Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules.

INTRODUCTION: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. METHODS: A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. RESULTS: A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). CONCLUSION: Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure.

Radiofrequency Ablation of Benign and Malignant Thyroid Nodules.

Thyroid nodule treatment has significantly evolved over recent years with attempts to individualize treatment on the basis of the cause of the nodule and patient performance status. The risks and complications associated with surgery and radioactive iodine have promoted interest in additional therapies such as radiofrequency ablation (RFA). RFA creates an electrical current through a target tissue (thyroid nodule) with resultant tissue heating causing coagulative necrosis. National and international groups are beginning to recognize the role of RFA as a viable therapeutic option in the treatment of thyroid nodules. Based on numerous guidelines, RFA is indicated in the treatment of symptomatic benign nodules and autonomously functioning nodules when surgery is refused or when the patient would not tolerate surgery. The treatment of thyroid malignancy with RFA is controversial, with some groups advocating for its use in the treatment of small papillary thyroid cancers in specific scenarios. The most important aspect of RFA is the preprocedural workup and adequate patient selection. Procedural technique varies among centers. However, RFA is typically performed as a single-day-admission outpatient procedure. Methods such as hydrodissection and a moving shot technique are employed to ensure adequate coverage of the nodule without overtreating the peripheries and damaging sensitive structures. As a result, the procedure is well tolerated, and major complications such as recurrent laryngeal nerve injury and nodule rupture are very rare. In the proper patient cohort, thyroid RFA offers an efficacious and safe option in the management of thyroid nodules. An invited commentary by Filippiadis and Vrachliotis is available online. ©RSNA, 2022.

Musculoskeletal Oncologic Interventions: Proceedings from the Society of Interventional Radiology and Society of Interventional Oncology Research Consensus Panel.

Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel's proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed the effectiveness of ablation within specific patient populations, the effect of combination of ablation with radiotherapy and/or immunotherapy, and the potential of standardization of techniques, including modeling and monitoring, to improve the consistency and predictability of treatment outcomes.

Initial testing of pegfilgrastim (Neulasta Onpro) on-body injector in multiple radiological imaging environments.

PURPOSE: An increasing number of implantable or external devices can impact whether patients can receive radiological imaging examinations. This study examines and tests the Neulasta (pegfilgrastim) Onpro on-body injector in multiple imaging environments. METHODS: The injector was analyzed for four imaging modalities with testing protocols and strategies developed for each modality. In x-ray and computed tomography (CT), scans with much higher exposure than clinical protocols were performed with the device attached to an anthropomorphic phantom. The device was monitored until the completion of drug delivery. For magnetic resonance imaging (MRI), the device was assessed using a hand-held magnet and underwent the magnetically induced displacement testing in a 1.5T clinical MRI scanner room. For ultrasound, magnetic field changes were measured around an ultrasound scanner system with three transducers. RESULTS: For x-ray and CT no sign of device error was identified during or after the high radiation exposure scans. Drug delivery was completed at expected timing with expected volume. For MRI the device showed significant attractive force towards the hand-held magnet and a 50-degree deflection angle at 50 cm from the opening of the scanner bore. No further assessment from the gradient or radiofrequency field was deemed necessary. For ultrasound the maximum magnetic field change from baseline was measured to be +11.7 µT in comparison to +74.2 µT at 4 inches from a working microwave. CONCLUSIONS: No device performance issue was identified under the extreme test conditions in x-ray or CT. The device was found to be MR Unsafe. Magnetic field changes around an ultrasound system met the limitation set by manufacture. Patient ultrasound scanning is considered safe as long as the transducers do not inadvertently loosen the device.

Safety and Efficacy of Retrograde Pyeloperfusion for Ureteral Protection during Renal Tumor Cryoablation.

PURPOSE: To determine safety and efficacy of retrograde pyeloperfusion for ureteral protection during cryoablation of adjacent renal tumors. MATERIALS AND METHODS: Retrospective review of 155 patients treated with renal cryoablation, including adjunctive retrograde pyeloperfusion, from 2005 to 2019 was performed. Ice contacted the ureter in 67 of the 155 patients who represented the study cohort. Median patient age was 68 years old (interquartile range [61, 74]), 52 patients (78%) were male, and 37 tumors (55%) were clear cell histology. Mean tumor size was 3.4 ± 1.3 cm, and 42 tumors (63%) were located at the lower pole. Treatment-related complication and oncologic outcomes were recorded based on a review of post-procedural images and chart review. RESULTS: Technical success of cryoablation was attained in 67 cases (100%), and technical success of pyeloperfusion was attained in 66 cases (99%). A total of 13 patients (19.4%) experienced SIR major C or D complications related to the procedure, including hemorrhage (n = 4), urine leak (n = 3), transient urinary obstruction (n = 2), pulmonary embolism (n = 1), hypertensive urgency (n = 1), acute respiratory failure (n = 1), and ureteropelvic junction (UPJ) stricture (n = 1). No complications were attributable to pyeloperfusion. Three of 45 patients with biopsy-proven renal cell carcinoma experienced local recurrence resulting in local recurrence-free survival of 92% (95% confidence interval, 81.5%-100%) 3 years after ablation. CONCLUSIONS: Retrograde pyeloperfusion of the renal collecting system is a relatively safe and efficacious option for ureteral protection during renal tumor cryoablation. This adjunctive procedure should be considered for patients in whom cryoablation of a renal mass could potentially involve the ureter.

Dual-Energy CT Monitoring of Cryoablation Zone Growth in the Spinal Column and Bony Pelvis: A Laboratory Study.

PURPOSE: To evaluate the use of dual-energy computed tomography (CT) virtual noncalcium imaging (VNCa) to visualize ice ball growth during skeletal cryoablation procedures in the spine and bony pelvis. MATERIALS AND METHODS: Cryoablation was performed in the spine and bony pelvis of swine and human cadavers at 5 and 6 locations, respectively. CT scans were acquired every 2 minutes using a dual-source dual-energy scanner. Artifacts were suppressed using iterative metal artifact reduction, and ablation zones in the bones and surrounding tissue were visualized using multiplanar VNCa and mixed kV imaging. For each probe location and time point, ice detectability was determined and the volume of the ice was measured. RESULTS: At each location, ice was visualized within the bone before reaching critical neural and intraabdominal structures. Within bone, the ice ball could not be visualized on mixed kV images, but was seen using VNCa images before reaching the adjacent soft tissue in 7/11 (64%) scenarios. Volume of the smallest ice ball seen in VNCa images was 18% of the final volume after cryoablation compared with 42% for mixed kV (P = .014). CONCLUSIONS: This application of dual-energy CT and VNCa imaging to cryoablation monitoring permits earlier ice visualization within the vertebral column and pelvic bones in near real time. Because these scanners and imaging techniques increase in availability in interventional suites, cryoablation of tumors along the spine and pelvic bone potentially could be performed with greater confidence.

Development of a robust MRI fiducial system for automated fusion of MR-US abdominal images.

We present the development of a two-component magnetic resonance (MR) fiducial system, that is, a fiducial marker device combined with an auto-segmentation algorithm, designed to be paired with existing ultrasound probe tracking and image fusion technology to automatically fuse MR and ultrasound (US) images. The fiducial device consisted of four ~6.4 mL cylindrical wells filled with 1 g/L copper sulfate solution. The algorithm was designed to automatically segment the device in clinical abdominal MR images. The algorithm's detection rate and repeatability were investigated through a phantom study and in human volunteers. The detection rate was 100% in all phantom and human images. The center-of-mass of the fiducial device was robustly identified with maximum variations of 2.9 mm in position and 0.9° in angular orientation. In volunteer images, average differences between algorithm-measured inter-marker spacings and actual separation distances were 0.53 ± 0.36 mm. "Proof-of-concept" automatic MR-US fusions were conducted with sets of images from both a phantom and volunteer using a commercial prototype system, which was built based on the above findings. Image fusion accuracy was measured to be within 5 mm for breath-hold scanning. These results demonstrate the capability of this approach to automatically fuse US and MR images acquired across a wide range of clinical abdominal pulse sequences.

Comprehensive assessment of renal tumour complexity in a large percutaneous cryoablation cohort.

OBJECTIVE: To evaluate the association between renal tumour complexity and outcomes in a large cohort of patients undergoing percutaneous cryoablation (PCA). PATIENTS AND METHODS: Patients with renal tumours treated with PCA were identified using our prospectively maintained ablation registry (2003-2015). Salvage procedures and inherited tumour syndromes were excluded. The associations between R.E.N.A.L. nephrometry score (NS) and risk of complications, renal function impairment, local failure and cancer-specific mortality (CSM) were evaluated using univariate and multivariable logistic, linear and Cox regression models. RESULTS: The cohort included 618 tumours treated during 580 procedures in 565 patients. The median (interquartile range [IQR]) follow-up was 34 (14.66) months. Complications (any grade) during a procedure (n[total] = 87, 15%) were more frequent with higher NS (NS 4-6: 10%; NS 7-9: 14%; NS 10-12: 36%; P < 0.001). Higher NS was independently associated with risk of complications (odds ratio [OR; per 1 point] = 1.3; 95% confidence interval [CI] 1.2-1.5; P < 0.001). Of all the NS components, tumour size was the most strongly associated with complication risk (OR 3.4; 95% CI 2.2-5.2; P < 0.001). The median (IQR) decline in glomerular filtration rate (GFR) from baseline was 9% (0, 22) at last follow-up. Each additional point in NS was associated with a 1.3% (95% CI 0.4-2.1; P = 0.005) greater GFR decline from baseline. NS was not significantly associated with local failure (n [total] = 14, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 5%; P = 0.32) or CSM (n [total] = 8, 2%; NS 4-6: 2%; NS 7-9: 3%; NS 10-12: 2%; P = 0.88). CONCLUSION: In high-complexity tumours PCA was associated with a tumour size-driven increased risk of post-procedural complications. Higher NS was associated with a small, clinically minor additional decline in renal function. Risks for local failure and CSM were low, regardless of tumour complexity.

Image-Guided Thermal Ablative Therapies in the Treatment of Sarcoma.

OPINION STATEMENT: Percutaneous thermal ablation, including microwave ablation (MWA), radiofrequency ablation (RFA), and cryoablation, is a well-established focal treatment option for primary and metastatic malignancies. While published literature specific to ablation of sarcomas is relatively lacking compared with non-sarcomatous malignancies, what is available is promising. In situations where a focal treatment option is desired, strong consideration should be given to percutaneous thermal ablation, in addition to surgery and radiation therapy. A significant advantage of percutaneous thermal ablation over surgery and radiation includes the repeatability of ablation, as there is no absolute limit on the number of times an ablation can be performed. Compared with surgery, ablation offers the potential of decreased recovery time, a less invasive procedure, and is often performed in patients deemed not medically fit for surgery.

Percutaneous Cryoablation of Extraabdominal Desmoid Tumors: A 10-Year Experience.

OBJECTIVE: Extraabdominal desmoid (EAD) tumors pose a therapeutic challenge because they often recur locally and behave aggressively. Accepted management options include surgery, radiation, chemotherapy, and observation. The objective of this study was to assess the safety and efficacy of percutaneous cryoablation for the treatment of EAD tumors. MATERIALS AND METHODS: A retrospective search of our cryoablation database was performed to identify patients with EAD tumors treated with percutaneous cryoablation between June 15, 2004, and June 15, 2014. During this 10-year time period, we treated 18 patients with 26 discrete tumors during 31 treatment sessions. After cryoablation, contrast-enhanced MRI or CT was performed. Any enhancing soft tissue was considered viable EAD tumor and was measured in three planes. RESULTS: Of the 26 EAD tumors treated, follow-up imaging with IV contrast material was available for 23 tumors. The mean imaging follow-up was 16.2 ± 20.0 (SD) months. All 31 sessions were technically successful procedures. No residual viable EAD tumor was observed in nine of 23 tumors (39.1%). Some degree of volume reduction was evident in 22 of 23 tumors (95.7%). Progressive disease was observed in one of the 23 tumors (4.3%). Of the cases with residual or progressive disease, the recurrence occurred at the margin of the treated tumor in all cases. No major complications were observed, and none of the complications was more severe than Clavien-Dindo grade I. CONCLUSION: Percutaneous cryoablation is a safe, effective, and repeatable treatment for achieving local control of EAD tumors.

Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control.

PURPOSE: To describe the technical methods, safety, and local tumor control rate associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). MATERIALS AND METHODS: A retrospective review of a percutaneous renal ablation registry was used to identify 46 patients with a total of 46 biopsy-proven RCC lesions measuring 4.1-7.0 cm treated with cryoablation between 2003 and 2011. The main outcome parameters investigated were adjunctive maneuvers, complications, and local tumor progression, and cancer-specific survival rates. Complication rates were categorized and recorded using the Clavien-Dindo classification system. Progression-free and cancer-specific survival rates were estimated using the Kaplan-Meier method. RESULTS: The mean treated RCC size was 4.8 cm (range, 4.1-6.4 cm). Prophylactic tumor embolization was performed in 7 patients (15%), ipsilateral ureteral stents were placed in 7 patients (15%), and hydrodisplacement of bowel was performed in the treatment of 16 tumors (35%). A single technical failure (2.2%) was observed at the time of ablation. Thirty-six tumors (78%) had follow-up imaging at 3 months or later following ablation, including a single recurrence at 9 months after ablation. The mean duration of follow-up for the 35 RCC tumors that did not recur was 2.0 years (range, 0.3-6.1 y). Estimated local progression-free survival rate at 3 years was 96.4%. Of the 46 cryoablation procedures, there were 7 complications (15.2%) of grade II or worse. CONCLUSIONS: The results suggest that cryoablation represents a valid treatment alternative for select patients with clinical stage T1b RCC. Complications are frequent enough that multidisciplinary patient management should be considered.

Feasibility and oncologic control after percutaneous image guided ablation of metastatic renal cell carcinoma.

PURPOSE: We assessed the safety, local control and oncologic efficacy of percutaneous ablation in the treatment of metastatic renal cell carcinoma. MATERIALS AND METHODS: A retrospective review was performed of 61 patients who underwent 74 ablation procedures to treat 82 metastatic renal cell carcinoma lesions with the intent of local eradication. Technical success, local tumor control, complications and patient survival were analyzed according to standard criteria. RESULTS: Four (4.9%) technical failures were observed while 2 patients were lost to followup. Time to recurrence was assessed for the subset of 76 (93%) tumors that were followed after ablation. Six (of 76, 7.9%) tumors recurred at a mean of 1.6 years after ablation (median 1.4, range 0.6 to 2.9). Thus, known overall local tumor control was achieved in 70 of 80 (87.5%) tumors. Estimated local recurrence-free survival rates (95% CI, number still at risk) at 1, 2 and 3 years after ablation were 94% (88-100, 41), 94% (88-100, 32) and 83% (70-97, 17), respectively. Estimated overall survival rates (95% CI, number still at risk) at 1, 2 and 3 years after ablation were 87% (79-97, 42), 83% (73-94, 31) and 76% (63-90, 19), respectively. CONCLUSIONS: Image guided ablation of metastatic renal cell carcinoma is a relatively safe procedure with acceptable local control rates. Ablation may offer patients a minimally invasive option of local tumor eradication and warrants a role in the multimodal treatment approach for select patients.

Cryoablation of sternal metastases for pain palliation and local tumor control.

PURPOSE: To determine safety and effectiveness of cryoablation of sternal metastases for pain palliation and local tumor control. MATERIALS AND METHODS: A tumor ablation database was retrospectively reviewed for sternal cryoablation procedures performed between January 2005 and June 2013, which yielded 15 procedures to treat 12 sternal metastases in 12 patients (five men). Median patient age was 57 years (range, 38-80 y). Metastases arose from five primary sites (breast, lung, kidney, ampulla, and thyroid), and median tumor size was 3.8 cm (range, 2.2-7.5 cm). Seven patients (58%) underwent cryoablation for pain palliation, and five (42%) underwent cryoablation for local tumor control of oligometastatic disease. Clinical outcomes (including complications, local tumor control, and pain response) were evaluated retrospectively. RESULTS: Mean pain scores decreased from 7.0 ± 1.9 (median, 7; range, 4-10) at baseline to 1.8 ± 1.2 (median, 1.5; range, 0-4) following cryoablation (P = .00049). Two patients had durable pain palliation, and four had greater than 1 month of pain relief, with a median duration of 5.7 months (range, 1.5-14.7 mo). Two patients in whom recurrent pain developed underwent repeat cryoablation, with durable pain relief. Allowing for a single repeat treatment, local tumor control was achieved in four of five patients (80%) treated for this indication, with median follow-up of 8.4 months (range, 2.6-13.6 mo). In one patient (8%), an infectious complication developed that was successfully treated with antibiotics on an outpatient basis. CONCLUSIONS: Cryoablation is a safe and potentially effective treatment for patients with painful sternal metastases and can achieve local tumor control in select patients.

Motor evoked potential monitoring during cryoablation of musculoskeletal tumors.

PURPOSE: To describe the use of intraprocedural motor evoked potential (MEP) monitoring to minimize risk of neural injury during percutaneous cryoablation of perineural musculoskeletal tumors. MATERIALS AND METHODS: A single-institution retrospective review of cryoablation procedures performed to treat perineural musculoskeletal tumors with the use of MEP monitoring between May 2011 and March 2013 yielded 59 procedures to treat 64 tumors in 52 patients (26 male). Median age was 61 years (range, 4-82 y). Tumors were located in the spine (n = 27), sacrum (n = 3), retroperitoneum (n = 4), pelvis (n = 22), and extremities (n = 8), and 21 different tumor histologies were represented. Median tumor size was 4.0 cm (range, 0.8-15.0 cm). Total intravenous general anesthesia, computed tomographic guidance, and transcranial MEP monitoring were employed. Patient demographics, tumor characteristics, MEP findings, and clinical outcomes were assessed. RESULTS: Nineteen of 59 procedures (32%) resulted in decreases in intraprocedural MEPs, including 15 (25%) with transient decreases and four (7%) with persistent decreases. Two of the four patients with persistent MEP decreases (50%) had motor deficits following ablation. No functional motor deficit developed in a patient with transient MEP decreases or no MEP change. The risk of major motor injury with persistent MEP changes was significantly increased versus transient or no MEP change (P = .0045; relative risk, 69.8; 95% confidence interval, 5.9 to > 100). MEP decreases were 100% sensitive and 70% specific for the detection of motor deficits. CONCLUSIONS: Persistent MEP decreases correlate with postprocedural sustained motor deficits. Intraprocedural MEP monitoring helps predict neural injury and may improve patient safety during cryoablation of perineural musculoskeletal tumors.

Conventional and spectral- CT for renal cell carcinoma thermal ablation: A case report.

Dual-energy or spectral computed tomography (CT) information may be obtained by either sending X-ray beams of different energy spectra through the patient or by discriminating the energy of the X-rays that reach the detector. The spectral signal is then used to generate multiple results: conventional, virtual monoenergetic (MonoE), effective atomic number, electron density, and other material specific (e.g., iodine, calcium, or uric acid). This report demonstrates the potential benefits of spectral CT imaging during percutaneous tumor ablation procedures, specifically regarding visualization of inconspicuous tumors, accurate probe placement, and assessment of treatment efficacy.

Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors.

PURPOSE: We applied the R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry scoring system to renal tumors treated with percutaneous ablation to determine whether this score is associated with oncological outcomes and complications. MATERIALS AND METHODS: A total of 751 renal tumors were treated at 679 percutaneous ablation sessions in 627 patients at our institution between 2000 and 2012. Of these renal masses 430 (57%) were treated with cryoablation and the remaining 321 were treated with radio frequency ablation. R.E.N.A.L. tumor scores were analyzed to determine the association of the score with ablation treatment outcomes and complications according to Clavien criteria. RESULTS: The mean ± SD R.E.N.A.L. nephrometry score of all ablated tumors was 6.7 ± 1.9. Those treated with cryoablation had higher scores than those treated with radio frequency ablation (mean 7.2 ± 1.9 vs 6.1 ± 1.8, p <0.001). We identified a total of 28 local treatment failures (3.7%) in the 751 tumors during a mean computerized tomography/magnetic resonance imaging followup of 27.9 ± 27.8 months. There was a significant association between R.E.N.A.L. nephrometry score and local treatment failure. Mean nephrometry score was 7.6 ± 2.2 vs 6.7 ± 1.9 for tumors with vs without local treatment failure (p <0.001). Of the 679 ablation treatments 38 (5.6%) major (grade 3 or greater) patient complications occurred. There was a significant association between R.E.N.A.L. nephrometry score and major complications. Patients with vs without a major complication had a mean nephrometry score of 8.1 ± 2.0 vs 6.8 ± 1.9 (p <0.001). CONCLUSIONS: The R.E.N.A.L. nephrometry scoring system predicts treatment efficacy and complications following percutaneous renal ablation.

Safety and accuracy of aortic and periaortic CT-guided percutaneous core needle biopsy.

PURPOSE: The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years. MATERIALS AND METHODS: A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated. RESULTS: 32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5-10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3-1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%. CONCLUSION: CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield.

Emerging Indications for Interventional Oncology: Expert Discussion on New Locoregional Treatments.

Interventional oncology (IO) employs image-guided techniques to perform minimally invasive procedures, providing lower-risk alternatives to many traditional medical and surgical therapies for cancer patients. Since its advent, due to rapidly evolving research development, its role has expanded to encompass the diagnosis and treatment of diseases across multiple body systems. In detail, interventional oncology is expanding its role across a wide spectrum of disease sites, offering a potential cure, control, or palliative care for many types of cancer patients. Due to its widespread use, a comprehensive review of the new indications for locoregional procedures is mandatory. This article summarizes the expert discussion and report from the "MIOLive Meet SIO" (Society of Interventional Oncology) session during the last MIOLive 2022 (Mediterranean Interventional Oncology Live) congress held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions. The aim of this paper is to provide an updated review of the new techniques and devices available for innovative indications not only to residents and fellows but also to colleagues approaching locoregional treatments.

Percutaneous cryoablation of solitary sporadic renal cell carcinomas.

UNLABELLED: What's known on the subject? and What does the study add? Percutaneous renal cryoablation is a safe and effective treatment for patients with small renal masses, who are poor surgical candidates. Oncological outcomes from previous percutaneous ablation studies are difficult to interpret because of the large number of patients treated with a history of RCC (38% in our experience) and the large number of treated renal masses without a pathology-proven diagnosis. This cryoablation study addresses these issues by evaluating only solitary, sporadic biopsy-proven RCC. Oncological outcomes and complications were also evaluated by tumour T-stage, which allows some degree of comparison with previously published surgical results. OBJECTIVE: • To evaluate retrospectively our single institution experience with percutaneous cryoablation of solitary, sporadic renal cell carcinomas (RCCs), and to compare the efficacy and safety of this technique for treatment of different T-stage RCC. PATIENTS AND METHODS: • 116 patients were treated with percutaneous cryoablation for a solitary, sporadic biopsy-proven RCC in a single treatment session between November 2003 and November 2010. • The technical success of the ablation procedure, complications and evidence for local or metastatic tumour recurrence were evaluated for each patient. RESULTS: • 83 patients (72%) were treated for a stage T1a RCC, 27 patients (23%) for a stage T1b RCC, and six patients (5%) for a stage T2 RCC. • Technical success was achieved in the treatment of 115 of 116 (99%) renal tumours. The single technical failure occurred in the treatment of a 4.3-cm RCC. • Local recurrent tumour was identified in one of 88 patients (1%) with follow-up computed tomography (CT) or magnetic resonance imaging available for review >3 months from the time of ablation. The median (range) imaging follow-up in these patients was 21 (3-73) months. The local tumour recurrence was identified on CT 11 months after the ablation procedure in a patient treated for a 2.7 cm RCC. • None of the patients developed metastatic RCC. • The major complication rate was 4% for patients with stage T1a tumours, 15% for those with stage T1b tumours, and 33% for those with stage T2 tumours. There were no procedural-related deaths. CONCLUSIONS: • Percutaneous renal cryoablation of RCC can be performed with high technical success in patients with tumours up to, and beyond 7 cm in maximum diameter. • The tumour recurrence rate after percutaneous renal cryoablation was low, and recurrence was not related to tumour size in this group of patients. • Statistically significant higher complication rates were seen with treatment of larger (higher T-stage) RCCs.

Renal oncocytoma growth rates before intervention.

OBJECTIVE: To describe the growth rates of oncocytomas before treatment with surgical resection or percutaneous ablation. PATIENTS AND METHODS: This single-institution retrospective study included 33 consecutive, pathologically proven renal oncocytomas with serial contrast-enhanced computed tomography scans spanning at least 1 year before intervention, from 2000 to 2009. Tumours were measured by two radiologists, and growth rates and interobserver variability were calculated. The mean (range) pre-procedural imaging surveillance period was 36 (12-124) months (median 33 months). RESULTS: The mean (SD) oncocytoma size was 17 (11) mm (range 4-47 mm, median 15 mm) in maximum transverse diameter on initial imaging and grew to a mean (SD) of 26 (5) mm (range 10-83 mm, median 23 mm) by the time of treatment. Overall, the mean (SD) and median growth rates were 2.9 (2.6) mm/year and 2.7 mm/year, respectively (range -1.2-10.9 mm/year). After weighting by the se of each tumour's growth rate, the mean (SD) change was 2.1 (1.2) mm/year. The mean (range) interobserver variability for each tumour measurement was 1 (0-7) mm with an intraclass correlation coefficient of 0.99. CONCLUSIONS: Renal oncocytomas grow at a rate similar to reported growth rates of renal cell carcinoma. As the observation of growth does not distinguish between benign and malignant renal tumours, growth of small renal masses under active surveillance should be carefully considered before a switch is made to intervention.