IVC filter retrieval: a multicenter proposal of two score systems to predict application of complex technique and procedural outcome.

PURPOSE: Aim of this study was to identify preprocedural parameters, which may predict the application of a complex IVC filter retrieval technique and estimate the procedural outcome by applying two dedicated score systems. MATERIALS AND METHODS: In this retrospective multicenter analysis, data concerning patient, filter and procedure characteristics were retrieved from January 2018 to March 2020. Patients were evaluated according to the retrieval technique (standard vs. complex) and the procedural outcome (success vs. failure). Significant differences among these groups were evaluated, and two score systems were developed to predict the application of a complex retrieval technique and the procedural outcome. RESULTS: One hundred and sixteen IVC filters were retrieved in 116 patients. In 98 subjects, the filter was retrieved with a standard procedure (Standard group, 84.5% vs. Complex group, 15.5%), while in 106 patients the procedure was successful (Success group, 91.4% vs. Failure group, 8.6%). Statistically significant differences were noted in terms of embedded filter hook, filter apex tilt, angle between filter axis and IVC, caval wall penetration, dwelling time and procedural time. Two score 0-5 points to predict the need for a complex retrieval technique and the procedural outcome were developed, with a prognostic accuracy of 88.8% and 91.4%, respectively. CONCLUSION: Significant differences were appreciable analyzing the sample data comparing both the retrieval technique applied and the procedural outcome. Two predictive scores were developed to assess the need for applying a complex retrieval technique and to estimate the procedural outcome.

Longitudinal study of interventional radiology activity in a large metropolitan Italian tertiary care hospital: how the COVID-19 pandemic emergency has changed our activity.

OBJECTIVES: To retrospectively analyze interventional radiology (IR) activity changes in the COVID-19 era and to describe how to safely and effectively reorganize IR activity. METHODS: All IR procedures performed between January 30 and April 8, 2020 (COVID-era group) and the same 2019 period (non-COVID-era group) were retrospectively included and compared. A sub-analysis for the lockdown period (LDP: 11 March-8 April) was also conducted. Demographic, hospitalization, clinical, and procedural data were obtained for both groups and statistically compared with univariable analysis. RESULTS: A total of 1496 procedures (non-COVID era, 825; COVID era, 671) performed in 1226 patients (64.9 ± 15.1 years, 618 women) were included. The number of procedures decreased by 18.6% between 2019 and 2020 (825 vs 671, p < .001), with a reduction by 48.2% in LDP (188 vs 363, p < .0001). In the LDP COVID era, bedside procedures were preferred (p = .013), with an increase in procedures from the intensive care unit compared with the emergency department and outpatients (p = .048), and an increased activity for oncological patients (p = .003). No incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of healthcare workers in the IR service was registered. CONCLUSIONS: Coronavirus disease outbreak changed the interventional radiology activity with an overall reduction in the number of procedures. However, this study confirms that interventional radiology continuum of care can be safely performed also during the pandemic, following defined measures and protocols, taking care of all patients. KEY POINTS: • Coronavirus disease pandemic determined a reduction of interventional radiology activity as compared to the same period of the previous year. • Interventional radiology procedures for life-threatening conditions and non-deferrable oncologic treatments were prioritized as opposed to elective procedures. • Strict adoption of safe procedures allowed us to have until now no incidents of cross-infection of non-infected from infected patients and no evidence of COVID-19 infection of HCWs in the IR service.

Efficacy and safety of irreversible electroporation in unresectable perihilar cholangiocarcinoma: a systematic review and meta-analysis.

OBJECTIVES: The prognosis of patients with perihilar-cholangiocarcinoma (PHC) is poor. The only potential curative treatment for patients with PHC is surgical resection, but the large majority present with unresectable disease at diagnosis. The standard of care in patients with unresectable PHC is palliative chemotherapy (CHT).Irreversible electroporation (IRE) has been introduced as a novel ablation technique, working predominantly nonthermal. This review aims to analyse the efficacy and safety of IRE in treating unresectable PHC. METHODS: This systematic review and meta-analysis was performed according to a specific protocol designed a priori, and reported according to the PRISMA. PubMed/MEDLINE, Scopus, and Cochrane CENTRAL were used for the bibliographic research through December 2023. Primary Outcome of interest of our meta-analysis was the mean Overall Survival. Secondary outcomes were Progression-Free Survival and Adverse Event rate. RESULTS: Mean OS is estimated to be 25.49 months (CI 21.47-38.72 I2, 81.37%), PSF 17.86 (CI 13.00-22.72, I2 11.42%), with 12% (CI -7% to 31%, I2 83.57%) of AE incidence. High heterogeneity was found among studies, with no single study fully responsible for it, suggesting high variability among facilities\populations. CONCLUSION: IRE is an effective and relatively safe method in this group of patients. The lack of prospective studies and randomized trials comparing chemotherapy or locoregional treatment with IRE prevents drawing sufficiently robust conclusions. ADVANCES IN KNOWLEDGE: IRE appears is a safe and effective technique for treating unresectable perihilar cholangiocarcinoma.

Combination of Local Ablative Techniques with Radiotherapy for Primary and Recurrent Lung Cancer: A Systematic Review.

In patients with early-stage or recurrent NSCLC who are unable to tolerate surgery, a benefit could derive only from a systemic therapy or another few forms of local therapy. A systematic review was performed to evaluate the feasibility and the effectiveness of radiotherapy combined with local ablative therapies in the treatment of primary and recurrent lung cancer in terms of toxicity profile and local control rate. Six studies featuring a total of 115 patients who met eligibility criteria and 119 lesions were included. Three studies evaluated lung cancer patients with a medically inoperable condition treated with image-guided local ablative therapies followed by radiotherapy: their local control rate (LC) ranged from 75% to 91.7% with only 15 patients (19.4%) reporting local recurrence after combined modality treatment. The other three studies provided a salvage option for patients with locally recurrent NSCLC after RT: the median follow-up period varied from 8.3 to 69.3 months with an LC rate ranging from 50% to 100%. The most common complications were radiation pneumonitis (9.5%) and pneumothorax (29.8%). The proposed intervention appears to be promising in terms of toxicity profile and local control rate. Further prospective studies are need to better delineate combining LTA-RT treatment benefits in this setting.

Association between contralateral background parenchymal enhancement on MRI and outcome in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy.

PURPOSE: The purpose of this study was to retrospectively investigate whether background parenchymal enhancement (BPE) of the contralateral breast on magnetic resonance imaging (MRI) is associated with clinical outcomes in patients with unilateral invasive breast cancer receiving neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: A total of 228 women (47.6 years ± 10 [SD]; range: 24-74 years) with invasive breast cancer who underwent NAC between 2005 and 2013 were included. All included patients underwent breast MRI before and after NAC. Quantitative semiautomated analysis of BPE of the contralateral healthy breast was performed. The enhancement level on baseline MRI (baseline BPE) and on MRI after chemotherapy (final BPE) and the change in enhancement rate between baseline MRI and final MRI were recorded. Cox regression was used to test associations between BPE variables, patient and tumor characteristics, overall survival (OS) and disease-free survival (DFS). Subgroup analyses based on menopausal status and immunohistochemical subtypes were performed. RESULTS: Median follow-up was 92 months. Multivariable analysis revealed that Ki-67 level (P = 0.026) and receipt of mastectomy (P = 0.015) were independent variables associated with OS while Ki-67 level (P = 0.010) and post-NAC pathological node categorization (P = 0.027) were independent variables associated with DFS. BPE was not associated with OS (P = 0.500, 0.546 and 0.712 for baseline BPE, final BPE and BPE change, respectively) or with DFS (P = 0.568, 0.412 and 0.327, respectively). CONCLUSION: BPE of the contralateral breast on MRI may have limited prognostic value in patients with breast cancer treated with NAC.

Uterine Myomas: Endovascular Treatment.

Uterine fibroids embolization is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication to treatment is usually the presence of symptomatic uterine fibroids. In this review, a systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was conducted, with a special focus on the indication to treatment, technique, procedural outcomes and pain control. All clinical trials published in English language, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered.