Three-Dimensional Margin as a Predictor of Local Tumor Progression after Microwave Ablation: Intraprocedural versus 4-8-Week Postablation Assessment.

PURPOSE: To evaluate the prognostic accuracy of intraprocedural and 4-8-week (current standard) post-microwave ablation zone (AZ) and margin assessments for prediction of local tumor progression (LTP) using 3-dimensional (3D) software. MATERIALS AND METHODS: Data regarding 100 colorectal liver metastases (CLMs) in 75 patients were collected from 2 prospective fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT)-guided microwave ablation (MWA) trials. The target CLMs and theoretical 5- and 10-mm margins were segmented and registered intraprocedurally and at 4-8 weeks after MWA contrast-enhanced CT (or magnetic resonance [MR] imaging) using the same methodology and 3D software. Tumor and 5- and 10-mm minimal margin (MM) volumes not covered by the AZ were defined as volumes of insufficient coverage (VICs). The intraprocedural and 4-8-week post-MWA VICs were compared as predictors of LTP using receiver operating characteristic curve analysis. RESULTS: The median follow-up time was 19.6 months (interquartile range, 7.97-36.5 months). VICs for 5- and 10-mm MMs were predictive of LTP at both time assessments. The highest accuracy for the prediction of LTP was documented with the intra-ablation 5-mm VIC (area under the curve [AUC], 0.78; 95% confidence interval, 0.66-0.89). LTP for a VIC of 6-10-mm margin category was 11.4% compared with 4.3% for >10-mm margin category (P < .001). CONCLUSIONS: A 3D 5-mm MM is a critical endpoint of thermal ablation, whereas optimal local tumor control is noted with a 10-mm MM. Higher AUCs for prediction of LTP were achieved for intraprocedural evaluation than for the 4-8-week postablation 3D evaluation of the AZ.

Microwave Ablation versus Stereotactic Body Radiotherapy for Stage I Non-Small Cell Lung Cancer: A Cost-Effectiveness Analysis.

PURPOSE: To assess the cost effectiveness of microwave ablation (MWA) and stereotactic body radiotherapy (SBRT) for patients with inoperable stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A literature search was performed in MEDLINE with broad search clusters. A decision-analytic model was constructed over a 5-year period. The model incorporated treatment-related complications and long-term recurrence. All clinical parameters were derived from the literature with preference to long-term prospective trials. A healthcare payers' perspective was adopted. Outcomes were measured in quality-adjusted life years (QALYs) extracted from prior studies and U.S. dollars from Medicare reimbursements and prior studies. Base case calculations, probabilistic sensitivity analysis with 10,000 Monte Carlo simulations, and multiple 1- and 2-way sensitivity analyses were performed. RESULTS: MWA yielded a health benefit of 2.31 QALYs at a cost of $195,331, whereas SBRT yielded a health benefit of 2.33 QALYs at a cost of $225,271. The incremental cost-effectiveness ratio was $1,480,597/QALY, indicating that MWA is the more cost-effective strategy. The conclusion remains unchanged in probabilistic sensitivity analysis with MWA being the optimal cost strategy in 99.84% simulations. One-way sensitivity analyses revealed that MWA remains cost effective when its annual recurrence risk is <18.4% averaged over 5 years, when the SBRT annual recurrence risk is >1.44% averaged over 5 years, or when MWA is at least $7,500 cheaper than SBRT. CONCLUSIONS: MWA appears to be more cost effective than SBRT for patients with inoperable stage I NSCLC.

Computed Tomography-Guided Microwave Ablation of Cystic Renal Cell Carcinoma: Assessment of Technique and Complications.

This report evaluates the techniques and complications of microwave ablation of cystic renal cell carcinoma. Five patients with cystic renal cell carcinoma were treated with microwave ablation between October 2015 and June 2020. Medical records were reviewed to evaluate technique and complications. Technical success and primary technique efficacy both were 100%. There were no complications. Mean follow-up time was 18 months (range, 6-36 months). No local recurrence was identified during the follow-up period. Renal function remained stable at 1 month and the last follow-up. Percutaneous microwave ablation is promising for the nonsurgical management of cystic renal cell carcinoma.

The creation of an assessment tool for the analysis of two forms of heat damage in animal hair.

Animal cruelty cases can involve a variety of mistreatment to domestic animals. A common source of abuse is the use of heat sources, such as ovens, hot surfaces and microwaves. Analysis of damage to skin by a veterinarian is a key aspect of these investigations but additional information can be provided by observing the hair of the animal, including heat source type and exposure time. This study developed an objective grading system for the analysis of heat damage in hairs which can be used to quantify different damage characteristics including bubbling, discolouration, expansion of hair, fractures, changes to the medulla and scales and scale removal/melting. This grading scheme was applied to the investigation of dog (Canis familiaris) skin samples with full pelage and loose hairs exposed to microwaves and a heated environment in order to identify any distinguishing damage characteristics from the two different heated environments. Samples were exposed to a furnace for 1min at different temperature ranges (50-350°C with 50°C intervals) and also a microwave at maximum power for different time periods (15, 30, 45, 60, 120, 180, 240 and 300s). Hairs were extracted for examination using high powered light microscopy and scanning electron microscopy. Overall, it can be determined that the type of damage observed is influenced by the nature of heat applied and the context and substrate in which the hair is situated at the time of exposure. Using principal component analysis (PCA) it was concluded that as temperature increases in a furnace so does the severity of each of the damage characteristics observed. It can be noted that with furnace exposure, any one of the characteristics could be used to indicate the temperature to which it has been exposed. For furnace exposed samples there was no significant difference between loose or embedded hairs. PCA analysis determined that there are two independent forms of damage that occur when hairs are exposed to microwave radiation, these are: increased bubbling and discolouration in the root and increased bubbling and discolouration of the shaft and tip. Exposure time is correlated with both the root and shaft/tip observations. The results indicated some clear distinctions between heat source and exposure useful for the objective interpretation of such evidence. This standardised approach for the observation of heat damage characteristics in animal hair provides investigators with a tool to differentiate between methods of abuse, providing a greater understanding of the crime committed.

Risk Assessment of Chronic Kidney Disease following Microwave Ablation for Stage T1 Renal Cell Carcinoma.

PURPOSE: To assess safety and renal-function outcomes after microwave (MW) ablation of localized stage T1 renal cell carcinoma (RCC). MATERIALS AND METHODS: A retrospective review was conducted of 38 patients (28 men; mean age, 69 y; range, 51-88 y) who underwent computed tomography (CT)-guided MW ablation for stage T1N0M0 RCC. Baseline and follow-up renal function surrogates including creatinine level and estimated glomerular filtration rate (eGFR) were statistically compared. Peri- and postoperative complication rates, technical success, and treatment response were also assessed. RESULTS: A total of 44 biopsy-proven stage T1N0M0 RCCs measuring 1.2-6.9 cm (mean, 2.5 cm) were treated, and renal function was measured 1 mo after treatment. Mean eGFRs were 60 mL/min/1.73 m2 at baseline and 59 mL/min/1.73 m2 at 1 month after ablation. At 1-year and last follow-ups, the means of difference were 3.3% (95% confidence interval, -4.4 to 4.3; P = .99) and 3.3% (95% confidence interval, -4.3 to 4.8; P = .91), respectively. The 2-years freedom from eGFR decrease to < 60 mL/min/1.73 m2 was 2% (P = .91). Among the 5 patients (13%) with preexisting stage 4 chronic kidney disease (CKD; eGFR < 30 mL/min/1.73 m2) before ablation, there was no significant postablative onset of decline or CKD upstaging (P = .001). There were no major complications, and 5 patients (13%) had small asymptomatic perinephric hematomas (Society of Interventional Radiology minor complication, class A/B) that were managed conservatively. CONCLUSIONS: At 2-year follow-up, CT-guided percutaneous MW ablation is safe and well-tolerated and achieves nephron preservation similar to existing ablative modalities.

Genotoxic Effects in Human Fibroblasts Exposed to Microwave Radiation.

In the last decades, technological development has led to an increasing use of devices and systems based on microwave radiation. The increased employment of these devices has elicited questions about the potential long-term health consequences associated with microwave radiation exposure. From this perspective, biological effects of microwave radiation have been the focus of many studies, but the reported scientific data are unclear and contradictory. The aim of this study is to evaluate the potential genotoxic and cellular effects associated with in vitro exposure of human fetal and adult fibroblasts to microwave radiation at the frequency of 25 GHz. For this purpose, several genetic and biological end points were evaluated. Results obtained from comet assay, phosphorylation of H2AX histone, and antikinetochore antibody (CREST)-negative micronuclei frequency excluded direct DNA damage to human fetal and adult fibroblasts exposed to microwaves. No induction of apoptosis or changes in prosurvival signalling proteins were detected. Moreover, CREST analysis showed for both the cell lines an increase in the total number of micronuclei and centromere positive micronuclei in exposed samples, indicating aneuploidy induction due to chromosome loss.

Thermal Ablation of T1c Renal Cell Carcinoma: A Comparative Assessment of Technical Performance, Procedural Outcome, and Safety of Microwave Ablation, Radiofrequency Ablation, and Cryoablation.

PURPOSE: To evaluate perioperative outcomes of thermal ablation with microwave (MW), radiofrequency (RF), and cryoablation for stage T1c renal cell carcinoma (RCC). MATERIALS AND METHODS: A retrospective analysis of 384 patients (mean age, 71 y; range, 22-88 y) was performed between October 2006 and October 2016. Mean radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines; preoperative aspects and dimensions used for anatomic classification; and centrality index scores were 6.3, 7.9, and 2.7, respectively. Assessment of pre- and postablation serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate was performed to assess functional outcomes. Linear regression analyses were performed to compare sedation medication dosages among the three treatment cohorts. Univariable and multivariable logistic regression analyses were performed to compare rates of residual disease and complications among treatment modalities. RESULTS: A total of 437 clinical stage T1N0M0 biopsy-proven RCCs measuring 1.2-6.9 cm were treated with computed tomography (CT)-guided MW ablation (n = 44; 10%), RF ablation (n = 347; 79%), or cryoablation (n = 46; 11%). There were no significant differences in patient demographic or tumor characteristics among cohorts. Complication rates and immediate renal function changes were similar among the three ablation modalities (P = .46 and P = .08, respectively). MW ablation was associated with significantly decreased ablation time (P < .05), procedural time (P < .05), and dosage of sedative medication (P < .05) compared with RF ablation and cryoablation. CONCLUSIONS: CT-guided percutaneous MW ablation is comparable to RF ablation or cryoablation for the treatment of stage T1N0M0 RCC with regard to treatment response and is associated with shorter treatment times and less sedation than RF ablation or cryoablation. In addition, the safety profile of CT-guided MW ablation is noninferior to those of RF ablation or cryoablation.

CT-Guided Percutaneous Microwave Ablation of Tumors in the Hepatic Dome: Assessment of Efficacy and Safety.

PURPOSE: To evaluate the technique, efficacy, safety, and clinical outcomes of CT-guided microwave ablation of tumors in the hepatic dome. MATERIALS AND METHODS: Retrospective review was conducted of 46 consecutive patients (31 men and 15 women; mean age, 64 y) treated with CT-guided microwave ablation for hepatic-dome tumors between June 2011 and December 2014. Baseline demographics of sex, tumor diagnosis, tumor location, tumor size, and technical details were recorded. Technical success was evaluated. Treatment response was assessed per European Association for the Study of the Liver criteria. Overall success and overall survival were calculated, and complications were recorded. RESULTS: Forty-eight tumors were treated. Tumor locations included segments VIII (n = 32), VII (n = 10), and VIa (n = 6). Mean tumor size was 2.4 cm (range, 0.9-5.2 cm). Thirty-four tumors (70%) were treated following creation of artificial ascites with 0.9% normal saline solution (mean volume, 1,237 mL; range, 300-3,000 mL). The technical success rate was 100%, and the complete response rate was 94%. Overall survival rate was 73.9% over 24.7 months of follow-up. There were no major complications. Two patients experienced small, asymptomatic pneumothoraces that were aspirated at the time of the procedure and required no further treatment. CONCLUSIONS: CT-guided microwave ablation of tumors in the hepatic dome is associated with a high technical success rate, high complete response rate, and low complication rate.

Estimation of radiofrequency power leakage from microwave ovens for dosimetric assessment at nonionizing radiation exposure levels.

The electromagnetic field leakage levels of nonionizing radiation from a microwave oven have been estimated within a complex indoor scenario. By employing a hybrid simulation technique, based on coupling full wave simulation with an in-house developed deterministic 3D ray launching code, estimations of the observed electric field values can be obtained for the complete indoor scenario. The microwave oven can be modeled as a time- and frequency-dependent radiating source, in which leakage, basically from the microwave oven door, is propagated along the complete indoor scenario interacting with all of the elements present in it. This method can be of aid in order to assess the impact of such devices on expected exposure levels, allowing adequate minimization strategies such as optimal location to be applied.

Microwave ablation of osteoid osteomas using dynamic MR imaging for early treatment assessment: preliminary experience.

PURPOSE: To evaluate the efficacy of microwave ablation for osteoid osteomas by using dynamic contrast-enhanced magnetic resonance (MR) imaging in early treatment assessment. MATERIALS AND METHODS: Ten patients (two female, eight male; mean age, 28 y; range, 16-47 y) presenting with osteoid osteomas were treated between June 2010 and December 2012 with the use of computed tomography (CT)-guided microwave ablation. Osteoid osteomas were found at the femoral neck (n = 4), tibia (n = 3), calcaneus (n = 1), navicular bone (n = 1), and dorsal rib (n = 1). Dynamic contrast-enhanced MR imaging at 3.0 T was performed 1 day before microwave ablation and again after ablation. The procedure was considered successful if the signal intensity (SI) of the lesion on MR imaging decreased by at least 50% and the patient was pain-free within 1 week of intervention. RESULTS: All patients were pain-free within 1 week after microwave ablation and remained so during the 6 months of follow-up. No major or minor complications developed. On average, SI of the lesions decreased by 75% (range, 55.5%-89.1%) after treatment. The difference in lesion SI before versus after ablation was significant by t test (P < .0001; confidence interval, 120.26-174.96) and Wilcoxon test (P = .0020). CONCLUSIONS: Microwave ablation treatment of osteoid osteoma was highly successful, without any complications observed. Dynamic contrast-enhanced MR imaging is a useful tool for diagnosing osteoid osteoma and evaluating treatment.

Assessment of cytogenetic damage and oxidative stress in personnel occupationally exposed to the pulsed microwave radiation of marine radar equipment.

Due to increased usage of microwave radiation, there are concerns of its adverse effect in today's society. Keeping this in view, study was aimed at workers occupationally exposed to pulsed microwave radiation, originating from marine radars. Electromagnetic field strength was measured at assigned marine radar frequencies (3 GHz, 5.5 GHz and 9.4 GHz) and corresponding specific absorption rate values were determined. Parameters of the comet assay and micronucleus test were studied both in the exposed workers and in corresponding unexposed subjects. Differences between mean tail intensity (0.67 vs. 1.22) and moment (0.08 vs. 0.16) as comet assay parameters and micronucleus test parameters (micronuclei, nucleoplasmic bridges and nuclear buds) were statistically significant between the two examined groups, suggesting that cytogenetic alterations occurred after microwave exposure. Concentrations of glutathione and malondialdehyde were measured spectrophotometrically and using high performance liquid chromatography. The glutathione concentration in exposed group was significantly lower than in controls (1.24 vs. 0.53) whereas the concentration of malondialdehyde was significantly higher (1.74 vs. 3.17), indicating oxidative stress. Results suggests that pulsed microwaves from working environment can be the cause of genetic and cell alterations and that oxidative stress can be one of the possible mechanisms of DNA and cell damage.

Assessment of metal contaminations leaching out from recycling plastic bottles upon treatments.

BACKGROUND, AIMS, AND SCOPE: Heavy metal contaminants in environment, especially in drinking water, are always of great concern due to their health impact. Due to the use of heavy metals as catalysts during plastic syntheses, particularly antimony, human exposure to metal release from plastic bottles has been a serious concern in recent years. The aim and scope of this study were to assess metal contaminations leaching out from a series of recycling plastic bottles upon treatments. METHODOLOGY: In this study, leaching concentrations of 16 metal elements were determined in 21 different types of plastic bottles from five commercial brands, which were made of recycling materials ranging from no. 1 to no. 7. Several sets of experiments were conducted to study the factors that could potentially affect the metal elements leaching from plastic bottles, which include cooling with frozen water, heating with boiling water, microwave, incubating with low-pH water, outdoor sunlight irradiation, and in-car storage. RESULTS: Heating and microwave can lead to a noticeable increase of antimony leaching relative to the controls in bottle samples A to G, and some even reached to a higher level than the maximum contamination level (MCL) of the US Environmental Protection Agency (USEPA) regulations. Incubation with low-pH water, outdoor sunlight irradiation, and in-car storage had no significant effect on antimony leaching relative to controls in bottle samples A to G, and the levels of antimony leaching detected were below 6 ppb which is the MCL of USEPA regulations. Cooling had almost no effect on antimony leaching based on our results. For the other interested 15 metal elements (Al, V, Cr, Mn, Co, Ni, Cu, As, Se, Mo, Ag, Cd, Ba, Tl, Pb), no significant leaching was detected or the level was far below the MCL of USEPA regulations in all bottle samples in this study. In addition, washing procedure did contribute to the antimony leaching concentration for polyethylene terephthalate (PET) bottles. The difference of antimony leaching concentration between washing procedure involved and no washing procedure involved (AC) was larger than zero for samples A to G. This interesting result showed that higher antimony concentration was detected in experiments with no washing procedures compared with those experiments with washing procedures. Our study results indicate that partial antimony leaching from PET bottles comes from contaminations on the surface of plastic during manufacturing process, while major antimony leaching comes from conditional changes. CONCLUSION: The results revealed that heating and microwaving enhance antimony leaching significantly in PET plastic bottles. Plastic bottle manufacturers should consider the contaminations during manufacturing process and washing bottles before first use was strongly recommended to remove those contaminants.

Problems in assessment of risks from exposures to microwaves of mobile communication.

Since pioneering investigations published in the beginning of 1970th, various biological responses to non-thermal (NT) microwaves (MW), including adverse health effects, have been described by many research groups all over the world. There is strong evidence that the NT MW biological effects depend on several physical parameters and biological variables, which must be controlled in replication studies. Apart from the fundamental importance, the development of comprehensive mechanisms for the NT MW effects is socially important. The effects of MW of mobile communications are of major concern because of the increased exposure in many countries. It has been shown that adverse effects of NT MW from GSM/UMTS mobile phones on human lymphocytes from healthy and hypersensitive to EMF persons depend on carrier frequency and modulation. Further investigations with human primary cells, animals and volunteers are needed to elucidate possible adverse effects of MW signals that are used in wireless communication. Identification of those types and frequency channels/bands for mobile communication, which do not affect human cells, is urgently needed as the high priority task for the development of safe mobile communication. Numerous data on the NT MW effects clearly indicate that the SAR-concept alone cannot underlie the safety guidelines for chronic exposures to MW from mobile communication and other approaches are needed. However, there is not enough research information to set exposure MW standards. Various genetic and epigenetic effects of signals used in mobile communication should be studied. It has been shown that NT MW affect cells of various types including stem cells and reproductive organs. Stem cells represent especially important cellular model because recent data suggest that different cancer types, including leukemia, have a fundamentally common basis that is grounded on epigenetic changes in stem cells.

Assessment of radiofrequency/microwave radiation emitted by the antennas of rooftop-mounted mobile phone base stations.

Radiofrequency (RF) and microwave (MW) radiation exposures from the antennas of rooftop-mounted mobile telephone base stations have become a serious issue in recent years due to the rapidly evolving technologies in wireless telecommunication systems. In Malaysia, thousands of mobile telephone base stations have been erected all over the country, most of which are mounted on the rooftops. In view of public concerns, measurements of the RF/MW levels emitted by the base stations were carried out in this study. The values were compared with the exposure limits set by several organisations and countries. Measurements were performed at 200 sites around 47 mobile phone base stations. It was found that the RF/MW radiation from these base stations were well below the maximum exposure limits set by various agencies.

Transurethral microwave thermotherapy v transurethral resection of prostate.

Transurethral resection of the prostate (TURP) has been the gold standard for the treatment of symptomatic benign prostatic hyperplasia for three decades but is now being challenged by other approaches such as transurethral microwave thermotherapy (TUMT). Comparison of these techniques must consider the functional, financial, and social aspects of each procedure. Because of differences in equipment, it is difficult to draw valid conclusions from the comparisons of the functional results of TURP v TUMT, but the two appear equivalent in relieving symptoms, although TUMT appears slightly less effective in improving flow. Preliminary data suggest that TUMT is less expensive than TURP, but more data are needed. Although high-energy TUMT is not yet on a par with TURP, it is a valid alternative for many patients.

An assessment of the thermal safety of microwave warming of crystalloid fluids.

We performed an in vitro study to determine the thermal safety of a domestic microwave to warm intravenous crystalloid solutions. Five-hundred-millilitre bags of crystalloid, randomly allocated to groups which differed in power setting, timer setting and whether or not agitation was performed after warming, were heated in a microwave oven to a calculated temperature of 39 degrees C. Timer accuracy was checked by stopwatch. Bag temperature was measured using an infrared tympanic temperature probe and fluid temperature was measured with an in-line thermocouple. Mean times measured by stopwatch were higher than set. No in-line temperatures reached 40 degrees C. Wider overall ranges and a higher mean were found with the tympanic probe compared with in-line temperature measurement. There were significant differences between the in-line temperatures of shaken and unshaken bags at each power setting, but not when groups were added together. There was no change in colour or odour of bags or fluid. One bag developed a pinhole leak when the packaging was removed.