CT-guided Percutaneous Cryoablation Research Articles

The efficacy and safety of computed tomography-guided percutaneous cryoablation for malignant liver tumors at high-risk sites

Objective: To assess the efficacy and safety of computed tomography (CT)-guided percutaneous cryoablation in treating malignant liver tumors located explicitly at high-risk sites. Methods: Data were collected retrospectively from patients with malignant liver tumors undergoing percutaneous cryoablation at Tianjin Medical University Cancer Hospital between January 2018 and December 2021. In all, 46 patients with malignant liver tumors at non-high-risk sites were matched 1∶1 according to the maximum tumor diameter. Technical success rate, complete ablation rate, and complications at 12 and 24 months post-surgery were evaluated. A statistical analysis of the ablation effect difference between the high-risk site and non-high-risk site groups was conducted. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Results: Both groups demonstrated a 100% intraoperative technical success rate, and no major complications related to cryoablation were observed. The complete ablation rate was 82.6% (38/46) and 71.7% (33/46) in the high-risk group and 84.8% (39/46) and 73.9% (34/46) in the non-high-risk group at 12 and 24 months, respectively. There was no significant difference in complete ablation rates between the two groups (P>0.05). Multivariate analysis identified the distance between the tumor edge and high-risk site ≤5 mm and preoperative trans-arterial chemoembolization (TACE) treatment as independent risk factors for cryoablation effect. Conclusion: CT-guided percutaneous cryoablation is a safe and effective approach for patients with malignant liver tumor at high-risk sites. Our results emphasize the importance of proper preoperative planning and intraoperative manipulation.

CT-Guided Percutaneous Cryoablation of Breast Cancer: A Single-Center Experience.

This study shall retrospectively evaluate the efficacy and safety of liquid-nitrogen based CT-guided cryoablation (CA) as a minimal-invasive technique for the curative treatment of primary breast cancer. A total of 45 female patients with 56 tumors were treated by CT-guided CA in analgosedation as an outpatient procedure. We used a liquid-nitrogen based system with a single cryoprobe and performed two freeze cycles with an intermediate thawing. The mean tumor diameter was 1.6 ± 0.7 cm. Follow-up was conducted via contrast-enhanced MR images of the breast. No complications were observed in all 56 ablations. Initial complete ablation was achieved in 100% of cases. Four cases of local tumor progression were reported, resulting in a rate of 8.9%, and 6 cases of intramammary distant recurrence at a rate of 13.3%. The extramammary tumor progression was observed in 7 patients at a rate of 15.6%. The mean overall survival was 4.13 years (95% CI: 3.7-4.5). The mean overall progression-free survival was 2.5 years (95% CI: 1.8-3.2) and the mean local progression-free survival was 2.9 years (95% CI: 2.3-3.6). Cryoablation is a safe and effective treatment for primary breast cancer tumors, which can be performed in analgosedation and as an outpatient procedure. However, potential for improvement exists and further evidence is necessary.

Percutaneous cryoablation of breast cancer metastases: Analysis of long-term single center experience, efficacy and outcomes.

e13105 Background: Percutaneous image-guided cryoablation is a minimally invasive loco-regional treatment modality with wide availability and advantages of minimal sedation, short recovery, and ability to continue concurrent systemic therapy. However, there is a paucity of data about its long-term effects in the treatment of metastatic breast cancer despite evidence suggesting a potential survival advantage with loco-regional therapy for oligo-metastatic disease. Methods: We conducted retrospective analysis of patients who underwent CT-guided percutaneous cryoablation for metastatic breast cancer and had at least 1 follow up post cryoablation. Patient data including demographics, cancer treatment history and outcomes were extracted by chart review after IRB approval. Descriptive analyses of overall survival (OS), progression-free survival (PFS), and time to next-line treatment (TTNL) was performed. Results: The study encompassed 37 metastatic breast cancer patients who underwent cryotherapy between 2004-2021. These ablation procedures targeted various metastatic sites, which included the liver, lung, renal, lymph nodes, subcutaneous nodules, and bone. Their median age at the time of cryoablation was 58 years (range: 34-90). Among them, 46% had triple-negative breast cancer (TNBC), 41% were HR+/HER2-, and 8% were HER2+. Prior to first cryoablation procedure, 59% of patients had received more than one line of systemic therapy, and 73% were actively undergoing systemic treatment. The median size of the metastatic lesions treated with cryoablation was 1.8 cm (range: 0.4-6.5 cm). The most frequent site for cryotherapy was the liver (38%), followed by lymph nodes (30%). For the entire cohort, median PFS, TTNL, and OS were 7.1, 14, and 65.7 months, respectively. Subgroup analysis revealed mPFS of 3.1, 7.4 and 14.2 months for TNBC, Her2+ and HR+/Her2- cohorts respectively. Subgroup analysis for OS was not reported due to the small number of events and premature follow up time. Among the 27 patients who experienced disease progression, the majority (74%) had distant progression, with 22% occurring within the same organ but outside the ablation zone. Local recurrence within the ablation zone was rare, observed in only 4% of cases. Conclusions: Percutaneous image-guided cryoablation of metastatic breast cancer lesions demonstrated durable local response, prolonged PFS, TTNL and OS. Future studies investigating cryoablation as part of a multidisciplinary treatment approach for patients with metastatic breast cancer are worthwhile to confirm disease control rate and improvement in survival.

High-Frequency Jet Ventilation Versus Spontaneous Respiration for Percutaneous Cryoablation of Lung Tumors: Comparison of Adverse Events and Procedural Efficiency.

BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.

Percutaneous cryoablation of 100 anterior renal tumors: safety and technical success.

To assess the safety, technical success, and clinical outcomes of percutaneous cryoablation (PCA) in patients with anterior renal tumors. A retrospective analysis of patients with anterior renal tumors, defined as tumors at or anterior to the level of the renal pelvis, treated with CT-guided PCA from 2008 to 2022. Summary statistics included demographics and baseline tumor attributes. Treatment and follow-up metrics included primary and secondary technical success, adverse events (AEs) according to the SIR classification, local recurrence, overall survival (OS), and cancer-specific survival (CSS)). 100 patients (60 males; mean age: 63, mean BMI: 33, mean Charlson comorbidity index:6) with 100 anterior renal tumors were included. 78% of tumors were T1a and 22% T1b with mean maximal tumoral dimension of 29mm (range: 6-62mm) and mean distance to nearest critical structure 9mm (range: 0-40mm). Mean follow-up was 20.9months (range: 3-103). 28% of PCAs required hydrodissection. Technical success was achieved in 92% of patients; with six remaining patients undergoing successful repeat PCA (secondary technical success: 98%). The remaining two patients without primary technical success were either surveilled or had a benign pathology on resulted concomitant biopsy. Four patients (4%) had major AEs (hemorrhage requiring prolonged admission, transfusion, or embolization (n = 3), perinephric abscess requiring drainage (n = 1)) and 27% had minor AEs. Eight patients (8%) had recurrence with a one-year OS of 94% and CSS of 100%. All recurrences underwent repeat ablation without additional recurrence and 3/8 (38%) were T1b and 5/8 (63%) were T1a tumors. PCA of anterior renal tumors can be performed safely with high rates of technical and oncologic success.

Percutaneous Cryoablation under Conscious Sedation: A Safe, Effective and Painless Option for the Treatment of Pediatric Osteoid Osteoma.

Percutaneous CT-guided cryoablation is an emerging technique for treating bone tumors. However, experience with using this procedure for osteoid osteomas in pediatric patients remains limited. Our study aims to assess its technical feasibility, clinical efficacy, and safety in children treated under conscious anesthesia. We conducted a retrospective study of consecutive pediatric patients who underwent CT-guided percutaneous cryoablation for osteoid osteomas at our institution between September 2017 and March 2021. All patients received conscious anesthesia. Data on peri-procedural VAS scores, post-procedural VAS scores, imaging findings, and nonsteroidal anti-inflammatory drug (NSAID) usage rates were collected for each patient. Technical success was defined as proper cryoprobe placement at the nidus center, while clinical success referred to pain relief without NSAID use. Intra- and post-operative complications were also evaluated. Nine patients underwent CT-guided percutaneous cryoablation for osteoid osteomas under conscious sedation, with a 100% overall success rate with low peri-procedural and median VAS scores (p < 0.01). No complications were observed during or after the procedure. CT-guided percutaneous cryoablation of pediatric osteoid osteomas is an effective and safe minimally invasive procedure feasible under conscious anesthesia, holding promise as a valuable treatment option.

The safety and response of CT guided percutaneous cryoablation for lung nodules by 17-gauge needles

BackgroundThe safety and efficacy of 17-gauge needles used in CT-guided percutaneous cryoablation for lung nodules were explored in this study. The purpose of the study was to compare the findings with earlier research and multi-center clinical trials that used various needle sizes.MethodsBetween 2016 and 2020, a retrospective study was conducted with approval from the institutional review board. A total of 41 patients were enrolled, and 71 lung nodules were treated in 63 cryoablation procedures using local anesthesia. Complication rates were recorded, and overall survival rates as well as tumor progression-free rates were calculated using the Kaplan-Meier method.ResultsSelf-limited hemoptysis was caused by 12.9% of the procedures, and drainage was required for pneumothoraces resulting from 11.3% of them. The overall survival rates at one, two, three, and four years were 97%, 94%, 82%, and 67%, respectively. The tumor progression-free rates at one, two, three, and four years were 86.2%, 77%, 74%, and 65%, respectively.ConclusionCryoablation for lung nodules using 17-Gauge needles can achieve similar rates of survival and tumor control rates, similar or even lower complication rates as compared with other studies and multi-center trials using mixed sized needles.

Percutaneous CT-Guided Cryoablation for Locally Recurrent Prostate Cancer: Technical Feasibility, Safety, and Effectiveness

PurposeTo assess the feasibility and safety of using computed tomography (CT) guidance for ablation of prostate cancer in the salvage setting. Materials and MethodsThis institutional review board–approved retrospective study of consecutive patients who presented with prostate cancer recurrence and underwent percutaneous CT-guided cryoablation was conducted between July 2020 and September 2022. A total of 18 patients met the inclusion criteria, and a total of 19 procedures were performed. Demographic details; preablation and postablation urinary, rectal, and erectile function assessment; procedure details; and preoperative and postoperative imaging findings and prostate-specific antigen (PSA) values were recorded. ResultsThe mean treated tumor size was 15.7 mm ± 6.2. Technical success was achieved in 18 of the 19 procedures (94.7%), with 1 procedure aborted due to inability to obtain a safe plane. The mean follow-up time was 10.0 months (range, 2.3–26.7 months) at the time of manuscript preparation. The mean PSA before ablation was 8.1 ng/mL ± 9.3, and postablation PSA nadir was 2.6 ng/mL ± 4.0 (P = .002). Of the 18 patients who had postoperative imaging, 16 (88.9%) had a complete response (ie, no evidence of residual disease), and 2 (11.1%) patients had residual disease. Overall, 16 (88.9%) of the 18 treated patients demonstrated a PSA and/or imaging response to ablation. Mild adverse events occurred in 4 (22%) of the 18 cases. ConclusionsCT-guided cryoablation appears to be a technically feasible, safe option for treating locally recurrent prostate cancer.

PD07-08 CLINICAL OUTCOMES AND IMMUNE RESPONSE OF PERCUTANEOUS CRYOABLATION FOR LOCALIZED RENAL CELL CARCINOMA: EXPERIENCE IN CLINICAL PRACTICE IN JAPAN

You have accessJournal of UrologyCME1 Apr 2023PD07-08 CLINICAL OUTCOMES AND IMMUNE RESPONSE OF PERCUTANEOUS CRYOABLATION FOR LOCALIZED RENAL CELL CARCINOMA: EXPERIENCE IN CLINICAL PRACTICE IN JAPAN Taigo Kato, Yohei Okuda, Yusuke Ono, Hiroki Higashihara, Yu Ishizuya, Yoshiyuki Yamamoto, Koji Hatano, Atsunari Kawashima, and Norio Nonomura Taigo KatoTaigo Kato More articles by this author , Yohei OkudaYohei Okuda More articles by this author , Yusuke OnoYusuke Ono More articles by this author , Hiroki HigashiharaHiroki Higashihara More articles by this author , Yu IshizuyaYu Ishizuya More articles by this author , Yoshiyuki YamamotoYoshiyuki Yamamoto More articles by this author , Koji HatanoKoji Hatano More articles by this author , Atsunari KawashimaAtsunari Kawashima More articles by this author , and Norio NonomuraNorio Nonomura More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy has been recognized as the standard treatment for small renal cell carcinoma (sRCC) (<7 cm, cT1 tumor) because it provides optimal oncological outcomes and maintains better renal function than radical nephrectomy. On the other hand, with the increase of longevity, percutaneous cryoablation (PCA) for sRCC has been validated as an alternative nephron-sparing therapy especially in patients with comorbidity. However, there are only a few reports regarding long-term clinical outcome of PCA. METHODS: Of 112 patients who underwent CT-guided PCA at our hospital from June 2014 to December 2021, we retrospectively analyzed clinical data, oncological outcomes, and safety of PCA in 97 patients with sRCC without metastasis. In addition, we collected tissue samples before and at 3 months after treatment to evaluate the infiltration of immune cells. RESULTS: Of the 97 patients, 71 (73%) were treated as initial therapy for renal cancer and 26 (27%) as treatment for local recurrence of renal cancer. During a median follow-up of 36 months (3.5-96 months), 1 (1%) and 5 (5%) patients had residual cancer and recurrence, respectively. For survival analysis, PCA had 87 % of 5-year overall survival, 100% of 5-year cancer-specific survival, and 90% of 5-year local recurrence-free survival (Figure 1A-C). The mean eGFR of pre-PCA and at 3-month post-PCA were 52.8±1.92 ml/min and 48.3±1.92 ml/min, respectively. In logistic regression analysis, high R.E.N.A.L nephrotmetry score (>7) was associated with the decrease in eGFR of more than 20% (odds ratio 3.27, 95% confidence interval 0.95-11.27, p =0.04). The rate of severe complication (Grade 3) was 2.0%. Through the immunohistochemistry analysis of CD8 and CD11c on a subset of samples (Figure 1D), we confirmed the significant increase of infiltrated CD8 T and CD11c cells in post-PCA tissues. CONCLUSIONS: Our study demonstrated that PCA achieves a long-term local control with strong immune reactions. PCA appears to be a reasonable option for patients with high comorbidity at presentation. Source of Funding: Not available © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e165 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taigo Kato More articles by this author Yohei Okuda More articles by this author Yusuke Ono More articles by this author Hiroki Higashihara More articles by this author Yu Ishizuya More articles by this author Yoshiyuki Yamamoto More articles by this author Koji Hatano More articles by this author Atsunari Kawashima More articles by this author Norio Nonomura More articles by this author Expand All Advertisement PDF downloadLoading ...

Feasibility of Computed Tomography-guided Percutaneous Renal Cryoablation Under Local Anesthesia: A Single Center Experience in Taiwan.

To survey the safety and efficacy of percutaneous cryoablation for renal tumors under local anesthesia and pain control by using the -40°C lethal isotherm of the ice ball to cover the tumor margin as well as the coaxial cryoablation technique. All procedures were performed between February 2014 and November 2021 with computed tomography (CT) guidance. All tumors were ablated by following the aforementioned plan, according to which tumor margins were covered by the -40°C lethal isotherm. Hydrodissection and coaxial cryoablation were performed in some cases to avoid organ injury and massive bleeding. 2% xylocaine was used for local anesthesia and 50 mg of pethidine (meperidine) was injected intramuscularly for pain control and sedation. The complications were evaluated and the Kaplan-Meier method was used to estimate local recurrence-free survival (LRFS). Sixty-five tumors [49 renal cell carcinomas (RCC) and 16 angiomyolipomas] were ablated in 55 patients (median Charlson Comorbidity Index=5.0). Local recurrence occurred in three of the 49 RCC cases. Two received a second cryoablation. LRFS at three and five years were both 91%. LRFS at three and five years reached 100% in tumors <3 cm. A large tumor (≥3 cm) was observed in the recurrence group. Hemorrhage was the most common complication (76.9%). Two patients who needed blood transfusion did not receive coaxial cryoablation. Three (4.6%) major complications (Clavien-Dindo grade ≥3) occurred. By using -40°C as the pre-plan tumor coverage, with the aid of coaxial cryoablation and multiplanar reconstruction method, CT-guided percutaneous renal cryoablation under local anesthesia is a safe and effective procedure in patients with many comorbidities.

CT-guided Percutaneous Cryoablation in Patients with Lung Nodules Mainly Composed of Ground-Glass Opacities

CT-guided Percutaneous Cryoablation in Patients with Lung Nodules Mainly Composed of Ground-Glass Opacities

CT-Guided Percutaneous Cryoablation for Lung Metastasis of Colorectal Cancer: A Case Series.

This study aimed to evaluate the efficacy of computed tomography (CT) guided percutaneous cryoablation (CA) for the management of lung metastases in patients with metastatic colorectal cancer (mCRC). Retrospective analysis was performed on 38 mCRC patients with lung metastases, who underwent CT-guided percutaneous CA at our center from May 1, 2020 to November 1, 2021. The technical success rate, 1-year local control (LC) rate, recurrence-free survival (RFS) and treatment-related complications were analyzed. The CA procedure was successfully performed in all patients, with a technical success rate of 100%. The 1-year LC rate was 94.7% (36/38), while 16 patients experienced new distant lung metastases during the follow-up period. The median RFS was 20 months (95% CI: 13.0-27.0). The median RFS of patients with and without extrapulmonary metastasis was 15 and 23 months, respectively. Complications were reported in 18 (47.4%) patients following the CA procedure. Pneumothorax was discovered in 15 (39.5%) patients, and five of these patients (13.2%) required chest tube intubation. Two patients (5.3%) presented with hemoptysis during the CA procedure. One patient developed subcutaneous emphysema as detected in the post-procedure follow-up imaging. All patients tolerated the peri-procedural pain well under local anesthesia, and the mean visual analog scale (VAS) score was 2.8. Lung CA is a safe and well-tolerated treatment with a satisfactory local control rate for patients with lung metastases derived from mCRC.

Long-term outcomes of cryoablation for biopsy-proven T1 stage renal cell carcinoma

BackgroundTo summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC.MethodsThis was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes.ResultsA total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10~200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (1~6 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7–127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA.ConclusionLCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.

Abstract No. 129 Safety and efficacy of PET/CT-guided and CT-guided percutaneous cryoablation of recurrent pleural mesothelioma

Abstract No. 129 Safety and efficacy of PET/CT-guided and CT-guided percutaneous cryoablation of recurrent pleural mesothelioma

Abstract No. 316 Percutaneous CT-guided cryovagotomy in patients with class I or class II obesity: a 4-year follow-up

Interruption of vagus nerve signaling has long been associated with loss of appetite in humans, as well as weight loss or attenuation of weight gain in all species studied. In 2017, 20 subjects with Class I or Class II obesity underwent percutaneous CT-guided cryoablation of the posterior vagal trunk to decrease hunger. The purpose of this study was to ascertain and report long-term follow up of these subjects.

Abstract No. 49 Percutaneous image-guided cryoablation of the intercostobrachial nerve for management of post-mastectomy pain syndrome

Breast cancer is the most common invasive cancer to affect women worldwide. Post-mastectomy pain syndrome (PMPS) is reported to affect 30-80% of patients who undergo mastectomy or lumpectomy. PMPS is described as persistent pain that affects the anterior thorax, axilla, and/or medial upper arm–for which no established efficacious treatment exists. The purpose of this study was to evaluate the feasibility, safety, and early efficacy of percutaneous CT-guided cryoablation of the intercostobrachial nerve for management of PMSP.

Persistent chyluria following renal cryoablation: A case report

Chyluria is a rare complication following renal intervention including partial nephrectomy and percutaneous ablation. To date, there are no reported cases of chyluria following renal cryoablation. An 82-year-old female patient at our institution underwent CT-guided percutaneous cryoablation for a renal cell carcinoma and presented with macroscopic fat in the urine 5 months after cryoablation. Presenting symptoms were polyuria, dysuria, and cloudy white urine. CT showed a fat-urine level in the ureter and bladder most consistent with chyluria. The patient experienced several episodes of presumptive lower urinary tract infection following diagnosis for which she was treated medically. Follow-up CT imaging 5 months post-diagnosis revealed persistent fat-fluid level in the collecting system and bladder. Operators performing renal cryoablation should be aware of the clinical and imaging manifestations of this complication.

CT-Guided Percutaneous Cryoablation in Patients with Lung Nodules Mainly Composed of Ground-Glass Opacities

PurposeTo assess the safety and efficacy of cryoablation in patients with lung nodules mainly composed of ground-glass opacities (GGOs). Materials and MethodsIn this retrospective study, 50 patients (mean age, 65.0 years ± 12.3; 28 women) with a diagnosis of lung GGO nodules who underwent cryoablation were included (from June 2016 to June 2021). The local recurrence rate, incidence of regional metastases to lymph nodes, incidence of distant metastases, adverse events, and lung function condition were analyzed. ResultsFollow-up computed tomography (CT) was performed at a mean of 33 months (range, 3–60 months) after the cryoablation procedure. Outcomes were only evaluated in 30 patients. A total of 20 patients were excluded. Of these 20 patients, 10 patients had no cancer detected by histopathological analysis and a diagnosis was made using CT or positron emission tomography (PET)-CT, The other 10 patients had nodules with a diameter of <10 mm and a consolidation-to-tumor ratio of >0.25; thus, histopathological analysis was not performed because of the small nodule size, and patients were diagnosed using CT or PET-CT. The local recurrence rate was 0% (0 of 30). Evidence of regional metastases of lymph nodes was not found in any patients (0%; 0 of 30), and the incidence of distant metastases was 0% (0 of 30). No major adverse events were noted. Lung function recovered to normal within 1 month after cryoablation in all patients. ConclusionsCryoablation may serve as a safe and feasible option for the treatment of lung nodules mainly composed of GGOs.

V69 - CT-guided percutaneous cryoablation for renal cell carcinoma

V69 - CT-guided percutaneous cryoablation for renal cell carcinoma

Osteoid Osteoma: Percutaneous CT-guided Cryoablation Is a Safe, Effective, and Durable Treatment Option in Adults.

Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; P < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.