Sex-Differences in Post-Procedural Pain Experiences After Thermal Liver Ablations for Liver Tumors: A Retrospective Study.

INTRODUCTION: Literature shows differences in pain experiences between sexes. The exact influence of thermal liver ablation on experienced pain is still not well-known. This study aims to investigate the maximum pain intensity at the recovery between men and women after percutaneous thermal liver ablation. METHODS: Patients treated with percutaneous thermal liver ablation (radiofrequency or microwave ablation) in Maastricht University Medical Center + between 2018 and 2022 for primary or secondary liver tumors were included retrospectively. Outcomes included maximum numerical rating scale (NRS, scale:0-10) score at the recovery room, prevalence of post-procedural pain (defined as NRS score ≥ 4), duration of anesthesia, length of stay at recovery, and complications. Regression analyses were adjusted for age, ASA-score, BMI, tumor type, maximum diameter of lesion, chronic pain in patients' history, and history of psychological disorder. RESULTS: 183 patients were included of which 123 men (67%). Results showed higher average maximum NRS scores in women patients compared to men (mean:3.88 versus 2.73), but not after adjustments (aß:0.75, 95%CI:-0.13-1.64). Women suffered more from acute post-procedural pain (59% versus 35%; aOR:2.50, 95%CI:1.16-5.39), and needed analgesics more often at the recovery room (aOR:2.43, 95%CI:1.07-5.48) compared to men. NRS score at recovery arrival did not significantly differ (aß:0.37, 95%CI:-0.48-1.22). No differences were seen in the length of stay at the recovery, duration of anesthesia, procedure time, and complication rate. Location of the tumor (subcapsular or deep), total tumors per patient, and distinction between primary and secondary tumors had no influence on the NRS. CONCLUSION: This retrospective single-center study shows higher post-procedural pain rates after thermal liver ablation in women, resulting in higher analgesics use at the recovery room. The results suggest considering higher dosage of analgesics during thermal liver ablation in women to reduce post-procedural pain. LEVEL OF EVIDENCE 3: Non-controlled retrospective cohort study.

Percutaneous thermal segmentectomy for liver malignancies over 3 cm: mid-term oncological performance and predictors of sustained complete response from a multicentric Italian retrospective study.

INTRODUCTION: Percutaneous thermal segmentectomy is a single-step combination of microwave ablation, performed during arterial occlusion obtained with a balloon micro catheter, followed in the same session by balloon-occluded TACE. The aim of this multicenter retrospective study is to report the mid-term oncological performance of this technique for liver malignancies > 3.0 cm and to identify risk factors for the loss of sustained complete response. METHODS: Oncological results were evaluated with CT or MRI according to m-RECIST (HCC) and RECISTv1.1 (metastasis/intra-hepatic cholangiocarcinoma, iCC) at 1-month, 3-6-month and then at regular-6-month intervals. To identify predictive variables associated with not achieving or losing complete response two mixed-effects multivariable logistic regression models were constructed. RESULTS: Sixty-three patients (40/23, male/female) with primary liver malignancies (HCC = 49; iCC = 4) and metastasis (n = 10) were treated. Median diameter of target lesion was 4.5 cm (range 3.0-7.0 cm). The median follow-up time was 9.2 months. At one-month follow-up, 79.4% of patients presented with a complete response and the remaining 20.6% were partial responders. At the 3-6-month follow-up, reached by 59 of the initial 63 patients, 83.3% showed a sustained complete response, while 10.2% had a partial response and 8.5% a local recurrence. At the last follow-up, 69.8% of the lesions showed a complete response. The initial diameter of the target lesion ≥ 5.0 cm was the only independent variable associated with the risk of failure in maintaining a complete response at 6 months (OR = 8.58, 95% CI 1.38-53.43; P = 0.02). CONCLUSION: Percutaneous thermal segmentectomy achieves promising oncological results in patients with tumors > 3.0 cm, with tumor dimension ≥ 5.0 cm being the only risk factor associated with the failure of a sustained complete response.

Exploring the impact of variable power outputs on the efficacy and safety during microwave ablation for lung carcinoma: a real-world study.

Background: Microwave ablation (MWA) is an important method for the treatment of lung cancer, but there is still a lack of standard guidelines for the selection of power. This study aimed to explore the effectiveness and safety of MWA at different power levels. Methods: The study gathered individuals underwent MWA for lung cancer between January 2012 and December 2020. All patients were divided into low power group and high power group based on the power of MWA. By intergroup comparisons, we clarified the differences between the two groups. Results: In this study, 265 participants were involved, with 192 in the low power group and 73 in the high power group. Compared to the low power group, the high power group had a significantly higher incidence of postoperative complications (63.0% vs. 24.0%). In the Kaplan-Meier analysis, overall survival (OS) and disease-free survival (DFS) of the high power group were both better than the low power group. We found through Cox regression analysis that smoking, tumor volume, tumor differentiation, gene mutation, neutrophil count, and lymphocyte count were independent factors affecting the OS of patients. Based on the above factors, we constructed a nomogram, with areas under the curve (AUCs) of 0.941, 0.903, and 0.905 for predicting 1-, 2-, and 3-year OS after MWA, respectively. Conclusions: While high-power MWA brings better long-term prognosis to patients, it also leads to an increase in postoperative complications. The application of a nomogram for stratifying the prognosis of patients may be a more feasible approach to further develop individualized treatment plans.

Is Ablation Suitable For Small Renal Masses (SRMs)? A Meta-Analysis.

RATIONALE AND OBJECTIVES: To compare perioperative and oncology outcomes of ablation and partial nephrectomy in small renal masses (SRMs). METHODS: We conduct this meta-analysis strictly according to the PRISMA standard, and the quality evaluation follows the AMSTAR standard. Four databases, Embase, PubMed, Cochrane Library, and Web of Science, were systematically searched. The search time range is from database creation to November 2023. Stata16 statistical software was used for statistical analysis. Weighted mean difference (WMD) represented continuity variables, odds ratio or relative risk (OR/RR) represented dichotomies variables, and 95% confidence intervals (95%CI) were calculated. RESULTS: A total of 27 studies, including 6030 patients. Results showed that patients undergoing partial nephrectomy were younger (WMD = -5.45 years, 95%CI [-7.44, -3.46], P < 0.05), had longer operation time (WMD = 64.91 min, 95%CI [44.47, 85.34], P < 0.05), had longer length of stay (WMD = 2.91 days, 95%CI [2.04, 3.78], P < 0.05), and had more estimated blood loss (WMD = 97.76 ml, 95%CI [69.48, 126.04]. P < 0.05), the overall complication rate was higher (OR = 1.84, 95%CI [1.48, 2.29], P < 0.05), the major complication rate was higher (OR = 1.98, 95%CI [1.36, 2.88], P < 0.05), and the recurrence rate was lower (OR = 0.32, 95%Cl [0.20, 0.50], P < 0.05). However, there were no differences between ablation and partial nephrectomy in cancer-specific survival (CSS) (HR = 2.07, 95%CI [0.61, 7.04], P > 0.05), overall survival (OS) (HR = 1.24, 95%CI [0.58, 2.65], P > 0.05), and recurrence-free survival (RFS) (HR = 2.68, 95%CI [0.91, 7.88], P > 0.05). CONCLUSION: Patients undergoing partial nephrectomy are younger, have longer operation time and length of stay, and have higher complication rate. However, there was no significant difference in CSS, OS, and RFS between partial nephrectomy and ablation, but more well-designed, high-quality studies are needed to confirm this.

Microwave Thermal Ablation of Thyroid Nodules with the MONTREAL Technique: Preliminary Clinical Results.

Ultrasound-guided percutaneous Microwave Thermoablation (MWA) is an increasingly popular minimally invasive therapy for the treatment of benign thyroid nodules due to its remarkable heating velocity and resilience to heat sinking. We present a cohort of 26 patients (17 F, 9M, mean age 56.2yy) with 20 goiters (mean volume 34.9cc, min 6.5cc-max 84cc) and 6 autonomously functioning nodules (AFTNs, mean volume 11.6cc, min 3.5cc-max 24cc) treated with MWA, using the moving shot technique and a novel energy delivery algorithm (MONTREAL), based on intra-operative real-time reflectivity measurements: each moving shot was automatically terminated when reflectivity was observed to ramp up. 17G or 18G internally cooled 2.45 GHz applicators were used (AMICA-PROBE, HS HOSPITAL SERVICE SpA), operated at 15-30W. On average, each treatment deposited 9.9±5.5kJ during 696±325s, through 26.7±14.4 moving shots: the mean moving shot duration was 28.1±9.0s, yielding a mean ablation time per unit nodule volume of 34.3±19.1s/cc. No mild nor severe complications were recorded. Post-MWA ultrasound follow-up showed a mean volume reduction ratio of 59.1±10.2% [min 44% - max 80%] at 3 months and of 70.1±8.5% [min 53% - max 91%] at 6 months, with slightly better outcomes in the AFTNs sub-group (volume reduction of 65.3±10.2%/76.0±4.0% at 3/6 months and, in all cases, normal TSH values at 3 months upon pharmacological therapy suspension). MWA treatments of benign nodules with the MONTREAL technique appeared to be safe, fast, and effective. Further research is warranted to confirm these preliminary results.

RPCA-based thermoacoustic imaging for microwave ablation monitoring.

Microwave ablation (MWA) is a potent cancer treatment tool, but its effectiveness can be hindered by the lack of visual feedback. This paper validates the feasibility of using microwave-induced thermoacoustic imaging (TAI) technique to monitor the MWA process. A feasibility analysis was conducted at the principle level and a high-performance real-time TAI system was introduced. To address the interference caused by MWA, a robust principal component analysis (RPCA)-based method for TAI was proposed. This method leverages the correlation between multiple signal frames to eliminate interference. RPCA's effectiveness in TAI was demonstrated through three sets of different experiments. Experiments demonstrated that TAI can effectively monitors the MWA process. This work represents the first application of RPCA-related matrix decomposition methods in TAI, paving the way for the application of TAI in more complex clinical scenarios. By providing rapid and accurate visual feedback, this research advances MWA technology.

Development of GPC3-CAR-NK cells and optimization as a therapy for HCC.

Hepatocellular carcinoma (HCC) is a highly malignant tumor characterized by insidious onset and rapid progression, with limited treatment choices. One treatment modality, chimeric antigen receptor (CAR)-modified natural killer (NK) cell immunotherapy, has shown promise for various cancers. In this study, we developed two GPC3-specific CAR-NK-92 cell lines (GPC3-CAR-NK) and explored their antitumor efficacy for the treatment of HCC. Significant levels of cytokine production and in vitro cytotoxicity were produced following co-culture of GPC3+ HCC cells with the developed GPC3-CAR-NK cells. GC33-G2D-NK cells with NK cell-specific signaling domains showed better activation and killing abilities than GC33-CD28-NK cells containing T cell-specific signaling domains. Moreover, GC33-G2D-NK cells efficiently eliminated tumors in cell-derived xenograft and patient-derived xenograft mouse models. In an abdominal metastasis model, intraperitoneally delivered GC33-G2D-NK cells showed better antitumor ability than intravenously injected cells. Finally, the combination of microwave ablation with GC33-G2D-NK cell administration showed greater CAR-NK infiltration and tumor regression in ablated tumors than monotherapy alone. These findings indicate that administration of GPC3-CAR-NK cells may be a potential strategy for the treatment of HCC, and regional delivery or their combination with microwave ablation may optimize their efficacy against HCC and may have translational value.

Maintenance treatment of immunotherapy after microwave ablation plus drug-eluting bead bronchial arterial chemoembolization for advanced non-small cell lung cancer: a retrospective single-center cohort study.

Background: The combination therapy of immunotherapy and drug-eluting bead bronchial artery chemoembolization (DEB-BACE) or microwave ablation (MWA) has been attempted as an effective and safe approach for advanced non-small cell lung cancer (NSCLC). However, the outcomes of immunotherapy plus multiple interventional techniques for advanced NSCLC remain unclear. This retrospective study thus aimed to investigate the effectiveness and safety of the maintenance treatment of programmed cell death protein 1 (PD-1) blockade after MWA plus DEB-BACE for advanced NSCLC. Methods: This retrospective cohort study consists of 95 patients with advanced NSCLC who were treated with DEB-BACE between April 2017 and October 2022 and who were allocated to three groups: group A (MWA + DEB-BACE + PD-1 blockade; n=15), group B (MWA + DEB-BACE; n=25), and group C (DEB-BACE alone; n=55). The adverse events (AEs) were compared between the three groups. The outcomes were compared via Kaplan-Meier methods, including median progression-free survival (PFS) and overall survival (OS). Survival analyses were performed via the univariate and multivariate analyses to investigate the prognostic predictors. Results: The overall incidence of AEs in the groups A-C was 53.3% (8/15), 36.0% (9/25), and 32.7% (18/55), respectively, which did not represent a significant difference (P=0.42). No severe AEs (SAEs) occurred. Group A, compared with group B and group C, had a significantly longer estimated median PFS (33.0 vs. 7.0 vs. 3.0 months; P<0.001) and OS (33.0 vs. 13.0 vs. 6.0 months; P=0.002). PD-1 blockade (P=0.006), tumor number (P=0.01), and DEB-BACE/bronchial artery infusion (BAI) chemotherapy cycles (P=0.04) were identified as the predictors of PFS, while the predictors of OS were PD-1 blockade (P<0.001), number of metastases (P<0.001), tumor diameter (P<0.001), and DEB-BACE/BAI cycles (P=0.02). Conclusions: Compared with that of advanced NSCLC treated with MWA plus DEB-BACE or DEB-BACE alone, the maintenance treatment of immunotherapy after MWA plus DEB-BACE might provide a superior prognosis without increasing the risk of AEs.

Radiofrequency ablation versus microwave ablation for hepatocellular carcinoma with cirrhosis: a propensity score analysis.

Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most frequently used percutaneous ablation techniques for the treatment of liver cancer. The aim of our study was to identify the ablation method that had a better long-term prognosis for patients with cirrhotic hepatocellular carcinoma (HCC). Methods: This retrospective study consisted of HCC patients with cirrhosis who underwent RFA and MWA between January 2014 to December 2021 at Beijing You'an Hospital. Patients were divided into two groups according to the therapeutic approaches: the RFA group and the MWA group. The prognosis was compared before and after 1:1 propensity score matching (PSM). Results: A total of 800 HCC patients with cirrhosis who received interventional treatment from January 2014 to December 2021 were prospectively enrolled. After PSM, there were 268 patients in each of the RFA and MWA groups. The statistically significant differences in recurrence-free survival (RFS) and overall survival (OS) between RFA and MWA groups can be observed, both before and after PSM. Besides, 1-, 3-year RFS, and 5-year OS rates were higher in those the RFA group than in the MWA group. Age, tumor size, gamma glutamyl transferase (GGT), and hepatitis B surface antigen (HBsAg) were independent risk factors for RFS. Child-Pugh, lymphocyte (Lym), GGT, and treatment modality were independent risk factors for OS. Conclusions: For patients with HCC associated with cirrhosis, RFA can provide a better prognosis than MWA, with lower recurrence and mortality rate.

Migraine aura discrimination using machine learning: an fMRI study during ictal and interictal periods.

Functional magnetic resonance imaging (fMRI) studies on migraine with aura are challenging due to the rarity of patients with triggered cases. This study optimized methodologies to explore differences in ictal and interictal spatiotemporal activation patterns based on visual stimuli using fMRI in two patients with unique aura triggers. Both patients underwent separate fMRI sessions during the ictal and interictal periods. The Gaussian Process Classifier (GPC) was used to differentiate these periods by employing a machine learning temporal embedding approach and spatiotemporal activation patterns based on visual stimuli. When restricted to visual and occipital regions, GPC had an improved performance, with accuracy rates for patients A and B of roughly 86-90% and 77-81%, respectively (p < 0.01). The algorithm effectively differentiated visual stimulation and rest periods and identified times when aura symptoms manifested, as evident from the varying predicted probabilities in the GPC models. These findings contribute to our understanding of the role of visual processing and brain activity patterns in migraine with aura and the significance of temporal embedding techniques in examining aura phenomena. This finding has implications for diagnostic tools and therapeutic techniques, especially for patients suffering from aura symptoms.

The Added Value of Transcatheter CT Hepatic Angiography (CTHA) Image Guidance in Percutaneous Thermal Liver Ablation: An Experts' Opinion Pictorial Essay.

With the rapidly evolving field of image-guided tumor ablation, there is an increasing demand and need for tools to optimize treatment success. Known factors affecting the success of (non-)thermal liver ablation procedures are the ability to optimize tumor and surrounding critical structure visualization, ablation applicator targeting, and ablation zone confirmation. A recent study showed superior local tumor progression-free survival and local control outcomes when using transcatheter computed tomography hepatic angiography (CTHA) guidance in percutaneous liver ablation procedures. This pictorial review provides eight clinical cases from three institutions, MD Anderson (Houston, TX, USA), Gustave Roussy (Paris, France), and Amsterdam UMC (Amsterdam, The Netherlands), with the intent to demonstrate the added value of real-time CTHA guided tumor ablation for primary liver tumors and liver-only metastatic disease. The clinical illustrations highlight the ability to improve the detectability of the initial target liver tumor(s) and identify surrounding critical vascular structures, detect 'vanished' and/or additional tumors intraprocedurally, differentiate local tumor progression from non-enhancing scar tissue, and promptly detect and respond to iatrogenic hemorrhagic events. Although at the cost of adding a minor but safe intervention, CTHA-guided liver tumor ablation minimizes complications of the actual ablation procedure, reduces the number of repeat ablations, and improves the oncological outcome of patients with liver malignancies. Therefore, we recommend adopting CTHA as a potential quality-improving guiding method within the (inter)national standards of practice.

Threatment Strategies for Recurrent Hepatocellular Carcinoma Patients: Ablation and its Combination Patterns.

With the development of guidance technology and ablation equipment, ablative procedures have emerged as important loco-regional alternatives to surgical resection for recurrent hepatocellular carcinoma (rHCC) patients. Currently, ablation modalities used in clinical practice mainly include radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA), cryoablation (CRA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE). Accumulated comparative data of ablation versus surgical resection reveal noninferior responses and outcomes but superior adverse effects. Moreover, studies demonstrate that ablation may serve as an excellent procedure for rHCC given its exact minimal invasiveness and immune modulation. We focus on the current status of ablation in clinical practice for rHCC and discuss new research in the field, including ablation combined with these other modalities, such as targeted therapy and immunotherapy.

Perfluorobutane application value in microwave ablation of small hepatocellular carcinoma (<3 cm).

BACKGROUND: No studies have been retrieved comparing perfluorobutane with sulfur hexafluoride for microwave ablation (MWA) in small hepatocellular carcinoma(sHCC). OBJECTIVE: To retrospective investigate the value of perfluorobutane ultrasonography contrast agent in ultrasonography (US)-guided MWA of sHCC. METHODS: We conducted a retrospective clinical controlled study about US-guided percutaneous MWA in patients with sHCC, and in patients undergoing intra-operative treatment with perfluorobutane or sulfur hexafluoride. In both groups, a contrast agent was injected to clear the tumor and then a needle was inserted. A 5-point needle prick difficulty score was developed to compare needle prick difficulty in the two groups of cases. RESULTS: A total of 67 patients were included: 25 patients in group perfluorobutane, aged 41-82 (60.64±9.46), tumor size 1.1-2.8 (1.78±0.45) cm. 42 patients in group sulfur hexafluoride, aged 38-78 (62.26±9.27), with tumor size of 1.1-3.0 (1.89±0.49) cm. There was no significant difference in age or tumor size in both groups (P > 0.05). Puncture difficulty score (5-point): 2.0-2.7 (2.28±0.29) in group perfluorobutane, and 2.0-4.7 (2.95±0.85) in group sulfur hexafluoride, and the difference between the two groups was statistically significant (P < 0.05). Enhanced imaging results within 3 months after surgery: complete ablation rate was 100% (25/25) in the group perfluorobutane, 95.2% (40/42 in the group sulfur hexafluoride), with no significant difference between the two groups (P > 0.05). CONCLUSION: Perfluorobutane kupffer phase can make the operator accurately deploy the ablation needle and reduce the difficulty of operation.

Brain connectome-based imaging markers for identifiable signature of migraine with and without aura.

Background: Cortical spreading depression (CSD) has been considered the prominent theory for migraine with aura (MwA). However, it is also argued that CSD can exist in patients in a silent state, and not manifest as aura. Thus, the MwA classification based on aura may be questionable. This study aimed to capture whole-brain connectome-based imaging markers with identifiable signatures for MwA and migraine without aura (MwoA). Methods: A total of 88 migraine patients (32 MwA) and 49 healthy controls (HC) underwent a diffusion tensor imaging and resting-state functional magnetic resonance imaging scan. The whole-brain structural connectivity (SC) and functional connectivity (FC) analysis was employed to extract imaging features. The extracted features were subjected to an all-relevant feature selection process within cross-validation loops to pinpoint attributes demonstrating substantial efficacy for patient categorization. Based on the identified features, the predictive ability of the random forest classifiers constructed with the 88 migraine patients' sample was tested using an independent sample of 32 migraine patients (eight MwA). Results: Compared to MwoA and HC, MwA showed two reduced SC and six FC (five increased and one reduced) features [all P<0.01, after false discovery rate (FDR) correction], involving frontal areas, temporal areas, visual areas, amygdala, and thalamus. A total of four imaging features were significantly correlated with clinical rating scales in all patients (r=-0.38 to 0.47, P<0.01, after FDR correction). The predictive ability of the random forest classifiers achieved an accuracy of 78.1% in the external sample to identify MwA. Conclusions: The whole-brain connectivity features in our results may serve as connectome-based imaging markers for MwA identification. The alterations of SC and FC strength provide possible evidence in further understanding the heterogeneity and mechanism of MwA which may help for patient-specific decision-making.

A probabilistic thermal dose model for the estimation of necrosis in MR-guided tumor ablations.

BACKGROUND: Monitoring minimally invasive thermo ablation procedures using magnetic resonance (MR) thermometry allows therapy of tumors even close to critical anatomical structures. Unfortunately, intraoperative monitoring remains challenging due to the necessary accuracy and real-time capability. One reason for this is the statistical error introduced by MR measurement, which causes the prediction of ablation zones to become inaccurate. PURPOSE: In this work, we derive a probabilistic model for the prediction of ablation zones during thermal ablation procedures based on the thermal damage model CEM43 . By integrating the statistical error caused by MR measurement into the conventional prediction, we hope to reduce the amount of falsely classified voxels. METHODS: The probabilistic CEM43 model is empirically evaluated using a polyacrilamide gel phantom and three in-vivo pig livers. RESULTS: The results show a higher accuracy in three out of four data sets, with a relative difference in Sørensen-Dice coefficient from - 3.04 % $-3.04\%$ to 3.97% compared to the conventional model. Furthermore, the ablation zones predicted by the probabilistic model show a false positive rate with a relative decrease of 11.89%-30.04% compared to the conventional model. CONCLUSION: The presented probabilistic thermal dose model might help to prevent false classification of voxels within ablation zones. This could potentially result in an increased success rate for MR-guided thermal ablation procedures. Future work may address additional error sources and a follow-up study in a more realistic clinical context.

Experimental study on monitoring microwave ablation efficacy by real-time shear wave elastography in ex vivo porcine brain.

Objective: Glioma constitutes the most common primary malignant tumor in the central nervous system. In recent years, microwave ablation (MWA) was expected to be applied in the minimally invasive treatment of brain tumors. This study aims to evaluate the feasibility and accuracy of microwave ablation in ex vivo brain tissue by Shear Wave Elastography (SWE) to explore the application value of real-time SWE in monitoring the process of MWA of brain tissue.Methods: Thirty ex vivo brain tissues were treated with different microwave power and ablation duration. The morphologic and microscopic changes of MWA tissues were observed, and the diameter of the ablation areas was measured. In this experiment, SWE is used to quantitatively evaluate brain tissue's degree of thermal injury immediately after ablation.Results: This study It is found that the ablation range measured by SWE after ablation is in good consistency with the pathological range [ICCSWEL1-L1 = 0.975(95% CI:0.959 - 0.985), ICCSWEL2-L2 = 0.887(95% CI:0.779 - 0.938)]. At the same time, the SWE value after ablation is significantly higher than before (mean ± SD,9.88 ± 2.64 kPa vs.23.6 ± 13.75 kPa; p < 0.001). In this study, the SWE value of tissues in different pathological states was further analyzed by the ROC curve (AUC = 0.86), and the threshold for distinguishing normal tissue from tissue after ablation was 13.7 kPa. The accuracy of evaluating ablation tissue using SWE can reach 84.72%, providing data support for real-time quantitative observation of the ablation range.Conclusion: In conclusion the accurate visualization and real-time evaluation of the organizational change range of the MWA process can be realized by real-time SWE.

Simultaneous percutaneous microwave ablation and biopsy for highly suspected malignant pulmonary nodules: a retrospective cohort study.

Background: The conventional diagnosis and treatment for highly suspected malignant pulmonary nodules (PNs) can avoid unnecessary treatment to some extent. However, the relatively separate puncture processes may not only increase puncture-related complications, but also increase the patient's radiation exposure and hospitalization costs. The purpose of this study was to retrospectively analyze the effectiveness of simultaneous percutaneous microwave ablation (MWA) and percutaneous biopsy (PB) for PNs. Methods: From August 2015 to August 2022, 65 consecutive patients [48 solid nodules, 6 ground glass opacities (GGOs), 11 mixed nodules] with suspected single malignant PN underwent MWA and PB combination treatments at the First Affiliated Hospital of Zhengzhou University. The total of 30 patients in Group A underwent synchronous PB and MWA (strategy: low-power MWA-PB-high-power MWA), whereas 35 patients in Group B underwent asynchronous PB and MWA. The technical success, complete ablation (CA), complications, total procedure time (TPT), patient exposure dose (PED), hospitalization time, and costs were compared. An independent samples t-, χ2, or Fisher's exact tests were used. Results: The technical success (100% vs. 100%) and CA (100% vs. 97.1%) rates were not significantly different between Groups A and B. The complications of intrapulmonary hemorrhage (16.7% vs. 41.4%, P=0.02) and hemoptysis (0% vs. 8.6%, P=0.04) were significantly different between Groups A and B. TPT (41.6±7.9 vs. 57.3±8.8 min, P<0.001), PED (12.9±1.4 vs. 19.4±2.3 mSv, P<0.001), hospitalization stay (4.7±1.3 vs. 9.1±2.1 days, P<0.001) and costs (3,768.8±652.9 vs. 4,508.0±514.1 USD, P<0.001) also showed significant differences between Groups A and B. Conclusions: Synchronous PB and MWA for PNs is a safe and effective strategy that can decrease bleeding, PED, the hospitalization stay, and costs.

Efficacy and safety of different thermal ablative therapies for desmoid-type fibromatosis: a systematic review and meta-analysis.

Background: Desmoid-type fibromatosis (DF) is a locally aggressive tumor characterized by peripheral infiltration of neoplastic cells and remote metastasis disability. This systematic review examined the efficacy and safety of thermal ablative therapy for DF tumors. Methods: A literature search was conducted using PubMed, Web of Science, Cochrane Library, and Embase from January 1, 2000, to November 12, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to guide literature selection. The inclusion criteria were the following: (I) the patients were diagnosed with aggressive fibromatosis pathologically, (II) the patients were treated by thermal ablations, and (III) a focus on treatment efficacy and safety. Meanwhile, the exclusion criteria were the following: (I) cohorts of patients with hypertrophic scar, Gardner fibroma, or nodular fasciitis; (II) conference abstracts, reviews, case reports, letters to editors, comments, or editorials; (III) number of patients <5; (IV) in vitro or animal experiments; and (V) non-English language articles. The inverse variance method with a random effects model was used to obtain the pooled data. Subgroup analyses were performed to identify treatment factors. Egger test was conducted to assess the risk of publication bias. Results: After literature selection, 694 DF tumors were identified in 23 studies. In terms of modality, 13 studies used cryoablation, 9 studies used high-intensity focused ultrasound (HIFU), and 1 study used microwave ablation (MWA). The pooled symptom relief rate was 90% [95% confidence interval (CI): 80-97%], with that for HIFU being 100% (95% CI: 85-100%), that for cryoablation being 87% (95% CI: 74-97%), and that MWA being 89% (95% CI). The pooled major complication rate was 3% (95% CI: 1-7%), and that for each modality was as follows: HIFU =2% (95% CI: 0-6%), cryoablation =4% (95% CI: 1-8%), MWA =11%, ultrasound =6% (95% CI: 1-13%), computed tomography (CT) =2% (95% CI: 0-7%), and magnetic resonance imaging (MRI) =3% (95% CI: 0-14%). The pooled nonperfused volume rate (NPVR) was 76% (95% CI: 71-81%), and that for each modality was as follows: HIFU =77% (95% CI: 71-85%), cryoablation =74% (95% CI: 69-79%), ultrasound =75% (95% CI: 67-83%), CT =76% (95% CI: 67-87%), and MRI =78% (95% CI: 70-87%). The pooled local control rate was 88% (95% CI: 79-94%) and that for each modality was as follows: HIFU =99% (95% CI: 96-100%), cryoablation =80% (95% CI: 68-90%), and MWA =78%. The differences in major complication rate (P=0.77) and NPVR between imaging-guided modalities (P=0.40) were not significant, nor were the differences in symptom relief rate (P=0.32) and major complication rate (P=0.61) between ablative techniques; however, the differences in local control rate (P=0.01) were significant between ablative techniques. Conclusions: Imaging-guided thermal ablative therapies contribute to symptom relief with a duration of more than 6 months and a low major complication rate of DF tumors.

Efficacy of Thermal Ablation for Small-Size (0-3 cm) versus Intermediate-Size (3-5 cm) Colorectal Liver Metastases: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE).

PURPOSE: Thermal ablation is widely recognized as the standard of care for small-size unresectable colorectal liver metastases (CRLM). For larger CRLM safety, local control and overall efficacy are not well established and insufficiently validated. The purpose of this comparative series was to analyze outcomes for intermediate-size versus small-size CRLM. MATERIAL AND METHODS: Patients treated with thermal ablation between December 2000 and November 2021 for small-size and intermediate-size CRLM were included. The primary endpoints were complication rate and local control (LC). Secondary endpoints included local tumor progression-free survival (LTPFS) and overall survival (OS). RESULTS: In total, 59 patients were included in the intermediate-size (3-5 cm) group and 221 in the small-size (0-3 cm) group. Complications were not significantly different between the two groups (p = 0.546). No significant difference between the groups was found in an overall comparison of OS (HR 1.339; 95% CI 0.824-2.176; p = 0.239). LTPFS (HR 3.388; p < 0.001) and LC (HR 3.744; p = 0.004) were superior in the small-size group. Nevertheless, the 1-, 3-, and 5-year LC for intermediate-size CRLM was still 93.9%, 85.4%, and 81.5%, and technical efficacy improved over time. CONCLUSIONS: Thermal ablation for intermediate-size unresectable CRLM is safe and induces long-term LC in the vast majority. The results of the COLLISION-XL trial (unresectable colorectal liver metastases: stereotactic body radiotherapy versus microwave ablation-a phase II randomized controlled trial for CRLM 3-5 cm) are required to provide further clarification of the role of local ablative methods for intermediate-size unresectable CRLM.

Percutaneous microwave ablation combined with endocrine therapy versus standard therapy for elderly patients with HR-positive and HER2-negative invasive breast cancer: a propensity score-matched analysis of a multi-center, prospective cohort study.

Background: There is a growing trend to apply minimally invasive local treatments for elderly patients with early-stage breast cancer. As a minimally invasive thermal therapy, microwave ablation (MWA) has been attempted to treat breast cancer of small lesions, but its long-term local efficacy on elderly patients has seldom been reported. In this study, we aimed to compare outcomes of MWA combined with endocrine therapy to standard surgery combined with adjuvant therapy in the treatment of hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative invasive breast cancer for elderly patients. Methods: This prospective multi-center cohort study enrolled patients over 70 years old diagnosed with HR-positive and HER2-negative early-stage invasive breast cancer between January 2016 and July 2021. Patients chose either non-randomized to undergo MWA combined with endocrine therapy (MWA group) or standard surgery combined with adjuvant therapy (surgery group). Endpoints for the comparisons were disease-free survival (DFS), overall survival (OS) and length of hospital stay (LOS) after adjusting for previously reported risk factors using propensity score matching (1:3). Results: Of the enrolled 132 patients, 33 were in the MWA group and 99 were in the surgery group. MWA was successfully performed in all cases, and technical effectiveness was achieved in all cases. With a median follow-up of 31 months, only one case had local recurrence 23 months after MWA. MWA combined with endocrine therapy and standard surgery combined adjuvant therapy for elderly patients with breast cancer achieved similar DFS [hazard ratio, 0.536; 95% confidence interval (CI): 0.128-2.249] and OS (hazard ratio, 0.537; 95% CI: 0.089-3.235). Besides, MWA had much shorter LOS than standard surgery (7.1 versus 13.0 days, P<0.001). Conclusions: MWA combined with endocrine therapy and standard surgery combined with adjuvant therapy for elderly breast cancer patients achieved similar outcomes. MWA combined with endocrine may be a feasible treatment strategy for elderly patients with HR-positive and HER2-negative invasive breast cancer.