Ablation Sessions Research Articles

Microwave ablation for small papillary thyroid carcinomas: clinical outcomes and thyroid function preservation.

This study explores the impact of microwave ablation on thyroid function in patients with Small Papillary Thyroid Carcinomas, using a specific energy/volume model to optimize treatment and evaluate clinical efficacy. A cohort of 70 patients with confirmed Small Papillary Thyroid Carcinomas underwent microwave ablation tailored to individual nodule characteristics. Pre- and post-ablation assessments included ultrasound imaging for nodule size, and thyroid function tests (TSH, Free T4, and Free T3 levels) were conducted at baseline, 1, 3, 6, and 12 months post-treatment. The main results are the complete ablation rate of nodules and the stability of thyroid function after treatment. Secondary outcomes include the incidence of complications and other clinical parameters. The complete ablation rate was achieved in 95% of the nodules, with most patients (90%) requiring a single ablation session. Nodule size reduced significantly from an average of 174.0 ± 259.1 mm3 to 3.2 ±11.3 mm3 , with the mean volume reduction rate (VR) of 98.47 (5.82%) at 18-months follow-up. Stable thyroid function and minimal fluctuations in hormone levels were observed in 90% of patients, demonstrating the effectiveness of microwave ablation in preserving thyroid function. Notably, lower energy/volume ratios were linked to reduced risk of complications and preservation of thyroid function. Only 5% of patients reported minor complications, with no major adverse events. The study's results validate the clinical utility of Microwave ablation (MWA) in energy/volume setting as an effective, minimally invasive treatment for small papillary thyroid carcinomas.

Safety, efficacy, and changing trends in endoscopic ablation for dysplastic Barrett esophagus in Poland: a long-term multicenter retrospective analysis.

Endoscopic ablation is the mainstay of treatment for dysplastic Barrett esophagus (BE), of which radiofrequency ablation (RFA) and argon plasma coagulation (APC) are the most widely available options. We aimed to analyze the safety and outcomes of endoscopic ablation for BE at the Polish centers offering this procedure. We retrospectively analyzed data from 3 high‑volume endoscopy centers between 2002 and 2024. We included adult patients with confirmed BE who received at least 1 ablation session with either conventional / hybrid APC (APC/h‑APC) or RFA, followed by at least 1 endoscopic follow‑up. The outcomes included the rate of complete remission of intestinal metaplasia (CR‑IM) and dysplasia (CR‑D), and adverse event (AE) rate. Risk factors for treatment failure were analyzed using a multivariable logistic regression model. We analyzed data from 191 patients, of which 160 were included (mean [SD] age, 59.4 [10.8] years; 79.4% men). The overall CR‑IM and CR‑D rates were 80% and 93.8%, respectively. We reported 49 minor AEs (30.6%), and 9 major AEs (5.6%), including 7 esophageal strictures (4.4%). In the early 2000s, APC was the only available ablation modality. However, since 2008, it has been gradually replaced by RFA. Notably, RFA was used for more severe BE cases and carried a higher risk of failed treatment than APC/h‑APC (odds ratio [OR], 7.48; P = 0.001). Other risk factors for treatment failure included the BE length (OR, 1.3; P = 0.002) and diabetes (OR, 7.48; P <0.001). Endoscopic ablation for BE is safely and effectively provided in Poland at a few expert centers. Patients with diabetes and long‑segment BE are at an increased risk for treatment failure.

Risk factors of complications after thermal ablation for hepatocellular carcinoma: the role of assessment of liver background.

To use an elastography technology and other clinical and radiological data for assessment of liver background and analyze risk factors of complications after thermal ablation in patients with hepatocellular carcinoma. Demographics, laboratory analyses, and radiological characteristics were collected from all patients. Main elastography-related indicators included F index (fibrosis index), A index (inflammation index), ATT (attenuation coefficient), E (kPa), AREA (area of blue parts), and CORR (correlation). All complications after thermal ablation were collected. Univariate analysis was performed to detect significant variables, which subsequently entered a stepwise logistic regression analysis (conditional forward selection) to identify independent variables. A total of 218 patients from October 2020 to June 2023 with 291 thermal ablation sessions were enrolled. 115 patients (52.8%) developed complications. Fifteen patients (6.9%) developed major complications. Minor complications included postoperative pain (20.6%), fever (19.3%), effusion (22.5%), and hyperammonemia (1.8%). AREA ( P = 0.034), tumor size ( P = 0.005), and abnormal aspartate aminotransferase (AST) ( P = 0.018) were independent predictors for complications. F index ( P = 0.021), tumor size ( P < 0.001), and abnormal AST ( P = 0.047) were independent predictors for effusion. The results of univariate analysis of infection showed that tumor size, CORR, ATT, diabetes, Child-Turcotte-Pugh grade, abnormal AST, total protein, and albumin were significant (all P < 0.05). Several radiological and combinational elastography indicators related to liver fibrosis, steatosis, or inflammation were significantly correlated with the occurrence of complications. Clinical assessment of the liver background should not be neglected in the management of postablation complications.

Surgical Management of Moderate Rhinophyma with Nasal Nodules: An Electrosurgery Approach

Introduction: Rhinophyma, a severe manifestation of rosacea, is characterized by hypertrophy of sebaceous glands and fibrosis of the nose, often leading to significant aesthetic and functional impairments. Surgical treatment is the preferred approach for advanced cases to restore nasal appearance and function. Case Report: We present the case of a 60-year-old man with moderate rhinophyma and nodules on the nostrils. Surgical management under local anesthesia involved the use of thermal loops for excision of the lesions and bipolar electrosurgery for hemostasis. The patient was also treated for rosacea with topical agents, including metronidazole and azelaic acid, and oral doxycycline for inflammatory lesions. Directed healing followed the surgery, along with LED phototherapy and ablative erbium laser sessions to optimize results. Discussion: The use of thermal loops and electrosurgery allowed for precise excision and control of bleeding. Postoperative care, including daily greasy vaseline dressings, facilitated rapid healing. Mild infection at the excision sites was treated with topical and prophylactic antibiotics. Six sessions of LED therapy combining four types of light (infrared, red, yellow, and blue) improved healing and reduced inflammation. Ablative erbium laser was proposed to further enhance the aesthetic outcome. Conclusion: A combined surgical approach and careful postoperative management yielded satisfactory results in the treatment of rhinophyma.

Image-guided percutaneous microwave ablation for unresectable pancreatic cancers: A multicenter retrospective study

Image-guided percutaneous microwave ablation for unresectable pancreatic cancers: A multicenter retrospective study

Irreversible Electroporation in Treating Colorectal Liver Metastases in Proximity to Critical Structures

Irreversible Electroporation in Treating Colorectal Liver Metastases in Proximity to Critical Structures

Efficacy of Fractional Versus Fully Ablative CO2 Laser for Distolateral Onychomycosis: Experience With 20 Patients.

Oral antifungals are the treatment choice for onychomycosis, and topical therapies are favored in cases of limited nail involvement. Recently, carbon dioxide (CO2) laser treatment has emerged as an option to enhance the effectiveness of topical therapies. Our objective was to compare the efficacy of fractional ablative and fully ablative CO2 laser treatments for distolateral subungual onychomycosis affecting a single toenail and caused by dermatophytes. The records of 10 patients treated with a single fully ablative CO2 session were matched with those of 10 patients who underwent a single CO2 fractional treatment. All had previously failed topical antifungal lacquers and were discharged with the prescription of topical ciclopirox nail lacquer (8%) for 3 months. The clinical response rates were 80% for the fully ablative group and 60% for the fractional group. Additionally, the mean reduction in Onychomycosis Severity Index from baseline to 8.6±1.6 weeks after treatment completion was 6.9±5.4 in the fully ablative group and 3.6±6.6 in the fractional group. The relapse rate among responders was 12.5% in the fully ablative and 33.3% in the fractional group after a mean follow-up time of 29.4±2.3 weeks. Fractional and fully ablative CO2 laser in combination with ciclopirox lacquer could increase the response rate in onychomycosis resistant to topical antifungals when systemic therapy is contraindicated or not yet pursued. Fully ablative mode therapy is significantly more effective than fractional (P < 0.05). Further studies are needed to identify prognostic response factors and assess the long-term effectiveness of CO2 laser treatment.

10 Cases of Nonresponse to Laser Thermoablation from a Series of 187 Patients: Histological Outcomes after Surgery and Related Evaluations.

Thyroid thermoablative techniques have been developed as an alternative to surgery for the treatment of symptomatic benign nodes, with the advantage of being minimally invasive, repeatable, with a minimal complication rate, and avoiding the perioperative risks and irreversible consequences of surgery. A series of patients undergoing laser thermoablation by the same team of endocrinologists operating in 2 centers from May 2016 to December 2022 is presented. The procedure was performed in patients with compressive symptomatology determined by a thyroid node typed TIR 2, or TIR 3A with rejection of the surgical option. We analyzed cases that required surgery because of persistent compressive symptoms, reduction failure, or increase in volume. From May 2016 to December 2022, 207 thermoablative procedures were performed (187 patients). Single ablative session was unresolved in 28 patients (15%). The proportion of nodes with TIR 3A cytology was significantly higher (21.4 vs 7.0%). In this group, the response in terms of volumetric reduction 6 months after the procedure was significantly lower (5.7% vs 50%). Ten patients (5.3%) underwent surgery, whose histological outcome demonstrated malignancy in 50% of cases. Data show the importance of timely re-evaluation with referral to surgical treatment for patients presenting a less than 20% volume reduction 6 months after thermoablation, in order to ensure promptly effective treatment of misrecognized malignancies.

A sensitivity analysis of laser thermotherapy efficacy in lung cancer treatment to the temperature dependence of thermal properties.

Laser interstitial thermotherapy has shown potential in the treatment of inoperable lung cancers, which make up 70-80 % of all cases, thanks to the possibility of real-time ultrasound guidance, a fine introducer needle, and faster recovery after the procedure. To plan a laser ablation session through numerical modeling, the sensitivity analysis of the input parameters is necessary since simplifying the influential parameters could lead to a different treatment outcome.The purpose of this study is to determine the sensitivity of laser-induced ablated volume, an indicator of therapy efficacy, with regard to the temperature dependence of thermal properties in the clinical power ranges (i.e., between 2 W and 5 W at the wavelength of 1064 nm) for lung tissue. According to the results, the difference between ablated volumes derived from constant and temperature-dependent thermal properties grows with increasing power, reaching 17.5% and 60.3% under ex vivo and in vivo conditions at 5 W, respectively. As the blood perfusion rate strongly affects the thermal effects in tissue, the temperature dependency of this parameter cannot be ignored. The assumption of constant thermal properties is valid for ex vivo planning by acceptable error when the laser power is set at a low level, e.g., ~ 2% at 2 W and ~ 6% at 3 W.Clinical Relevance-The methods and results of this study set the basis for defining the accurate pre-planning of laser-induced thermotherapy of lung cancer.

Image-Guided Thermal Ablation for Hepatic Epithelioid Hemangioendothelioma: A Multicenter Experience

Image-Guided Thermal Ablation for Hepatic Epithelioid Hemangioendothelioma: A Multicenter Experience

Incidental Ring-hyperenhancing Liver Micronodules at CT Hepatic Arteriography-guided Percutaneous Thermal Ablation of Colorectal Liver Metastases.

CT during hepatic arteriography (CTHA) is a highly sensitive imaging method for detecting colorectal liver metastases (CLMs), which supports its use during percutaneous thermal liver ablation. In contrast to its high sensitivity, its specificity for incidental small CLMs not detected at preablation cross-sectional imaging is believed to be low given the absence of specific imaging signatures and the common presence of pseudolesions. In this retrospective study of 22 patients (mean age, 55 years ± 10.6 [SD]; 63.6% male, 36.4% female) with CLMs undergoing CTHA-guided microwave percutaneous thermal ablation between November 2017 and October 2022, the authors provided a definition of incidental ring-hyperenhancing liver micronodules (RHLMs) and investigated whether there is a correlation of RHLMs with histologic analysis or intrahepatic tumor progression at imaging follow-up after applying a biomechanical deformable image registration method. The analysis revealed 25 incidental RHLMs in 41.7% (10 of 24) of the CTHA images from the respective guided ablation sessions. Of those, four RHLMs were ablated. Among the remaining 21 RHLMs, 71.4% (15 of 21) were confirmed to be CLM with either histology (n = 3) or imaging follow-up (n = 12). The remaining 28.6% (six of 21) of RHLMs were not observed at follow-up imaging. This suggests that RHLMs at CTHA may be an early indicator of incidental small CLMs. Keywords: Colorectal Neoplasms, Liver, Angiography, CT, Incidental Findings, Ablation Supplemental material is available for this article. © RSNA, 2024.

Thermal ablation for local control of lung metastases and its effect on pulmonary function

Image-guided thermal ablation in the lung has consistently demonstrated preservation of lung function without permanent decline following treatment compared to other local treatment options, specifically surgical intervention or stereotactic radiation therapy. Here, we report a case of a 68-year-old female with mesonephric adenocarcinoma of the uterus metastatic to the lung, treated with primarily thermal ablation to manage her lung tumor burden. The patient underwent a hysterectomy and wedge resection of the left lower lobe in addition to first-line chemotherapy. To reduce the total lung tumor burden, in the absence of other more effective therapies and to strategically eradicate ultra-central lung tumors, the patient underwent multiple ablative therapies. In total, she underwent 45 ablation sessions, of which 42 were cryoablation with the rest conducted with microwave ablation, two stereotactic body radiation therapies, and one brachytherapy for 75 lung metastases. Pulmonary function tests were conducted before the start of serial ablation treatments and measured again after 32 ablation sessions which revealed minimal change in pulmonary function parameters while maintaining adequate functional status. We highlight the potential benefit of ablative therapies regarding pulmonary function compared to other local treatment options for metastatic lung cancer.

Ratio of P-Wave Duration to P-Wave Amplitude and Left Atrial Remodeling: Insights from Electrophysiological Findings and Myocardial Injury After Cryoballoon Ablation

Ratio of P-Wave Duration to P-Wave Amplitude and Left Atrial Remodeling: Insights from Electrophysiological Findings and Myocardial Injury After Cryoballoon Ablation

OGBN O01 Durability of Radiofrequency Ablation for Long-segment and Ultralong-segment Barrett’s Esophagus over 10 years

Abstract Background Long-term durability data for radiofrequency ablation(RFA) to prevent esophageal adenocarcinoma in long-segment(LSBE) and ultralong-segment Barrett’s esophagus(ULSBE) is lacking. This study aimed to determine 10-year cancer progression, eradication, and complication rates in LSBE and ULSBE patients treated with RFA. Methods Single surgeon prospective database of patients with LSBE (≥3 to &amp;lt;8cm) and ULSBE (≥8cm) who underwent RFA (2001-2021) were retrospectively analyzed. Ten-year cancer progression calculated with Kaplan-Meier analysis. Eradication rates, including complete remission of dysplasia (CR-D) and intestinal metaplasia (CR-IM), and rates of recurrence and complications, compared between LSBE and ULSBE groups. Results Ten years after starting treatment, the cancer rate was 14.3% in 56 patients. CR-D and CR-IM rates were 87.5% and 67.9%, respectively. Eradication rates for dysplasia in LSBE and ULSBE patients(90.6%versus83.3%) and IM(71.9%versus62.5%) were not significantly different. ULSBE patients required higher mean number of ablation sessions for IM eradication(4.7versus3.7,p=0.032), while complication rates including strictures(4.2%versus6.2%), perforation(0versus0) and bleeding(4.2%versus3.1%), were similar between ULSBE and LSBE patients, respectively. On multivariate analysis, shorter Barrett’s segment and baseline low grade dysplasia were associated with increased likelihood for eradication of IM and dysplasia. Conclusions RFA was durable in maintaining dysplasia and IM eradication in both LSBE and ULSBE over 10 years, and with low complication rates. IM eradication was more difficult to achieve in ULSBE. Late development of cancer occurred in 14.3%.

Abstract 17674: Serum Brain-Derived Neurotropic Factor Levels Predict the Recurrences of Atrial Fibrillation Following Catheter Ablation

Background: Brain-derived neurotropic factor (BDNF) is a growth factor with roles within the nervous system and cardiovascular system. It has been reported that serum BDNF is decreased in diseases related to persistent stress, such as chronic inflammation. Atrial fibrillation (AF) is also considered to be one of the diseases related to chronic inflammation, although the relationship between serum BDNF and AF remains unclear. Methods: This prospective study included 68 consecutive patients (44 men; 69 [58-69] years) who underwent first session of paroxysmal AF ablation. Before and 3 months after the ablation, blood samples were obtained to measure the several biomarkers that are known to be related to AF in addition to serum BDNF. AF recurrence was defined as the appearance of AF after 3 month blanking period following the ablation. Results: The serum BDNF levels before ablation were significantly increased after AF ablation (3.5 [1.6-16.6] ng/ml vs. 22.1 [16.2-27.4] ng/ml, p&lt;0.001). During follow-up period of 10±2 months, AF recurrence occurred in 5 (7%) patients. The serum BDNF at 3 months post-ablation were significantly lower in patients with recurrent AF than in those without (19.6 [13.8-20.8] ng/ml vs. 22.0 [17.5-27.1] ng/ml, p=0.019). Furthermore, the serum BDNF at 3 months post-ablation was an independent predictor of AF recurrence (odds ratio 0.912, 95% confidence interval 0.835-0.996, p=0.040). According to the ROC curve analysis, the serum BDNF at 3 months post-ablation &lt;22.0 ng/ml was associated with AF recurrence with 100% sensitivity and 54% specificity (area under the curve=0.817, p=0.019). Kaplan-Meier survival curve showed that the recurrence rate of AF was higher in the group L (the serum BDNF at 3 months post-ablation &lt;22.0 ng/ml) than the group H at 3 months post-ablation &gt;22.0 ng/ml) (p = 0.02) [figure 1]. Conclusions: Lower serum BDNF levels at 3 months after blanking period following the AF ablation might be a predictor of AF recurrence.

A novel feature extraction method for the localization of accessory pathways in patients with Wolff-Parkinson-White syndrome

A novel feature extraction method for the localization of accessory pathways in patients with Wolff-Parkinson-White syndrome

Thermoablative Treatment of De Novo Tumor in Kidney Allograft.

The overall cancer risk increases in transplant patients, including in kidney allografts. This study aimed to analyze the outcome of patients with kidney allograft malignant tumors who underwent percutaneous thermal ablation. We included 26 renal allograft tumors, including 7 clear-cell renal cell carcinoma (RCCs), 16 papillary RCCs, 1 clear-cell papillary RCC, and 2 tubulocystic RCCs, treated in 19 ablation sessions. Outcomes of thermal ablation therapy were assessed, including technical success, adverse events, local tumor progression, development of metastases, survival after thermal ablation, and changes in renal function. Success rate was achieved in all ablation sessions (primary success rate: 96%; secondary success rate: 100%). No adverse events were observed in grades 3, 4, or 5. The median follow-up period was of 34 mo (15-69 mo). Two patients died during follow-up from a cause independent of renal cancer. The median decrease in estimated glomerular filtration rate 1 y after procedure was -4 (interquartile range, -7 to 0) mL/min/1.73 m 2 . One patient returned to dialysis within the year of the procedure. Percutaneous thermal ablation shows convincing results for treating malignant renal graft tumors and should be a useful treatment option. The shorter hospitalization time, the advantage of avoiding a potentially challenging dissection of the transplant, and the excellent preservation of allograft function appear encouraging to extend this indication.

Long-term follow-up of CT-guided percutaneous radiofrequency ablation of T1 renal cell carcinoma

BackgroundRadiofrequency ablation (RFA) has an established role in effective treatment of renal cell carcinomas (RCCs), as most of RCCs are diagnosed incidentally in early stages. Long-term follow-up is however important to consolidate the technique. Most of the literature contains series of short-term follow-ups of periods shorter than 2 years. This study in hand demonstrates the results of longer-term follow-up than the previously published series.ResultsData analysis of 31 patient records involved in this study demonstrated the high clinical efficacy of RFA for long term, 12-year follow-up, by following the absence of tumor recurrences, as shown on regular interval contrast enhanced computed tomography (CT) and or magnetic resonance imaging (MRI).ConclusionsRFA continues to prove its competent role in treating RCCs on longer-term follow-ups; the smaller the size of a tumor and the more peripheral the tumor is, the more effective the therapy. Even in larger early stages tumors, repeating the ablative sessions results in complete ablation without the need for more invasive surgical interventions.

Surgery for ventricular tachycardia originating from the left ventricular summit.

Ventricular tachycardia (VT) originating from the left ventricular summit region, the most superior region of the left ventricle surrounded by the major coronary arteries and veins, is frequently refractory to pharmacological therapies and endocardial and epicardial catheter ablation. Eleven patients with an age from 31 to 79 (median 56) years old, underwent map-guided surgery for left ventricular summit VT. All patients had undergone 1-5 unsuccessful sessions of catheter ablation for incessant VT, preoperatively. Five patients had suffered VT storm and 1 had a history of cardiopulmonary resuscitation. Four patients had implanted with a defibrillator. Epicardium to endocardium transmural cryothermia was applied at the VT origin determined by intraoperative epicardial mapping with electro-anatomical mapping system. Harmonic scalpel was used to remove the epicardial fat and cryothermia was applied directly to the myocardium, avoiding thermal or mechanical injuries to the coronary vessels. Additional endocardial cryothermia at the VT origin was performed by a cryoprobe introduced into the left ventricular cavity through an aortotomy. There was no surgical mortality or long-term mortality related to VT during a median follow-up period of 60 months (interquartile range: 34-82). Five-year freedom from preoperatively documented left ventricular summit VT and non-documented VT was 91% and 73%, respectively. All the patients with postoperative VT underwent successful catheter ablation. Other patients were free from VT during the follow-up period. Epicardial to endocardial transmural cryothermia at the VT origin guided by intraoperative electro-anatomical mapping with a close collaboration with electrophysiologists was crucial in successful surgery for left ventricular summit VT.

Double closed loop small bowel obstruction due to right diaphragmatic hernia after transcatheter arterial chemoembolization and microwave ablation for hepatocellular carcinoma.

64-Year-old male patient with hepatocellular carcinoma (HCC), liver cirrhosis, chronic hepatitis C infection, and glottic cancer presented with acute progressive abdominal pain and palpable mass in right upper quadrant of the abdomen. Despite treatment with hyoscine and tramadol, the symptoms persisted. He had received three sessions of Transcatheter arterial chemoembolization (TACE) and two sessions of microwave ablation (MWA) for HCC treatment, with the last session being TACE 11months prior. Plain film abdomen showed bowel gas pattern in the right hemithorax compatible with bowel obstruction. CT imaging revealed a right diaphragmatic hernia containing closed loop small bowel obstruction. An emergency exploratory laparotomy was performed. The patient improved and was discharged. There was no recurrence of diaphragmatic hernia or abdominal mass or pain at the 6-month follow-up visit. We herein demonstrate a catastrophic complication of TACE by using an IPA and MWA which leads to right diaphragmatic hernia.