosis of treatment response (p = 0.86). Conclusion ADC value assessment following ablation may allow the early prediction of treatment efficacy after MWA of inoperable lung neoplasms. Key Points • ADC value calculated 24 h post-treatment may allow the early prediction of MWA efficacy as a treatment of pulmonary tumors and can be used in the early immediate post-ablation imaging follow-up. • The pre-treatment ADC value of lung neoplasms is not different between the responding and non-responding tumors.

Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations.We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL.40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6-16.9 %] vs. 3.4 % [2/59; 0.4-11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %-30.5 %] vs. 16.9 % [10/59; 8.4-29.0 %]), or median ihPFS (15.5 months vs. 14.3 months).Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement.· Liver tumors can be successfully ablated even if they are not detectable on the navigational CT scan.. · Anatomical landmarks should be used and compared to preinterventional imaging..· Barzakova E, Senthilvel N, Bruners P et al. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome . Fortschr Röntgenstr 2022; 194: 515 - 520.ZIEL: Intrahepatische maligne Läsionen, geplant für CT-gesteuerte perkutane Ablation, können MR-tomographisch oder CT-graphisch in einer bestimmten Kontrastmittelphase abgrenzbar sein, jedoch okkult in der nativen CT-Untersuchung, genutzt zur Planung der Ablation. Ziel dieser Studie ist zu untersuchen, ob die Abgrenzbarkeit der Zielläsion in der Planungsuntersuchung einen Einfluss auf das kurz- und mittelfristige Ablationsergebnis hat.Es wurden 69 Patienten mit insgesamt 99 malignen Leberläsionen (25 Primärtumoren, 44 Metastasen) eingeschlossen, die zwischen 01/2015 und 06/2018 irreversibler Elektroporation (n = 35), Radiofrequenzablation (n = 41) oder Mikrowellenablation (n = 23) unterzogen wurden. Alle Verfahren wurden unter CT-Führung durchgeführt. Läsionen, die in der Planungs-CT nicht nachweisbar waren (NDL), wurden durch die Korrelation zu anatomischen Landmarken in der kontrastverstärkten CT oder MRT-Voruntersuchung lokalisiert. Es wurden die Raten unvollständiger Ablation, lokalen Tumorrezidivs, die Größe der Ablationszone, das intrahepatische progressfreie Überleben (ihPFS) und die Komplikationsraten für nachweisbare Läsionen (DL) gegenüber NDL verglichen.40 Läsionen waren NDL, 59 Läsionen waren DL auf die native Planungs-CT. Die mittlere Beobachtungsdauer war 16,2 Monate (14,8 für DL und 18,2 für NDL). Die mittleren Durchmesser von NDL und DL waren ähnlich (12,9 mm vs. 14,9 mm). Die mittleren Ablationszonengrößen waren ähnlich (37,1 mm vs. 38,8 mm). Es zeigten sich keine wesentlichen Unterschiede zwischen NDL und DL bezüglich der Häufigkeit unvollständiger Ablationen (5,0 % [2/40; 0,6 %–16,9 %] gegenüber 3,4 % [2/59; 0,4 %–11,7]), des Auftretens eines lokalen Tumorrezidivs (15,4 % [6/39; 5,7 %–30,5 %] gegenüber 16,9 % [10/59; 8,4 %–29,0]) oder des medianen ihPFS (15,5 Monate gegenüber 14,3 Monate).Die Nachweisbarkeit der Zielläsion in dem periinterventionellen Planungs-CT hat keinen signifikanten Einfluss auf das Ergebnis nach perkutanen Leberablationen, wenn anatomische Landmarken zur Nadelplatzierung genutzt werden.· Lebertumoren können erfolgreich abladiert werden, auch wenn sie in dem nativen Planungs-CT nicht nachweisbar sind.. · Anatomische Landmarken sollten verwendet und mit der präinterventionellen Bildgebung verglichen werden..

To evaluate utility of advanced CT techniques including HighlY constrained back-projection and dual-energy CT for intra- and post-procedure hepatic microwave ablation zone monitoring. 8 hepatic microwave ablations were performed in 4 adult swine (5 min/65 W). Low-dose routine CECT and dual-energy CT images were obtained every 1 min during ablation. Images were reconstructed ± HYPR. Image quality and dose metrics were collected. 21 MWA were performed in 4 adult swine. Immediate post-procedure CECT was performed in the arterial, portal venous, and delayed phases using both routine and DECT imaging with full-dose weight-based IV contrast dosing. An additional 16 MWA were subsequently performed in 2 adult swine. Immediate post-procedure CT was performed with half-dose IV contrast using routine and DECT. 12 patients (10 M/2F, mean age 62.4 yrs) with 14 hepatic tumors (4 HCC, 10 metastatic lesions) treated with MWA were prospectively imaged with DECT 1 month post-procedure. 120 kV equivalent images were compared to DECT [51 keV, iodine material density]. Image quality and dose metrics were collected. Gas created during MWA led to high CNR in all intraprocedural CT datasets. Optimal CNRs were noted at 4 min with CNR 6.7, 15.5,15.9, and 21.5 on LD-CECT, LD-CECT + HYPR, DECT, and DECT + HYPR, respectively (p

Introduction:We sought to determine and compare the perioperative cost associated with percutaneous microwave ablation (MWA) and robot-assisted partial nephrectomy (RA-PN) for treatment of ...

Hui-Zhou Li,1 Jie Tan,1 Tian Tang,2 Tian-Zhi An,3 Jun-Xiang Li,4 Yu-Dong Xiao1 1Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, People’s Republic of China; 2Department of Interventional Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, People’s Republic of China; 3Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550002, People’s Republic of China; 4Department of Interventional Radiology, Guizhou Medical University Affiliated Cancer Hospital, Guiyang, 550004, People’s Republic of ChinaCorrespondence: Yu-Dong XiaoDepartment of Radiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Changsha, 410011, People’s Republic of ChinaTel +86 13637403027Fax +86 731-85292116Email xiaoyudong222@csu.edu.cnPurpose: Transarterial chemoembolization (TACE) is recommended in patients with unresectable HCC beyond the Milan criteria (MC). However, the long-term efficacy of TACE remains unsatisfactory. Percutaneous microwave ablation (MWA) is a curative therapy for early-stage HCC that provides better local tumor control than TACE; however, MWA is limited for large or multifocal lesions. We aimed to compare treatment efficacy and downstaging rate following combined TACE-MWA and TACE alone in patients with unresectable HCC beyond the MC.Patients and Methods: Patients with unresectable HCC beyond the MC who underwent either TACE-MWA (n=91) or TACE alone (n=140) at four medical institutions were included. Potential influencing factors on overall survival (OS) and progression-free survival (PFS) were included in the Cox regression analysis. Propensity-score matching of patients treated with TACE-MWA and TACE alone was performed. Differences in OS and PFS were compared with the Log rank test. Patients who met the University of California, San Francisco criteria were eligible for assessment of the probability of downstaging within the MC. Downstaging rate was compared between the two groups.Results: In multivariate analysis, treatment with TACE alone was an independent predictor of poor PFS (P=0.011) and OS (P< 0.001). Both PFS (P=0.043) and OS (P=0.002) were significantly higher in patients treated with TACE-MWA than those treated with TACE alone. The downstaging rate was higher in patients treated with TACE-MWA than those treated with TACE alone (P=0.039).Conclusion: Compared with TACE alone, TACE-MWA may offer a survival benefit in terms of OS and PFS in HCC patients beyond the MC. Additionally, TACE-MWA may provide higher probability of downstaging within the MC than TACE alone, thereby increasing the possibility of liver transplantation.Keywords: microwave ablation, transarterial chemoembolization, survival, propensity score-matching, Milan criteria

To investigate the technical success, safety and outcomes of transcatheter arterial chemoembolization (TACE) combined with simultaneous cone-beam computed tomography (CBCT)-guided microwave ablation (MWA) in small hepatocellular carcinoma (SHCC).Retrospective analysis of 66 lesions in 50 patients (38 men, 12 women) who underwent TACE combined with simultaneous CBCT-guided MWA for SHCC. After 1 month of treatment, the tumor responses were assessed using the mRECIST criteria, along with interventional-related complications and changes in hepatic and renal function. Moreover, progression-free survival (PFS) and overall survival (OS) were calculated.All patients achieved technical success. The mean target tumor size was 3.4 ± 0.7 (range, 2.2-4.9) cm. The mean energy, ablation duration per tumor, and the mean safety margin were 51.3 ± 8.4 kJ, 6.7 ± 0.8 minutes and 1.4 ± 0.6 cm, respectively. The 1-, 3-, and 5-year PFS rates were 90.0%, 65.4%, and 35.7%, respectively, with a mean PFS of 43.46 months; and the 1-, 3-, and 5-year OS rates were 98.0%, 89.8%, and 74.3%, respectively, with a mean OS of 54.90 months. Multivariate Cox regression analysis further illustrated that TACE combined with MWA in the treatment of a single tumor with a diameter of less than 3 cm was an independent protective factor for PFS and OS (p0.001). The patients had no major complications. Among the exceptions, one patient (2%) had an asymptomatic perihepatic effusion that resolved spontaneously, two patients (4%) developed massive right pleural effusion, requiring thoracic drainage, and another patient (2%) developed a hepatic subcapsular hemorrhage required interventional embolization.CBCT-guided TACE combined with simultaneous MWA was a safe and successful treatment of SHCC with a high technical efficacy.

The purpose of the present review is to analyze and summarize the feasibility, effectiveness, and safety of ultrasound-guided percutaneous microwave ablation (MWA) for adenomyosis according to largest studies available in current literature, so as to provide a more robust foundation for its use in the treatment of patients with this condition.Adenomyosis is a common and frequently occurring gynecological disease. It can lead to clinical symptoms such as dysmenorrhea, menostaxis, menorrhagia, and anemia, and can seriously affect patients' quality of life. Treatments for adenomyosis include drug, minimally invasive, and surgical therapies. Among them, ultrasound-guided percutaneous microwave ablation has become a new hotspot in the minimally invasive treatment of adenomyosis in recent years, with its advantages of small trauma and a good therapeutic effect.Relevant studies were retrieved from the CNKI (Chinese National Knowledge Infrastructure), CQVIP, Wanfang, PubMed, Web of Science, Cochrane Library, EMBASE, ClinicalTrials.gov, and Google Scholar databases. The retrieval time range was from January 2000 to June 2021. Chinese search terms included "adenomyosis", "microwave ablation", and "ultrasound". English search terms included "microwave ablation", "ultrasound", "(adenomyosis) OR (endometrioma) OR (adenomyoma)".Ultrasound-guided percutaneous microwave ablation therapy is a feasible, safe, and effective technique for the treatment of adenomyosis, and is worthy of clinical application and promotion.

Background This study aimed to retrospectively explore the safety and feasibility of computed tomography (CT)-guided synchronous microwave ablation (MWA) followed by core-needle biopsy (CNB) via a coaxial cannula for highly suspected malignant lung ground-glass opacities (GGOs). Methods The clinical data of 66 patients (66 GGOs) treated with CT-guided synchronous MWA followed by CNB via a coaxial cannula from January 2019 to January 2021 were included in this study. The technical success rate, curative effect, and complications were evaluated. Results Technical success rates were 100%. The pneumothorax rate was 36.4% (24/66). 72.7% (48/66) patients had the bronchopulmonary hemorrhage, 81.3% of hemorrhage was attributable to CNB. 24.2% (16/66) patients had varying degrees of pleural effusion. The pathological results were adenocarcinomas (n = 44), atypical adenomatous hyperplasia (n = 2), chronic inflammation (n = 3) and indeterminate pathological diagnosis (n = 17) with a 69.7% (46/66) positive diagnosis rate. The therapeutic response rate was 100.0% (66/66). Conclusions Synchronous MWA followed by CNB via a coaxial cannula has a satisfactory ablation effectiveness and an acceptable biopsy positive rate, which is an alternative treatment for highly suspected malignant GGOs.

To evaluate the efficacy and safety of thermal ablation (radiofrequency, microwave, and laser) for treating lymph node metastasis from papillary thyroid carcinoma. A literature search was performed in the Medline, Embase, and Cochrane Library databases. Thirteen studies focusing on the efficacy and safety of thermal ablation for treating lymph node metastasis were eligible. The assessed outcomes were primarily pooled using a random- or fixed-effects model based on the results of the heterogeneity test. A total of 235 patients with 445 metastatic lymph nodes were included. Laser, microwave, and radiofrequency ablation all showed a significant reduction in maximum diameter and volume of metastatic lymph nodes (P

Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor. Although IMT generally exhibits benign biological behavior, some IMT patients may develop local recurrence or even distant metastasis. Surgery is the most common therapeutic approach. However, additional treatment options are necessary for those who are unable to undergo surgical treatments. Microwave ablation (MWA) is a developing treatment option for unresectable lung cancer. Compared with radiofrequency ablation (RFA), MWA possesses many advantages including larger ablation zones, shorter heating times, and less susceptibility to heat sink. Herein, we reported the case of an 80-year-old male patient who presented with a mass in the right lower pulmonary lobe and right pleural effusion. The maximum diameter of the mass was 53.76 mm, and the patient’s main complaint was fatigue for 2 months. Blood test showed severe anemia (hemoglobin: 79 g/L) and hypoproteinemia (albumin: 27.7 g/L). After undergoing blood transfusion, supplementation of albumin, thoracical puncturing and piping, the patient’s nutritional condition was improved (hemoglobin, 95 g/L; serum albumin, 29.9 g/L). The pathological diagnosis was pulmonary IMT by percutaneous lung biopsy. The patient was successfully treated with three rounds of percutaneous MWA and has no evidence of recurrence nearly 3 years later. This case has expanded the therapeutic options for elderly patients with pulmonary IMT. Percutaneous MWA monotherapy might serve as an emerging treatment strategy for medically inoperable patients.

Background/Aims: In July 2017, the Emprint™ next-generation microwave ablation system using thermosphere technology (Covidien, Boulder, CO, USA) was approved for use in Japan. This system can produce a predictable spherical ablation zone at higher temperatures than radiofrequency ablation (RFA). The aim of the present study was to elucidate whether this new microwave thermosphere ablation (MTA) could safely improve outcome compared to RFA, which is the standard of care for small hepatocellular carcinoma (HCC).Methods: This retrospective study analyzed 513 patients with 630 HCCs (≤3 cm) who were performed by percutaneous RFA (174 patients, 214 HCCs) or MTA (339 patients, 416 HCCs) between January 2016 and March 2020.Results: Median ablation time was significantly shorter for MTA (240 seconds) than for RFA (721 seconds; P

The pathologies of parathyroid glands are widespread among endocrine system diseases, excluding diabetes and thyroid pathology. There are only two methods that are used to treat hyperparathyroidisms, such as surgery and conservative therapy. However, transracial thermal destruction methods (ablation) have recently appeared in clinical practice. The methods have good precision and connect with physical phenomena, such as interaction laser, radiofrequency, microwave, and HIFU irradiation with bio substance. The review is dedicated to critically analyze the modern methods for local thermal destruction of the hyper-functioning parathyroid glands. The review includes data from randomized clinical trials from 2012 to 2021. The studies were from Google Scholar and Pubmed with a total number of 1,938 patients (laser ablation ― 216 patients, radiofrequency ablation ― 225, microwave ablation ― 1467, high-density ultrasound ablation ― 30 patients). Recommendations methods of thermal destruction application were obtained during the review. Furthermore, we have designed some algorithms for hyperparathyroidism treatment. Moreover, thermal destruction methods were observed. There are four modern methods of thermal destruction which have been analyzed like alternatives to surgery. Each of them has advantages and disadvantages, its profile of safety and effectiveness. After processing information from a proven database, the most popular among specialists is methods of microwave ablation. However, laser ablation is more effective than other ways.

Microwave (MW) ablation and stereotactic body radiation therapy (SBRT) have potentially complementary advantages and limitations for treating inoperable renal cell carcinoma (RCC). Combining SBRT and MWA may optimize tumor control and toxicity for patients with larger (>5 cm) RCCs or those with vascular involvement. We retrospectively reviewed patients at our institution with RCC treated between 2014 – 2018 to identify patients treated with a combination of SBRT and MW ablation. Seven patients with RCC were treated with combination of SBRT and MW ablation, median tumor size of 6.4 cm. Local control was 100% with a median follow-up of 15 months. Four patients experienced grade 2 nausea during SBRT. Three patients experienced toxicities after MW ablation, two with grade 1 hematuria and one with grade 3 retroperitoneal bleed/collecting system injury. Median eGFR preceding and following SBRT and MW ablation was 69 mL/min/1.73m2 and 68 mL/min/1.73m2 (p=0.19) respectively. In patients who are not surgical candidates, larger RCCs or those with vascular invasion are challenging to treat. Combination treatment with SBRT and MW ablation may balance the risks and benefits of both therapies and demonstrates high local control in our series. MW ablation and SBRT have potentially complementary advantages and limitations.

Objective: Thermal ablation poses challenges in the surgical resection (SR) of small hepatocellular carcinoma (HCC), and its therapeutic outcomes for larger lesions remain debated. Methods: This retrospective study evaluated 729 patients with HCC meeting the Milan criteria, who were treated with curative SR or microwave ablation (MWA) between 2008 and 2014. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and local tumor progression (LTP) were compared after propensity score matching (PSM). Co-variates associated with OS, CSS, LTP, and DFS were identified. The risk of death and tumor progression were compared. Results: During the median follow-up of 78.6 months, 253 patients were included in each group after PSM. For tumors ≤ 3.0 cm and 3.1–4.0 cm, MWA achieved comparable results in terms of OS, CSS, DFS, and LTP. For tumors 4.1–5.0 cm, MWA had lower OS, CSS, and DFS rates (all P < 0.05) than SR. Higher LTP rates were observed in the MWA group for tumors 4.1–5.0 cm, although the difference was not significant (P = 0.18). Complication rates (P = 0.41) were similar, but MWA led to less estimated blood loss (P < 0.01) and shorter postoperative hospitalization times (P < 0.01). Conclusions: MWA achieved comparable long-term oncologic outcomes with SR for ≤ 4 cm HCC, with lower complication rates and faster recovery.

Historically, adrenal glands diseases causing hypertension, such as Primary Aldosteronism (PA), have been treated through pharmacotherapy or surgical resection. Given the shortcomings of the available treatment options, the interest in alternative and less invasive treatment modalities such as microwave ablation (MWA), has increased. In order to develop and optimize this novel electromagnetic-based therapy, an accurate knowledge of the dielectric properties of human adrenal glands, as well as preclinical animal models, is crucial. In particular, ovine models represent a feasible animal model to test the safety and performances of MWA. In this study, the dielectric properties of ovine adrenal glands and of normal and diseased human adrenal glands are characterized ex vivo in the microwave frequency range. The dielectric properties of the two functional tissues (cortex and medulla) composing ovine adrenal glands are measured using the open-ended coaxial probe technique and represented with a two pole Cole-Cole model in the frequency range from 0.5 GHz to 8 GHz. This paper presents the first dielectric data of normal and diseased human adrenal tissues, including a functioning adenoma responsible for PA and it compares the human data with data from the animal model. peer-reviewed

Background Patients with early-stage lung cancer are sometimes medically inoperable, and for patients with multiple primary lung cancers, surgical resection alone sometimes proves to be impractical. Local treatments like microwave ablation (MWA) are investigational alternatives for these patients. Most reported MWA procedures for lung cancers are performed percutaneously under CT guidance. MWA navigated by electromagnetic bronchoscopy (ENB) has been limitedly studied. In this study, we aimed to evaluate the safety and feasibility of MWA under ENB guidance in patients with inoperable early-stage lung cancers or multiple primary lung cancers which cannot be completely resected. Methods From June 2019 to December 2020, preliminary attempts of ENB-guided MWA were made in five medically inoperable patients with a single early-stage lung cancer and ten patients with multiple primary lung cancers which were difficult to resect at the same time. For patients with concomitant pulmonary nodules which needed surgical resection, thoracoscopic resections were performed following ENB-guided MWA. The safety, feasibility, and technique effectiveness of treatments were evaluated. Results ENB-guided MWA for 15 ground glass nodules (GGNs) in 15 patients was completed in accordance with the planned protocol. Biopsy of 13 GGNs showed malignancy. Five patients received simple ENB-guided MWA without simultaneous surgical resection and ten patients received simultaneous surgical resection for 13 concomitant pulmonary nodules. CT scan by the first postoperative week showed technique effectiveness of ablation for 11 nodules indicated for MWA. Four patients had mild complications after the procedure and recovered shortly after treatment. Conclusions For medically inoperable patients with a single GGN manifesting early-stage lung cancer and patients with multiple primary early-stage lung cancers which cannot be resected at the same time, ENB-guided MWA might be a safe and feasible alternative local treatment, whether combined with surgical resection or not. However, large, prospective, randomized, multicenter studies are needed to confirm its role in the treatment of early-stage lung cancer.

Bone is among the most common metastasis sites in patients with advanced cancer. Approximately two-thirds of bone metastasis results in pain, the majority of which is moderate to unbearable pain, which seriously affects the quality of life of patients. With the development of ablation techniques, microwave ablation (MWA) has great potential to eliminate the pain caused by bone metastasis. This study aimed to evaluate the efficacy and safety of image-guided (computed tomography-guided) percutaneous MWA for metastatic osseous pain.This is a retrospective study involving 18 patients with cancer-related pain caused by osseous or soft tissue metastasis in the First Affiliated Hospital of Soochow University from June 2015 to October 2020. All patients (14 men and 4 women; mean age 60.2 years) underwent image-guided percutaneous palliative MWA. A paired-sample t-test was used to compare the changes in Numeric Rating Scale (NRS) score and dosage of morphine preoperatively and postoperatively (at 24 h, 3 days, and 14 days after MWA). In addition, we assessed the level of pain relief according to the patients' subjective feelings.The paired-samples t-test showed that the NRS score (6.83±0.92 vs. 1.67±0.97, P0.05) and dosage of morphine (85.56±17.23 vs. 32.78±4.61, P0.05) were significantly decreased at 3 days after MWA. At 14 days after MWA, the NRS score (6.83±0.92 vs. 0.94±0.87, P0.05) and dosage of morphine (85.56±17.23 vs. 10.56±8.73, P0.05) were also markedly decreased. Moreover, according to the patients' subjective feeling, 88.89% patients had pain relief postoperatively, while the remaining patients had no progress.Image-guided (Computed Tomography-guided) percutaneous MWA can effectively relieve pain, thus improving the quality of life in patients with osseous metastasis. MWA is a feasible, safe, and effective treatment for pain caused by bone metastasis.

BACKGROUND Hepatic hemangioma is the most common benign tumor of the liver. However, patients with large hemangiomas that cause compression symptoms or that are at risk of rupture may need further intervention. It is necessary to explore additional minimally invasive and personalized treatment options for hemangiomas. CASE SUMMARY A 47-year-old woman was diagnosed with a right hepatic hemangioma for more than 10 years. Abdominal contrast-enhanced computed tomography (CT) and contrast-enhanced ultrasound revealed that there was a large hemangioma in the right liver, with a size of approximately 95 mm × 97 mm × 117 mm. Due to the patient's refusal of surgical treatment, hepatic artery embolization was performed in the first stage. After 25 d of liver protection treatment, the liver function indexes decreased to normal levels. Then, ultrasound-guided microwave ablation of the giant hepatic hemangioma was performed. Ten days after the treatment, hepatobiliary ultrasonography showed that the hemangioma of the right liver was smaller than the previous size (the volume was reduced by approximately 30%). Then the patient was discharged from the hospital. One year after discharge, CT showed that the hepatic hemangioma had shrunk by about 80% CONCLUSION Transcatheter arterial embolization combined with microwave ablation is a safe and effective minimally invasive treatment for hepatic hemangioma.

Background The aim of the study was to explore the outcomes of computed tomography‐guided microwave ablation (MWA) in non‐small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI), and to compare the outcomes of ALI‐NSCLC and non‐ALI NSCLC patients after MWA. Methods A total of 319 NSCLC patients and 366 tumors treated with MWA were included in the study, comprising 34 ALI‐NSCLC patients and 285 non‐ALI NSCLC patients. Complications, local recurrence rates, progression‐free survival (PFS), and overall survival (OS) were compared. Logistic regression analyses were used to investigate the correlation between ALI and the occurrence of pneumothorax after MWA. Results The mean tumor diameter of ablated tumors was 3.6 ± 2.2 cm. There were 95 (29.8%) NSCLC patients in which pneumothorax occurred after MWA, and all patients recovered. Of these, the ALI group had a significantly higher incidence rate of pneumothorax than the non‐ALI group (52.9% vs. 27.0%, p = 0.002). The median PFS and OS for the ALI group were 12.0 ± 10.2 and 15.5 ± 9.5 months, respectively, and that of the non‐ALI group were 13.0 ± 10.6 and 17.0 ± 11.1 months, respectively, and no significant difference was found in PFS (p = 0.329) nor OS (p = 0.394) between the two groups. Local recurrence rates for ALI and non‐ALI groups were 29.4% and 20.7%, respectively, and no significant difference was found (p = 0.244). Logistic regression analyses revealed that ALI can increase the risk of pneumothorax (hazard ratio [HR], 2.867; p = 0.012). Conclusions MWA is an effective and safe approach for ALI‐NSCLC treatment. Although ALI can increase the risk of pneumothorax, ALI‐NSCLC patients reveal a comparable outcome to non‐ALI NSCLC patients after MWA., Microwave ablation is an effective and safe approach for non‐small cell lung cancer patients with adjacent lobe invasion. The presence of adjacent lobe invasion can increase the risk of pneumothorax after microwave ablation.

PURPOSE: Contrast-enhanced ultrasound (CEUS) is a useful tool to assess treatment response after percutaneous ablation or transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Here, we performed a systematic review and meta-analysis to evaluate the usefulness of CEUS in identifying residual tumor after locoregional therapy. METHODS: PubMed, Scopus, and Cochrane library databases were searched from their inception until March 8, 2021, for diagnostic test accuracy studies comparing CEUS to a reference standard for identifying residual tumors after locoregional therapy of HCC. The pooled sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) were obtained using a bivariate random effects model. Subgroup analyses were performed by stratifying the studies based on study design, type of locoregional therapy, CEUS criteria for residual tumor, timing of CEUS follow up, and type of standard reference. RESULTS: Two reviewers independently evaluated 1479 publications. After full-text review, 142 studies were found to be relevant, and 43 publications (50 cohorts) were finally included. The overall sensitivity of CEUS in detection of residual disease estimated from the bivariate random effects model was 0.85 (95% CI 0.80–0.89). Similarly, the overall specificity was 0.94 (95% CI 0.91–0.96). The diagnostic accuracy was 93.5%. The DOR was 70.1 (95% CI 62.2–148), and the AUROC was 0.95. Importantly, subgroup analysis showed no apparent differences in the diagnostic performance between locoregional therapy (TACE vs. ablation) and criteria used to define residual enhancement, timing of performing CEUS, study design, or type of reference standard. CONCLUSION: CEUS is a highly accurate method to identify HCC residual tumor after TACE or percutaneous ablation.

Background and Purpose: Operative microwave ablation (MWA) is a safe modality for treating hepatic tumors. The aim of this study is to present our 10-year, single-center experience of operative MWA for neuroendocrine liver metastases (NLM). Methods: A single-institution retrospective review of patients who underwent operative MWA for NLM was performed (2008-2018). Demographics, primary tumor site, operative approach, combined surgical operations, and carcinoid symptoms were recorded. Clinical outcomes for major complications, readmission, and mortality were analyzed 30 days postoperatively. Postablation imaging was evaluated for incomplete ablation/missed lesions, and surveillance imaging reviewed for local, regional, and metastatic recurrence. Results: Of the 50 patients (166 targeted lesions) who received MWA for NLM, 41 (82%) were treated with a minimally invasive approach, and 22 (44%) underwent MWA concomitant with hepatectomy and/or primary tumor resection. Within the study cohort 70% of patients were treated with curative intent with a 77% (27/35) success rate. Carcinoid symptoms were reported in 40% (20/50) of patients preoperatively, and MWA treatment improved symptoms in 19/20 patients. Incomplete ablation occurred in 1/166 treated lesions. Recurrence-free survival at 1 and 5 years was 86% and 28%, respectively. Overall survival at 1 and 5 years was 94% and 70%, respectively (median follow-up 32 months, range 0-116 months). Conclusion: Operative MWA is a versatile modality, which can be safe and effectively performed alone or combined with hepatectomy for NLM, preferably using a minimally invasive approach, to achieve symptom control and possibly improve survival.

Background Gold standard for colorectal liver metastases (CRLM) remains hepatic resection (HR). However, patients with severe comorbidities, unresectable or deep-situated resectable CRLM are candidates for ablation. The aim of the study was to compare recurrence rate and survival benefit of the microwave ablation (MWA), radiofrequency ablation (RFA) and HR by conducting the first network meta-analysis. Data sources Systematic search of the literature was conducted in the electronic databases. Both updated traditional and network meta-analyses were conducted and the results were compared between them. Results HR cohort demonstrated significantly less local recurrence rate and better 3- and 5-year disease-free (DFS) and overall survival (OS) compared to MWA and RFA cohorts. HR cohort included significantly younger patients and with significantly lower preoperative carcinoembryonic antigen (CEA) by 10.28 ng/mL compared to RFA cohort. Subgroup analysis of local recurrence and OS of solitary and ≤ 3 cm CRLMs did not demonstrate any discrepancies when compared with the whole sample. Conclusions For resectable CRLM the treatment of choice still remains HR. MWA and RFA can be used as a single or adjunct treatment in patients with unresectable CRLM and/or prohibitive comorbidities.

Liver cancer is a leading cause of cancer related deaths, however primary treatment options such as surgical resection and liver transplants may not be viable for many patients. Minimally invasive image-guided microwave ablation (MWA) provides a locally effective treatment option for these patients with an impact comparable to surgery for both cancer specific and overall survival. MWA efficacy is correlated with accurate image guidance, however conventional modalities such as B-mode ultrasound and computed tomography (CT) have limitations. Alternatively, ultrasound elastography has been utilized to demarcate post-ablation zones yet has limitations for pre-ablation visualization due to variability in strain contrast between cancer types. This study attempts to characterize both pre-ablation tumors and post-ablation zones using electrode displacement elastography (EDE) for 13 patients with hepatocellular carcinoma or liver metastasis. Typically, MWA ablation margins of 0.5 – 1.0 cm are desired, which are strongly correlated with treatment efficacy. Our results demonstrate an average estimated ablation margin inner quartile range of 0.54 – 1.21 cm with a median value of 0.84 cm. These treatment margins lie within or above the targeted ablative margin indicating the potential for using EDE for differentiating index tumors and ablated zones for use during clinical ablations. We also obtained a high correlation between corresponding segmented cross-sectional areas from contrast-enhanced computed tomography (CECT), the current clinical gold standard, when compared to EDE strain images with r(2) values of 0.97 and 0.98 for pre- and post-ablation regions.

Objective Microwave ablation (MWA) is a minimally invasive technique for the treatment of benign thyroid nodules. The purpose of this study was to evaluate efficacy and safety of ultrasound-guided MWA in the treatment of benign thyroid nodules, and to find out the recurrence related factors, so as to provide reference for future clinical work. Methods This study retrospectively analyzed the patients who received ultrasound-guided MWA for benign thyroid nodules in our hospital from October 2018 to March 2020. A total of 214 patients were included in the study. We assessed thyroid volume changes (represented by volume reduction ratio VRR), the energy per 1 mL reduction in nodular volume (represented by energy volume ratio ΔE), the serum levels of free triiodide thyroid hormone (FT3), free thyroxine (FT4), thyrotropin (TSH) and complications after MWA treatment. Results There were a total of 306 nodules in 214 patients, including 183 (85.51%) females and 31 (14.49%) males. The median diameter and volume of the nodule were 33 mm and 8.01 mL. The VRR at 1 month, 3 months, 6 months and 12 months were 40.79%, 60.37%, 74.59% and 85.60%, respectively. In addition, MWA had a better ablation effect for small nodules (initial volume ≤ 10 mL). In recurrent studies, we found that ΔE was an independent risk factor for benign thyroid nodules (P Conclusions Ultrasound-guided MWA is effective and safe in the treatment of benign thyroid nodules. In addition, it has little damage to surrounding tissues and no effect on thyroid function. Especially, the nodules with smaller initial volume, the treatment is better. On the other hand, the energy per 1 mL reduction ΔE in nodular volume may be associated with nodular recurrence, which requires further follow-up for longer periods. At this stage, we consider that ultrasound-guided MWA can be used as one of the main clinical treatment methods for benign thyroid nodules.

Background: Different loco-regional therapies have been progressed for irresectable liver tumors to achieve local tumor control. Examples of loco-regional therapies are different thermal ablation therapies such as microwave ablation, and radiofrequency ablation. Objectives: We aimed to evaluate treatment safety, efficacy, and complications related to radio-frequency ablation (RFA) in comparison with percutaneous microwave (MW) ablation for the management of HCC. Patients and Methods: 100 patients presented with liver cirrhosis and HCC proved by imaging ultrasonography and triphasic CT. Patients were assigned into two main comparison groups: Group 1: patients with single or multiple hepatic focal lesions (size up to 4cm) who received RFA. Group 2: patients with single or multiple hepatic focal lesions (size up to 4cm) who received MWA. Complete blood count, liver function tests, and AFP were measured for all subjects. Results: In All 100 patients; the assessment number of the hepatic focal lesion was done by abdominal ultrasonography and triphasic CT 93% of patients had a single focal lesion with a median size of 2.3cm. Group (1): (who were candidates for RFA) showed statistically significant higher values as regard (ALT) (p-value =0.091) compared to group (2): (who were candidates for MWA). There were no statistical differences between both groups as regard Total Bilirubin and serum AFP. The microwave ablation group was statistically significant as regard ablation success, shorter time, and shorter ablation than the radiofrequency ablation group (p-value =0.000). Conclusions: RFA and MWA are good ablative techniques. MWA showed more superiority than RFA in the overall outcome.

Purpose To explore the outcomes of computed tomography‒guided microwave (MW) ablation in patients with cavitary non–small cell lung cancer (NSCLC) and to compare the outcomes of cavitary and noncavitary NSCLC treated with MW ablation. Materials and Methods A total of 317 patients with NSCLC (194 men and 123 women) treated with MW ablation were include: 19 patients with cavitary NSCLC and 298 patients with noncavitary NSCLC. Complications, progression-free survival (PFS), and overall survival (OS) were evaluated and compared between the 2 groups. The Kaplan-Meier method was used to investigate the correlation of cavity and OS in patients with NSCLC. Results A total of 364 MW ablation procedures were performed. Adenocarcinoma was the predominant histopathological subtype in patients with cavitary NSCLC (73.7%). Cavitary NSCLC had an incidence rate of 57.9% in overall complications, which was significantly higher than that of 34.6% for noncavitary NSCLC (P = .040). In a mean follow-up of 27.2 months ± 11.9, the median PFS and OS for cavitary NSCLC were 9.0 months ± 8.5 and 14.0 months ± 10.8, respectively, and those for noncavitary NSCLC were 13.0 months ± 10.7 and 17.0 months ± 10.9, respectively. There was no significant difference in PFS (P = .180) or OS (P = .133) between cavitary and noncavitary NSCLC. In addition, the local recurrence rates for cavitary and noncavitary NSCLC were 15.8% and 21.5%, respectively, and no significant difference was found (P = .765). The Kaplan-Meier method revealed no association between the cavity and OS in patients with NSCLC treated with MW ablation. Conclusions MW ablation was an effective and safe approach for cavitary NSCLC treatment. Compared with noncavitary NSCLC, cavitary NSCLC manifested with more complications but a comparable outcome after MW ablation.

Objectives: To determine how well ultrasound-guidance percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) performed for benign symptomatic thyroid nodules in terms of clinical and functional outcomes. Methods: Patients who had a thyroid nodule-linked symptoms acting as dysphagia, cosmetic issues, pain, a foreign body sense, hyperthyroidism secondary to autonomous nodules, or concern of malignancy were involved in the study. The primary was the comparison in symptom scores obtained at 1, 3, and 6 months after RFA and MWA. The volume alterations in nodules and alterations in thyroid gland functions were secondary objectives. Results: This prospective study carried out from November 2014 and January 2017 at the General Surgery Department, Marmara University, Faculty of Medicine, Istanbul, Turkey included a total of 100 nodules (50% MWA, 50% RFA). There were statistically significance in pain scores, dysphagia scores, and foreign body sensation scores at 1, 3, and 6 months after therapy in both ablation groups (p=0.0006, p=00004, p=0.0005). At the same time, there were statistically significant reductions in size and volume of the nodules for RFA and MWA (p=0.0004, p=0.0003). There was no significant difference between the RFA and MWA groups’ cosmetic scoring and volume changes (p=0.68, p=0.43). Conclusions: Alternative therapies for benign symptomatic thyroid nodules include RFA and MWA. The findings of this research revealed that both approaches are safe and effective.

BACKGROUND: The purpose of this study is to evaluate the safety and intermediate-term efficacy of percutaneous microwave (MW) ablation for the treatment of colorectal liver metastases (CRLM) at a single institution. METHODS: A retrospective review was performed of all CRLM treated with MW ablation from 3/2011 to 7/2020 (102 tumors; 72 procedures; 57 patients). Mean age was 60 years (range, 36–88) and mean tumor size was 1.8 cm (range, 0.5–5.0 cm). The patient population included 19 patients with extra-hepatic disease. Chemotherapy (pre- and/or post-ablation) was given in 98% of patients. Forty-five sessions were preceded by other focal CRLM treatments including resection, ablation, radiation, and radioembolization. Kaplan-Meier curves were used to estimate local tumor progression-free survival (LTPFS), disease-free survival (DFS), and overall survival (OS) and multivariate analysis (Cox Proportional Hazards model) was used to test predictors of OS. RESULTS: Technical success (complete ablation) was 100% and median follow-up was 42 months (range, 1–112). There was a 4% major complication rate and an overall complication rate of 8%. Local tumor progression (LTP) rate during the entire study period was 4/98 (4%), in which 2 were retreated with MW ablation for a secondary LTP-rate of 2%. LTP-free survival at 1, 3, and 5 years was 93%, 58%, and 39% and median LTP-free survival was 48 months. OS at 1, 3, and 5 years was 96%, 66%, 47% and median OS was 52 months. There were no statistically significant predictors of OS. CONCLUSIONS: MW ablation of hepatic colorectal liver metastases appears safe with excellent local tumor control and prolonged survival compared to historical controls in selected patients. Further comparative studies with other local treatment strategies appear indicated.

Pancreatic cancer is a challenging malignancy with limited treatment options and poor life expectancy. The only curative option is surgical resection, but only 15%-20% of patients are resectable at presentation because more than 50% of patients has distant metastasis at diagnosis and the rest of them has locally advanced pancreatic cancer (LAPC). The standard of care first line treatment for LAPC patients is chemotherapy with or without radiation therapy. Recent developments in minimally invasive ablative techniques may add to the treatment armamentarium of LAPC. There are increasing number of studies evaluating these novel ablative techniques, including radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation. Most studies which included pancreatic tumor ablation, demonstrated improved overall survival in LAPC patients. However, the exact protocols are yet to set up to which stage of the treatment algorithm ablative techniques can be added and in what kind of treatment combinations. Patients with metastatic pancreatic cancer has dismal prognosis with 5-year survival is only 3%. The most common metastatic site is the liver as 90% of pancreatic cancer patients develop liver metastasis. Chemotherapy is the primary treatment option for patients with metastatic pancreatic cancer. However, when the tumor is not responding to chemotherapy or severe drug toxicity develops, locoregional liver-directed therapies can provide an opportunity to control intrahepatic disease progression and improve survival in selected patients. During the last decade new therapeutic options arose with the advancement of minimally invasive technologies to treat pancreatic cancer patients. These new therapies have been a topic of increasing interest due to the severe prognostic implications of locally advanced and metastatic pancreatic cancer and the low comorbid risk of these procedures. This review summarizes new ablative options for patients with LAPC and percutaneous liver-directed therapies for patients with liver-dominant metastatic disease.

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.

BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases. However, most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy. Ablation combined with hepatectomy can be an alternative to liver resection. AIM To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases. METHODS In this study, the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed. Before the operation, the patients did not receive any treatment for liver neuroendocrine tumors. After a multidisciplinary expert group discussion, all patients were deemed unsuitable for liver resection. All patients were diagnosed with neuroendocrine tumors by pathology. The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery. RESULTS Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018. The median number of liver metastatic nodules was 4 (range, 2 to 43). The median number of lesions resected was 1 (range, 1 to 18), and the median number of lesions ablated was 3 (range, 1 to 38). The mean operation time was 405.6 (± 39.4) min. The median intraoperative blood loss was 600 mL (range, 50 to 3000). Ten patients had a fever after surgery. The median duration of fever was 3 d (range, 0 to 21). Elevated bilirubin levels occurred in all patients after surgery. The median bilirubin on the first day after surgery was 28.5 (range, 10.7 to 98.9) µmol/L. One patient developed respiratory failure, renal insufficiency, and pneumonia after the operation. No patient died postoperatively during hospitalization. The mean overall survival time after surgery was 34.1 (± 3.7) mo, and the median progression-free survival time was 8 (range, 2 to 51) mo. One year after surgery, ten patients survived and five patients survived without progression. Three year after surgery, eight patients survived and two patients survived without progression. CONCLUSION Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy, but also has a low incidence of postoperative complications.

Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.

We updated the experience on percutaneous microwave ablation for renal cell carcinoma with five-center data and long-term follow-up. This retrospective study reviewed the T1N0M0 renal cell carcinoma patients who underwent microwave ablation between April 2006 and December 2019. Clinicopathological and procedural data were collected. Technical effectiveness and complications were assessed, and the Kaplan-Meier method was used for cancer-specific survival, disease-free survival, overall survival, and local neoplastic process analyses. A total of 323 consecutive patients (mean age, 62.9 years ± 14.0) with 371 biopsy-proved tumors (mean diameter, 2.9 cm ± 1.2) were enrolled, and 42.6% of the tumors were located adjacent to collecting system/bowel and technical effectiveness was achieved in 360 (97.0%) tumors. For 275 cT1a patients, during median follow-up time of 66.0 months (IQR, 58.4–73.6), 10-year local neoplastic processes, cancer-specific survival, disease-free survival, and overall survival rates were 1.9%, 87.4%, 71.8, and 67.5%, respectively. For 48 cT1b patients, during the median follow-up time of 30.4 months (IQR, 17.7–44.8), 5-year local tumor progression, cancer-specific survival, disease-free survival, and overall survival rates were 11.3%, 91.4%, 69.1, and 89.2%, respectively. Major complications showed no differences between cT1a (3.5%) and cT1b (6.9%) patients (p = 0.28). A clinical risk stratification system was developed based on multivariable model to predict DFS and CSS with c-indexes of 0.78 (95% CI: 0.71–0.85) and 0.77 (95% CI: 0.65–0.90), respectively. With matured follow-up at five institutions, ultrasound-guided percutaneous microwave ablation is a reliable treatment option for cT1a renal cell carcinoma even in dangerous location and appears to be promising for cT1b tumors. • To our knowledge, this is the first multicenter cohort of long-term oncologic outcomes with percutaneous MWA of cT1 RCC. • The predicting model we developed is accurate to predict the long-term DFS and CSS, which can help to provide a better MWA prognostication over routinely available clinical information. • The available evidence shows that microwave ablation of clinical stage T1 RCC is safe and reliable with promising long-term oncologic outcomes, especially for cT1a RCC with excellent 10-year results.

To evaluate the frequency and the degree of vital signs elevation, as well as to elucidate the risk factors for elevation of cardiopulmonary parameters. We retrospectively evaluated the medical records of 101 patients who received microwave ablation (MWA) under deep sedation with propofol. Univariate analysis followed by multivariate linear regression analysis was performed to determine the risk factors associated with the elevation of cardiopulmonary parameters. The heart rate (HR), mean blood pressure (BP) and respiratory rate (RR) were elevated in 53.5%, 45.5% and 30.7%. Hyperhemodynamic state (mean BP or HR increased > 30% of the baseline) and high RR (RR > 20 times/min) were detected in 23.8% and 13.9%. Age ≤ 50 years was signifiant for mean BP and HR elevation (p = 0.032; p = 0.027), ablation zone abutting the parietal peritoneum (p = 0.001; p = 0.001; p

Background Currently, the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation (RFA), microwave ablation, and irreversible (IRE) or reversible electroporation combined with low doses of chemotherapeutic drugs. Aim To report an overview and updates on ablative techniques in pancreatic cancer. Methods Several electronic databases were searched. The search covered the years from January 2000 to January 2021. Moreover, the reference lists of the found papers were analysed for papers not indexed in the electronic databases. All titles and abstracts were analysed. Results We found 30 studies (14 studies for RFA, 3 for microwave therapy, 10 for IRE, and 3 for electrochemotherapy), comprising 1047 patients, which were analysed further. Two randomized trials were found for IRE. Percutaneous and laparotomy approaches were performed. In the assessed patients, the median maximal diameter of the lesions was in the range of 2.8 to 4.5 cm. All series included patients unfit for surgical treatment, but Martin et al assessed a subgroup of patients with borderline resectable tumours who underwent resection with margin attenuation with IRE. Most studies administered chemotherapy prior to ablative therapies. However, several studies suggest that the key determinant of improved survival is attributable to ablative treatment alone. Nevertheless, the authors suggested chemotherapy before local therapies for several reasons. This strategy may not only downstage a subgroup of patients to curative-intent surgery but also support to recognize patients with biologically unfavourable tumours who would likely not benefit from ablation treatments. Ablation therapies seem safe based on the 1047 patients assessed in this review. The mortality rate ranged from 1.8% to 2%. However, despite the low mortality, the reported rates of severe post procedural complications ranged from 0%-42%. Most reported complications have been self-limiting and manageable. Median overall survival varied between 6.0 and 33 mo. Regarding the technical success rate, assessed papers reported an estimated rate in the range of 85% to 100%. However, the authors reported early recurrence after treatment. A distinct consideration should be made on whether local treatments induce an immune response in the ablated area. Preclinical and clinical studies have shown that RFA is a promising mechanism for inducing antigen-presenting cell infiltration and enhancing the systemic antitumour T-cell immune response and tumour regression. Conclusion In the management of patients with pancreatic cancer, the possibility of a multimodal approach should be considered, and conceptually, the combination of RFA with immunotherapy represents a novel angle of attack against this tumour.