Percutaneous Thermal Ablation for Managing Small Renal Metastatic Tumors.

Purpose: To retrospectively evaluate the treatment outcomes of thermal ablation for renal metastatic tumors. Materials and Methods: Thirteen consecutive patients with small renal metastatic tumors (≤3 cm), who underwent thermal ablation between 2009 and 2020, were included in this study. Eight patients had extra-renal tumors during renal ablation. The primary tumors were adenoid cystic carcinoma in four patients, lung cancer in three, hemangiopericytoma in three, leiomyosarcoma in two, and thyroid cancer in one. The therapeutic effects, safety, survival rate, prognostic factor, and renal function were evaluated. Results: We performed 18 ablation sessions (cryoablation, n = 13; radiofrequency ablation, n = 5) on 19 renal metastases with a mean diameter of 1.7 cm, which resulted in a primary technique efficacy rate of 100% without procedure-related deaths or major complications. Renal function significantly declined 6 months after ablation (P = 0.0039). During the mean follow-up period of 31.2 ± 22.4 months (range, 2.7-71.4 months), one patient had local tumor progression at 11.9 months following radiofrequency ablation. The overall survival rates at 1 and 3 years after ablation were 76.9% (95% confidence interval [CI], 54.0%-99.8%) and 59.3% (95% CI, 31.3%-87.3%), respectively. Tumor size ≥ 2 cm (P = 0.02) and metastasis from non-small cell lung cancer (P = 0.001) were significant worse prognostic factors in univariate analysis, and metastasis from non-small cell lung cancer (P = 0.01) was significant in multivariate analysis. Conclusions: Percutaneous thermal ablation for small renal metastases is safe and feasible and can control local tumors.

Cryptococcus granuloma mimicking local progressed tumor after cryoablation of renal cell carcinoma: A case report.

Infectious granulomas arising in the kidney are rare. However, there are few reports regarding renal granulomas, such as xanthogranulomatous pyelonephritis, sarcoidosis, malakoplakia, and tuberculosis. Here, we report a case of cryptococcal granuloma resembling a locally progressed tumor after percutaneous cryotherapy for renal cell carcinoma. A male patient in his 80s with rheumatoid arthritis underwent computed tomography (CT)-guided cryoablation for biopsy-proven papillary renal cell carcinoma. Follow-up contrast-enhanced CT imaging obtained 4 months after ablation confirmed an enhanced mass on the edge of the ablation zone. There were no symptoms related to the mass. This mass was radiologically diagnosed as local tumor progression and treated with repeated cryoablation. Percutaneous biopsy of the mass was performed immediately after the second cryoablation, and the mass was pathologically diagnosed as granuloma related to Cryptococcus infection. The patient was administered antifungal fluconazole for 1 year with a good outcome.

Computed tomography-guided biopsy for small renal masses before or immediately after tumor ablation: factors affecting diagnostic yield.

PURPOSE: To evaluate the diagnostic yield of percutaneous renal mass biopsy (RMB) before and after ablation. MATERIALS AND METHODS: In total, 333 renal masses in 332 consecutive patients underwent computed tomography (CT)-guided biopsies and were included in this study. All biopsies were performed with 18-gauge core needles with CT fluoroscopic guidance before ablation (n = 234) or immediately after radiofrequency ablation (RFA) (n = 40) or cryoablation (CA) (n = 59). The safety and diagnostic yield of RMB were evaluated. Both univariate and multivariate analyses were used to identify factors affecting diagnostic yield. RESULTS: No major complication occurred. The 281 specimens (84%) were diagnostic. There were 257 renal cell carcinomas (77%), 21 benign masses (6%), and 3 metastases (1%). The remaining 52 specimens (16%) were nondiagnostic. The diagnostic yields before ablation, after RFA, and CA were 91% (212/234), 80% (32/40), and 63% (37/59), respectively. Small masses (P = 0.050 and 0.006), cystic masses (P < 0.001 and < 0.001), and post-CA (P < 0.001 and < 0.001) were independent and significant factors affecting the nondiagnostic results in both univariate and multivariate analyses. CONCLUSION: CT-guided RMB can be nondiagnostic when the tumor is small, cystic, or biopsied immediately after CA.

Percutaneous Image-guided Thermal Ablation for Renal Cell Carcinoma.

Nephrectomy is the gold standard for the treatment of renal cell carcinoma (RCC). However, some patients are not suitable candidates for nephrectomy because of high surgical risk, reduced renal function, or the presence of multiple renal tumors. Percutaneous image-guided thermal ablation, including cryoablation and radiofrequency ablation, is a minimally invasive and highly effective treatment and can be used to treat RCC in patients who are not good candidates for surgery. This article will review percutaneous image-guided thermal ablation for RCC, covering treatment indications, ablation modalities and techniques, oncologic outcomes, and possible complications. In addition, the characteristics of each ablation modality and its comparison with nephrectomy are also presented.

Clinical utility of radiofrequency ablation following transarterial injection of miriplatin-iodized oil suspension in small hepatocellular carcinoma.

PURPOSE: To retrospectively evaluate the clinical utility of radiofrequency ablation (RFA) following transarterial injection of miriplatin-iodized oil suspension (MPT-RFA) for hepatocellular carcinoma treatment. MATERIALS AND METHODS: We evaluated clinical outcomes of MPT-RFA for three or fewer hepatocellular carcinomas. Twenty-one patients with 30 tumors (maximum diameter: mean 1.4 ± 0.4 cm, range 0.7-2.2 cm) received MPT-RFA. RESULTS: Nineteen patients (90.5 %, 19/21) achieved complete ablation at the first RFA session. Two patients (9.5 %, 2/21) required a second RFA session but achieved complete ablation. Primary and secondary technical success rates were 90.5 and 100 %. There were no deaths related to the procedures performed. Grade 3 or 4 increases in the serum aspartate aminotransferase, alanine aminotransferase, and bilirubin levels were found in six patients (38.1 %, 8/21). There were no liver infarctions. During the median follow-up period of 24.1 months (mean ± SD 24.7 ± 6.9 months, range 13.8-38.9 months), the local tumor progression rate and overall survival rate at 2 years was 5.0 % (95 % confidence interval 0.3-20.6 %) and 86.7 % (95 % confidence interval 56.3-96.5 %), respectively. The mean hospital stay was 8.4 ± 3.1 days (range 5-18 days). CONCLUSION: MPT-RFA is a safe therapeutic option that initially provides therapeutic results.

Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation.

PURPOSE: To evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT). MATERIALS AND METHODS: For this institutional review board approved retrospective study conducted during 2002-2012, stents were placed in outflow veins in 15 patients (11.3%, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4-69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT. RESULTS: Stents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100%, 15/15). Clinical manifestations improved in 11 patients (73.3%, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7%, 4/15) who died in the hospital 1.0-3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2%, p = .405). CONCLUSION: Stenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.