Improved outcome with combined US/CT guidance as compared to US guidance in percutaneous radiofrequency ablation of small renal masses.

Abstract

When performing percutaneous radiofrequency ablation (RFA) of small renal masses (SRM), use of optimized periprocedural image guidance is essential to secure curative outcome of the treatment. To retrospectively compare the short-term radiological and clinical outcomes of RFA under combined ultrasound (US) and computed tomography (CT) guidance with that of a previously performed US-guided series at the same institution. From November 2009 to November 2013, 60 patients (mean age, 70.1 years; range, 34-86 years) with renal masses measuring in the range of 13-50 mm in maximal diameter (mean diameter, 25.4 ± 6.8 mm) underwent percutaneous RFA with combined US/CT guidance. The technical success rate, recurrence-free survival, rate of complications, and the percentage change in the estimated glomerular filtration rate (eGFR) were compared with that of a previously published series of 41 patients with SRM treated with US-guided RFA between November 2002 and December 2008. The tumor and patient characteristics were similar between the two treatment groups. The primary and secondary technical success rate was significantly higher in the group treated with combined US/CT guidance compared with the group treated with US guidance alone (100% and 100% vs. 82% and 91%, respectively). The local recurrence-free survival was significantly better in the combined US/CT-guided group than in the US-guided group (P = 0.016). There was no significant difference in the rate of overall complications (13% vs. 17%) or the mean percentage decrease in the eGFR after the respective treatment (1.1 ± 18.3% vs. 5.0 ± 11.7%). The use of combined US/CT guidance when performing renal RFA resulted in superior primary and short-term outcome compared to the use of US guidance alone in patients treated at the same institution.