MP100-09 DOES ROUTINE BIOPSY IMPROVE DETECTION OF RESIDUAL RCC POST MICROWAVE ABLATION?

Abstract

You have accessJournal of UrologyKidney Cancer: Ablative Therapy1 Apr 2017MP100-09 DOES ROUTINE BIOPSY IMPROVE DETECTION OF RESIDUAL RCC POST MICROWAVE ABLATION? Brett Johnson, Amy Lim, Shane Wells, Sara Best, Michael Hartung, Meghan Lubner, Timothy Ziemlewicz, J. Louis Hinshaw, Fred Lee, Wei Huang, Richard Yang, Stephen Y Nakada, and E. Jason Abel Brett JohnsonBrett Johnson More articles by this author , Amy LimAmy Lim More articles by this author , Shane WellsShane Wells More articles by this author , Sara BestSara Best More articles by this author , Michael HartungMichael Hartung More articles by this author , Meghan LubnerMeghan Lubner More articles by this author , Timothy ZiemlewiczTimothy Ziemlewicz More articles by this author , J. Louis HinshawJ. Louis Hinshaw More articles by this author , Fred LeeFred Lee More articles by this author , Wei HuangWei Huang More articles by this author , Richard YangRichard Yang More articles by this author , Stephen Y NakadaStephen Y Nakada More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3116AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The histologic presence of residual RCC following thermal ablation without radiographic evidence of tumor is of uncertain clinical significance. The purpose of this study is to evaluate the incidence of viable RCC in patients with no radiographic recurrence following percutaneous microwave (MW) ablation. METHODS Routine post-ablation biopsy was obtained approximately 9 months following ablation. Four cores were routinely sampled from the ablation bed (2 for H&E staining, 2 for NAD diaphorase testing). A pilot study included ex-vivo ablation of RCC immediately following nephrectomy to evaluate histologic effect of ablation. RESULTS Pilot study included 10 patients who had nephrectomy for RCC. A sample containing tumor and normal renal parenchyma was evaluated histologically following ex-vivo supra-therapeutic MW ablation. Preservation of tumor histology was demonstrated in specimens evaluated after H&E processing. Fifty-six biopsy proven RCC tumors in 52 patients (37M/15F, median age: 67.5 IQR: 64 - 71.3) following percutaneous MW ablation from April 2012 through May 2016 were evaluated. Median tumor diameter and nephrometry score were 2.8 cm (IQR: 2.0 - 3.2) and 6.5 (IQR: 5.0 - 8.0). Median Charlson Co-Morbidity Index was 2.0 (IQR: 0.75 - 3.0). Clear cell histology represented 40/56 (71.4%). Median follow up was 15.3 months (IQR: 8.4 - 27.0). Median time between ablation and biopsy was 9.3 months (IQR: 9.0 - 10.3). Following ablation, ablation zone biopsy has no RCC present in 51/56 (91.1%) tumors while 5/56 (8.9%) had the appearance of histologically residual tumor. Positive versus negative post-ablation biopsies did not significantly differ in nephrometry score, age, tumor size, or histology (p > 0.05). In patients with residual tumor, 2 were treated with repeat ablation and 3 elected surveillance. No patients have subsequently developed radiologically identifiable kidney recurrence and one patient with negative renal ablation bed biopsy was treated surgically for recurrence outside kidney and is currently NED. CONCLUSIONS Histologically identifiable tumor was identified in 9% of routine biopsies in the absence of radiologic recurrence following microwave ablation. The clinical significance of preserved tissue histology is unclear as no patients have radiological recurrence in ablated renal tumors to date. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1333 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Brett Johnson More articles by this author Amy Lim More articles by this author Shane Wells More articles by this author Sara Best More articles by this author Michael Hartung More articles by this author Meghan Lubner More articles by this author Timothy Ziemlewicz More articles by this author J. Louis Hinshaw More articles by this author Fred Lee More articles by this author Wei Huang More articles by this author Richard Yang More articles by this author Stephen Y Nakada More articles by this author E. Jason Abel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...