Ultrasound-guided microwave ablation versus surgery for solitary T1bN0M0 papillary thyroid carcinoma: a prospective multicenter study.

OBJECTIVE: Microwave ablation (MWA) has emerged as a minimally invasive technology for papillary thyroid microcarcinoma (PTMC), but it has not been widely applied to treat T1bN0M0 PTC with high-level evidence. This study was designed to compare the real-world efficacy and safety of MWA or surgery for treating T1bN0M0 PTC. METHODS: From December 2019 to April 2021, 123 continuous unifocal T1bN0M0 PTC patients without lymph node metastasis (LNM) or distant metastasis (DM) were included from 10 hospitals. Patients were allocated into the MWA or surgery group based on their willingness. The main outcomes were local tumour progression (LTP), new thyroid cancer, LNM, and DM. The secondary outcomes included changes in tumour size and volume, complications, and cosmetic results. Subgroup analyses were conducted to identify influencing factors. RESULTS: Fifty-two patients chose MWA, and 71 patients chose surgery. Patients had similar demographic information and tumour characteristics in the two groups. The follow-up durations after MWA and surgery were 10.6 ± 4.2 and 10.4 ± 3.4 months, respectively. The LNM rate was 5.8% in the MWA group and 1.4% in the surgery group (p = 0.177). No LTP, new thyroid cancer, or distant metastasis (DM) occurred in either group. Five (9.6%) of the 52 patients in the MWA group and 8 (11.3%) of the 71 patients in the surgery group had complications (p = 0.27). Better cosmetic results were found in the MWA group (p < 0.01). CONCLUSION: MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. CLINICAL RELEVANCE STATEMENT: MWA achieved comparable short-time treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC. KEY POINTS: • MWA achieved comparable short-term treatment efficacy with surgery. MWA might be an optional choice for surgery for low-risk T1bN0M0 PTC but concerns about LNM need to be studied further. • The complication rate in the surgery group was higher than that in the MWA group without a significant difference. • There was no statistically significant difference in the LNM rate between the MWA and surgery groups.

Microwave Ablation for Papillary Thyroid Microcarcinoma with and without US-detected Capsule Invasion: A Multicenter Prospective Cohort Study.

Background Microwave ablation (MWA) has achieved favorable results in the treatment of papillary thyroid microcarcinoma (PTMC) confined in glandular parenchyma. However, studies on the outcome of MWA for PTMC with US-detected capsular invasion remain unclarified in the literature. Purpose To compare the feasibility, effectiveness, and safety of MWA in the treatment of PTMC with and without US-detected capsular invasion. Materials and Methods Participants from 12 hospitals with a PTMC maximal diameter of 1 cm or less without US- or CT-detected lymph node metastasis (LNM) who planned to undergo MWA were enrolled in this prospective study between December 2019 and April 2021. All tumors were evaluated with preoperative US and were divided into those with and those without capsular invasion. The participants were observed until July 1, 2022. The primary end points, including technical success and disease progression, and the secondary end points, including treatment parameters, complications, and tumor shrinkage during follow-up, were compared between the two groups, and multivariable regression was performed. Results After exclusion, 461 participants (mean age, 43 years ± 11 [SD]; 337 women) were included: 83 with and 378 without capsular invasion. After one participant with capsular invasion aborted MWA because of technical failure, 82 participants with and 378 participants without capsular invasion (mean tumor volume, 0.1 mL ± 0.1 vs 0.1 mL ± 0.1; P = .07) were analyzed with a mean follow-up period of 20 months ± 4 (range, 12-25 months) and 21 months ± 4 (range, 11-26 months), respectively. In those with and those without capsular invasion, comparable technical success rates were achieved (99% [82 of 83] vs 100% [378 of 378], P = .18), with one and 11 complications, respectively (1% [one of 82] vs 3% [11 of 378], P = .38). There was no evidence of differences in disease progression (2% [one of 82] vs 1% [four of 378]; P = .82) or tumor shrinkage (mean, 97% ± 8 [SD] vs 96% ± 13; P = .58). Conclusion Microwave ablation was feasible in the treatment of papillary thyroid microcarcinoma with US-detected capsular invasion and showed comparable short-term efficacy with or without the presence of capsular invasion. © RSNA, 2023 Clinical trial registration no. NCT04197960 Supplemental material is available for this article.

Analysis of Sonazoid contrast-enhanced ultrasound for predicting the risk of microvascular invasion in hepatocellular carcinoma: a prospective multicenter study.

OBJECTIVES: The aim of this study was to evaluate the potential of Sonazoid contrast-enhanced ultrasound (SNZ-CEUS) as an imaging biomarker for preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). METHODS: From August 2020 to March 2021, we conducted a prospective multicenter study on the clinical application of Sonazoid in liver tumor; a MVI prediction model was developed and validated by integrating clinical and imaging variables. Multivariate logistic regression analysis was used to establish the MVI prediction model; three models were developed: a clinical model, a SNZ-CEUS model, and a combined model and conduct external validation. We conducted subgroup analysis to investigate the performance of the SNZ-CEUS model in non-invasive prediction of MVI. RESULTS: Overall, 211 patients were evaluated. All patients were split into derivation (n = 170) and external validation (n = 41) cohorts. Patients who had MVI accounted for 89 of 211 (42.2%) patients. Multivariate analysis revealed that tumor size (> 49.2 mm), pathology differentiation, arterial phase heterogeneous enhancement pattern, non-single nodular gross morphology, washout time (< 90 s), and gray value ratio (≤ 0.50) were significantly associated with MVI. Combining these factors, the area under the receiver operating characteristic (AUROC) of the combined model in the derivation and external validation cohorts was 0.859 (95% confidence interval (CI): 0.803-0.914) and 0.812 (95% CI: 0.691-0.915), respectively. In subgroup analysis, the AUROC of the SNZ-CEUS model in diameter ≤ 30 mm and ˃ 30 mm cohorts were 0.819 (95% CI: 0.698-0.941) and 0.747 (95% CI: 0.670-0.824). CONCLUSIONS: Our model predicted the risk of MVI in HCC patients with high accuracy preoperatively. CLINICAL RELEVANCE STATEMENT: Sonazoid, a novel second-generation ultrasound contrast agent, can accumulate in the endothelial network and form a unique Kupffer phase in liver imaging. The preoperative non-invasive prediction model based on Sonazoid for MVI is helpful for clinicians to make individualized treatment decisions. KEY POINTS: • This is the first prospective multicenter study to analyze the possibility of SNZ-CEUS preoperatively predicting MVI. • The model established by combining SNZ-CEUS image features and clinical features has high predictive performance in both derivation cohort and external validation cohort. • The findings can help clinicians predict MVI in HCC patients before surgery and provide a basis for optimizing surgical management and monitoring strategies for HCC patients.

Microwave ablation vs. surgery for papillary thyroid carcinoma with minimal sonographic extrathyroid extension: a multicentre prospective study.

OBJECTIVES: Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE. METHODS: From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed. RESULTS: The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p > 0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p < 0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p < 0.001 and p = 0.003, respectively). CONCLUSIONS: Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound. KEY POINTS: • Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE. • Thermal ablation is technically feasible for mETE-PTC treatment. • Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.

Volume reduction for ≥2 cm benign breast lesions after ultrasound-guided microwave ablation with a minimum 12-month follow-up.

OBJECTIVE: To prospectively evaluate the efficacy of microwave ablation (MWA) for benign breast lesions (BBLs) ≥2 cm and explore the possible factors associated with the volume reduction rate (VRR) of ablated lesions. MATERIALS AND METHODS: From November 2013 to December 2017, a total of 80 patients with 104 biopsy-proved BBLs larger than 2 cm in size underwent MWA. After the procedure, patients were followed up via physical and imaging examination consisting of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI). Possible factors associated with 12-month VRR were assessed, including basic patient characteristics, index lesions and parameters of ablation technique. RESULTS: The mean tumor size was 2.6 ± 0.6 cm (ranging 2.0-6.3 cm). Of the 104 lesions, 70 were fibroadenomas, 27 adenosis and 7 fibrocystic changes. Post-procedure CEUS or contrast-enhanced MRI showed that all lesions were completely ablated. No immediate or delayed complications were observed. All patients were followed up for more than 12 months (median follow-up 12.5 months). After MWA, the ablated lesion volume decreased significantly by 12 months (p < 0.001), with a mean volume reduction of 80.2 ± 13.1%. Multiple linear regression analysis showed that location adjacent to areola (ß = 7.5, 95%CI: 1.0-13.9, p = 0.025) and location adjacent to skin (ß = -7.4, 95%CI: -12.7 to -13.9, p = 0.007) were independent factors respectively associated with the increased and decreased 12-month VRR. CONCLUSION: For BBLs larger than 2 cm, US-guided MWA is a favorable treatment modality, with BBLs adjacent to the areola being associated with more significant 12-month VRR after MWA.

Symptomatic aseptic necrosis of benign thyroid lesions after microwave ablation: risk factors and clinical significance.

BACKGROUND: Symptomatic aseptic necrosis (SAN) followed by nodule rupture is a kind of severe complications after thermal ablation for benign thyroid nodules (BTN). No studies are available to evaluate its pathologic process, clinical manifestations, risk factors and effectiveness of therapies after microwave ablation (MWA). METHODS: From 2012 to 2019, 398 patients who received MWA for BTN were retrospectively reviewed. Clinical data included baseline patient characteristics, imaging features (internal vascularity and the proportion of the solid component), ablation power and time, complications and prognosis were collected and documented. RESULTS: Ten patients (2.51%) experienced post-MWA SAN, eight patients with nodule rupture and the other two without. The mean time from MWA to SAN symptom was 8.6 days and to rupture was 16.3 days. The initial symptoms of SAN patients were neck bulging, swelling and discomfort. Patients would go through nodule rupture once the nodule contents extended into the extrathyroidal area with the discontinuity of the anterior thyroid capsule, and fistula formed unavoidably in this condition. Incision drainage was effective for rupture and early treatment of non-steroidal anti-inflammatory drug might cure the early-stage SAN. Multivariate analysis showed sex (OR = 0.13; 95% CI: 0.03, 0.61; p=.03) was the risk factor leading to SAN and males were more vulnerable to SAN. CONCLUSION: SAN after MWA came earlier and initially illustrated as neck bulging, swelling and discomfort. Early detection and early treatment might prevent the rupture of nodules. Once the breakdown of thyroid capsule occurred, rupture of ablated nodules out of skin was unavoidable and invasive procedures might be the most effective treatment.

Ultrasound-guided percutaneous microwave ablation for 755 benign breast lesions: a prospective multicenter study.

OBJECTIVES: To evaluate the clinical efficacy of microwave ablation (MWA) of benign breast lesions (BBLs) and compare the learning curves of international radiologists (IRs) and surgeons. METHODS: In total, 440 patients with 755 clinicopathologically confirmed BBLs from 5 centers were prospectively enrolled from February 2014 to July 2018. Technical success, complications, volume reduction ratio (VRR), palpability, and cosmetic satisfaction after ablation were analyzed. In addition, the ablation time (AT) and energy (AE) with the number of procedures were analyzed for learning curve evaluation. RESULTS: The mean maximum diameter was 1.7 ± 0.6 cm. The complete ablation rate reached 100%, including 45.8% lesions adjacent to the skin, pectoralis, or areola. After a median follow-up of 13.7 months, the 12-month VRR of all lesions was 97.9%, and that for 1.0- to 2.0-cm and ≥ 2.0-cm lesions was 98.6% and 96.9%, respectively. A total of 55.9% of BBLs became nonpalpable (palpable in 85.7% of cases before MWA) by both the clinician and patient. The cosmetic and minimally invasive satisfaction rates were good or excellent in 98.4% and 94.5% of patients, respectively. The median AT/cm3 and AE/cm3 decreased as experience increased. The AE/cm3 of the IR with 5 years of experience was lower than that of the IR with 1 year of experience and the surgeons, while the AT/cm3 of surgeons was comparable with that of the IR with 5 years of experience at relatively mature phase. CONCLUSIONS: Ultrasound-guided percutaneous MWA is a valuable technique for the treatment of BBLs. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02860104) KEY POINTS: • Ultrasound-guided percutaneous microwave ablation has the potential to become a valuable technique for the treatment of benign breast lesions. • A skilled interventional radiologist shows a rapid improvement in mastering the technique.

Beneficial body mass index to enhance survival outcomes in patients with early-stage hepatocellular carcinoma following microwave ablation treatment.

Purpose: To identify the beneficial body mass index (BMI) for patients with hepatocellular carcinoma (HCC) to achieve longer survival time following curative microwave ablation (MWA).Methods: This retrospective study evaluated 474 patients with solitary primary HCC who underwent MWA. BMI at initial admission and other characteristics were collected. The associations of the BMI with the overall survival (OS) and disease-free survival (DFS) were analyzed by Cox proportional hazards regression analysis in multiple models. A two-piecewise linear regression model was applied to examine the threshold effect of the BMI on OS and DFS by maximized log likelihood method. The threshold level was determined by using trial and error.Results: Patients with a normal BMI range achieved improved survival outcomes but similar DFS in multiple models. In the model with adjustments of the age, size, and Charlson score, patients with BMI ≤ 22.9 and ≤24.9 kg/m2 exhibited a lower death rate than patients with BMI ≤18.5 kg/m2 (p < 0.05). U-shaped relationships between the BMI and OS were illustrated when the BMI was set as a continuous variable. The death prevalence decreased with an increasing BMI up to the first turning point of 21.5 and increased with an increasing BMI up to the second turning point of 23.1 (p = 0.00). The threshold effect analysis indicated that no turning point was selected in the DFS results (p = 0.10).Conclusions: The beneficial BMI level for HCC patients following MWA, with a more likely favorable survival outcome, is 21.5 to 23.1 kg/m2.

Efficacy and safety of percutaneous ultrasound-guided microwave ablation for cervical metastatic lymph nodes from papillary thyroid carcinoma.

PURPOSE: Our purpose is to assess the efficacy and safety of percutaneous US-guided microwave ablation (MWA) for cervical metastatic lymph nodes from papillary thyroid carcinomas (PTC). METHODS: In total, 37 patients with 98 cervical metastatic lymph nodes from PTC were enrolled in this retrospective study. Among them, 8 had subtotal thyroidectomy, 4 lobectomy, 2 no operation, and the rest total thyroidectomy. A multipoint and multiplane fixed ablation method was used. Monitoring of ablation process and clinical follow-up consisted of US or CEUS. RESULTS: All 98 metastatic lymph nodes successfully treated in a single session with 100% complete ablation. The average longest and shortest diameter of the tumors were reduced from 13.21 ± 5.86 mm to 6.74 ± 5.66 mm (p =.00) and from 9.29 ± 4.09 mm to 4.31 ± 3.56 mm (p =.00) at the final follow-up. There were no evidence of recurrence at ablated sites. The common intraoperative complications were a burning sensation and pain. Only 3 patients had vagal reflex. CONCLUSIONS: US-guided MWA can effectively control cervical metastatic lymph nodes from PTC. MWA may become an alternative therapy in selected PTC patients with cervical lymph node metastasis.

Acute kidney injury after nephron sparing surgery and microwave ablation: focus on incidence, survival impact and prediction.

Purpose: To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction.Materials and methods: Patients were studied retrospectively after NSS (n = 1267) or MWA (n = 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness.Results: AKI occurred more commonly in NSS (27.85%) cohort, when compared to MWA (17.72%) cohort (p = 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282-1.265; p = 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%; p < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110-7.165; p = 0.029). Predictors for both NSS- and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities ≥5%. SP predicted by Law of Total Probability was comparable to actual OS.Conclusion: AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.

Hepatic Microwave Ablation-Induced Tumor Destruction and Animal End Point Survival Can Be Improved by Suppression of Heat Shock Protein 90.

OBJECTIVES: To investigate the effect of heat shock protein 90 (HSP90) modulation on tumor necrosis, apoptosis, tumor growth delay, and end point survival by combining microwave ablation (MWA) with an HSP90 inhibitor in a nude mouse model. METHODS: This study was approved by the Ethics Committee. Forty mice with HepG2 subcutaneous xenograft tumors (10 ± 1 mm) were randomized into 4 groups: (1) no treatment, (2) MWA only, (3) the HSP90 inhibitor ganetespib only, and (4) ganetespib combined with MWA. Tumors were harvested 24 hours after treatment, and gross coagulation diameters were measured. The effect of ganetespib on HSP90 and caspase 3 expression in the periablational rim was assessed. Another 40 mice with the same tumors and groupings were observed after treatment. Tumor growth curve and Kaplan-Meier survival analyses were performed with a tumor diameter of 2.2 cm and 40 days of survival as the defined survival end points. RESULTS: Combination treatment significantly increased the coagulation size compared to tumors treated with MWA or ganetespib alone (P < 0.05). The combination of MWA and ganetespib decreased HSP90 expression and increased cleaved caspase 3 expression 24 hours after treatment. Compared with MWA or ganetespib only, combination treatment could lengthen the end point survival and reduce the tumor growth rate. CONCLUSIONS: Modulation of HSP production can improve MWA-induced tumor apoptosis and destruction, reduce residual tumor growth rates, and prolong end point survival.

Microwave Responsive Nanoplatform via P-Selectin Mediated Drug Delivery for Treatment of Hepatocellular Carcinoma with Distant Metastasis.

Hepatocellular carcinoma (HCC) with metastatic disease is associated with a low survival in clinical practice. Many curative options including liver resection, transplantation, and thermal ablation are effective in local but limited for patients with distant metastasis. In this study, the efficacy, specificity, and safety of P-selectin targeted delivery and microwave (MW) responsive drug release is investigated for development of HCC therapy. By encapsulating doxorubicin (DOX) and MW sensitizer (1-butyl-3-methylimidazolium-l-lactate, BML) into fucoidan conjugated liposomal nanoparticles (TBP@DOX), specific accumulation and prominent release of DOX in orthotopic HCC and lung metastasis are achieved with adjuvant MW exposure. This results in orthotopic HCC growth inhibition that is not only 1.95-fold higher than found for nontargeted BP@DOX and 1.6-fold higher than nonstimuli responsive TP@DOX but is also equivalent to treatment with free DOX at a 10-fold higher dose. Furthermore, the optimum anticancer efficacy against distant lung metastasis and effective prevention of widespread dissemination with a prolonged survival is described. In addition, no adverse metabolic events are identified using the TBP@DOX nanodelivery system despite these events being commonly observed with traditional DOX chemotherapy. Therefore, administering TBP@DOX with MW exposure could potentially enhance the therapeutic efficacy of thermal-chemotherapy of HCC, especially those in the advanced stages.

Comparison of ultrasound-guided percutaneous microwave ablation and parathyroidectomy for primary hyperparathyroidism.

Purpose: To compare the clinical efficacy of ultrasound-guided percutaneous microwave ablation (MWA) and parathyroidectomy for primary hyperparathyroidism. Methods: In an observational retrospective study, we compared the outcomes in patients with primary hyperparathyroidism who underwent ultrasound-guided MWA with the outcomes in those who underwent surgical resection (SR). The primary outcome was cure rate. Secondary outcomes were the rate of complications, and the difference of the treatment parameters of two treatment methods. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. Results: Among 108 patients who met inclusion criteria, 28 patients who underwent ultrasound-guided MWA (MWA group) and 28 who underwent SR (SR group) had similar propensity scores and were included in the analyses. There was no significant difference in the cure rate between MWA group and SR group (82.1% vs. 89.3%, p = .705). Patients who underwent MWA had significantly less estimated blood loss and shorter surgical time than those who underwent SR (p < .001). The incidence of side effects and complications was comparable between MWA group and SR group (21.4% vs. 25%, p = .752). Conclusions: MWA and SR provided comparable short-term results in terms of cure rate and complications in treatment of primary hyperparathyroidism. Ultrasound-guided percutaneous MWA is a promising and minimally invasive method for primary hyperparathyroidism.

Ultrasound-guided percutaneous microwave ablation of central intraductal papilloma: a prospective pilot study.

Background: Central intraductal papilloma (IDP) has a low risk of cancer evolution; therefore, surgical treatment of IDP is controversial. We sought to validate ultrasound (US)-guided percutaneous microwave ablation (MWA) for minimally invasive treatment of IDP. Methods: Thirteen women with central IDP, including six with nipple discharge, underwent US-guided core needle biopsy and MWA from December 2016 to November 2017. Lesions histologically diagnosed as benign IDP were included. The hydro-dissection technique was used to protect the nipple during the entire ablation procedure. We evaluated and recorded data of complete ablation, volume reduction, and complications. Results: MWA was successfully performed in all patients, with 100% complete ablation, assessed by magnetic resonance imaging or contrast-enhanced US. Mean tumor size was 13.5 ± 4.1 (7.0-20.0) mm; the mean ablation time was 1.4 (0.7-10.3) min. At the median 13.7-month follow-up, mean lesion sizes at 3, 6, and 12 months after MWA were all significantly smaller than that at baseline. Total volume reduction rates were 52.3 ± 18.2% (range, 24.2-81.8%), 72.6 ± 23.1% (range, 39.4-95.9%), and 92.9 ± 7.5% (range, 75.0-100%) at 3-, 6-, and 12-month follow-up, respectively, with significant differences (p < .01). Three lesions with diameters 7 mm, 9 mm, and 12 mm disappeared completely at 3, 6, and 6 months after MWA, respectively, on US imaging. Nipple discharge disappeared immediately after MWA. Cosmetic effects were reported as excellent by all patients and no complications were observed. Conclusion: US-guided MWA of central IDP proved feasible and effective, with considerable volume reduction and satisfactory cosmetic outcomes.

Amplified intracellular Ca2+ for synergistic anti-tumor therapy of microwave ablation and chemotherapy.

BACKGROUND: Developing new strategies to reduce the output power of microwave (MW) ablation while keeping anti-tumor effect are highly desirable for the simultaneous achievement of effective tumor killing and avoidance of complications. We find that mild MW irradiation can significantly increase intracellular Ca2+ concentration in the presence of doxorubicin hydrochloride (DOX) and thus induce massive tumor cell apoptosis. Herein, we designed a synergistic nanoplatform that not only amplifies the intracellular Ca2+ concentration and induce cell death under mild MW irradiation but also avoids the side effect of thermal ablation and chemotherapy. RESULTS: The as-made NaCl-DOX@PLGA nanoplatform selectively elevates the temperature of tumor tissue distributed with nanoparticles under low-output MW, which further prompts the release of DOX from the PLGA nanoparticles and tumor cellular uptake of DOX. More importantly, its synergistic effect not only combines thermal ablation and chemotherapy, but also obviously increases the intracellular Ca2+ concentration. Changes of Ca2+ broke the homeostasis of tumor cells, decreased the mitochondrial inner membrane potential and finally induced the cascade of apoptosis under nonlethal temperature. As such, the NaCl-DOX@PLGA efficiently suppressed the tumor cell progression in vivo and in vitro under mild MW irradiation for the triple synergic effect. CONCLUSIONS: This work provides a biocompatible and biodegradable nanoplatform with triple functions to realize the effective tumor killing in unlethal temperature. Those findings provide reliable solution to solve the bottleneck problem bothering clinics about the balance of thermal efficiency and normal tissue protection.

Microwave ablation of benign breast tumors: a prospective study with minimum 12 months follow-up.

PURPOSE: This prospective study was to evaluate clinical outcomes of microwave ablation (MWA) of benign breast tumors with minimum 12 months follow up. METHODS: With approval of the institutional ethics committee and written informed consent, 56 patients with 107 biopsy-proved breast benign tumors were recruited from November, 2013 to April, 2017. MWA with ultrasound (US) guidance was performed under local anesthesia. During the procedure, pull-back technique was used for tumors larger than 1.0 cm in diameter and hydro-dissection technique was used for tumors adjacent to skin, pectoralis and areola. Clinical outcomes were followed up by physical examination and medical images including US, contrast enhanced US and MR. RESULTS: The maximum diameter of these tumors was 1.6 ± 0.8 cm. MWA was successfully performed with the median 120 s of duration (ranging 20-1100 s). Technical success was achieved in all patients. At the median follow-up of 20.5 months (ranging 12-53 months), the mean volume reduction ratios (mVRRs) of tumors were 77.1 ± 8.2%, 84.3 ± 10.6%, 93.3 ± 8.2% at follow-up of 12, 18, 24 months (p < .0001), respectively. Compared with 92% of masses were palpable before ablation, mass palpabilities were 40%, 11%, 5% at follow-up of 12, 18, 24 months (p < .001), respectively. Cosmetic satisfaction was reported excellent or good in 100% of patients. CONCLUSIONS: As a safe and effective minimally invasive modality for inactivating benign breast tumors in situ, MWA achieved optimistic clinical outcomes on volume reduction and cosmetic satisfaction after minimum 12 months follow-up.

Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors.

PURPOSE: To retrospectively review long-term oncologic outcomes after ultrasound (US)-guided percutaneous microwave ablation (MWA) of T1a renal cell carcinoma (RCC) and to identify the incidence and risk factors that predict local tumor progression (LTP) after MWA of RCC. MATERIALS AND METHODS: The present study was approved by the institutional review board. A total of 162 patients with 171 RCC nodules (mean size, 2.6 ± 0.8 cm; range, 0.6-4.0 cm) were treated by MWA between April 2006 and January 2017. The influence of eight factors (age; sex; longest tumor diameter; tumor number, location and pathology type; ablation power and time) affecting the risk of LTP was assessed. Univariate Kaplan-Meier and Cox proportional hazard models were used for statistical analysis. RESULTS: LTP occurred in five patients (5 tumors) after US-guided percutaneous MWA of stage T1a RCC. The overall occurrence of LTP was 2.9% per tumor and 3.0% per patient with a median follow-up of 45.5 months. Among the 162 patients, there were no instances of LTP-related deaths; however, 20 patients died of other diseases. All patients with LTP survived through follow-up. The survival rate of LTP-free patients at 1, 3 and 5 years were 98.7%, 89.5% and 82.1%, respectively (p = .38). Univariate and multivariate analysis identified tumor location to be the only independent predictor of LTP. CONCLUSIONS: US-guided percutaneous MWA for T1a RCC achieved a relatively low LTP incidence rate. Tumors adjacent to the renal pelvis or bowel increased the potential of LTP occurrence.

Layered MoS2 Hollow Spheres for Highly-Efficient Photothermal Therapy of Rabbit Liver Orthotopic Transplantation Tumors.

Combining photothermal therapy (PTT) with clinical technology to kill cancer via overcoming the low tumor targeting and poor therapy efficiency has great potential in basic and clinical researches. A brand-new MoS2 nanostructure is designed and fabricated, i.e., layered MoS2 hollow spheres (LMHSs) with strong absorption in near-infrared region (NIR) and high photothermal conversion efficiency via a simple and fast chemical aerosol flow method. Owing to curving layered hollow spherical structure, the as-prepared LMHSs exhibit unique electronic properties comparing with MoS2 nanosheets. In vitro and in vivo studies demonstrate their high photothermal ablation of cell and tumor elimination rate by single NIR light irradiation. Systematic acute toxicity study indicates that these LMHSs have negligible toxic effects to normal tissues and blood. Remarkably, minimally invasive interventional techniques are introduced to improve tumor targeting of PTT agents for the first time. To explore PTT efficiency on orthotopic transplantation tumors, New Zealand white rabbits with VX2 tumor in liver are used as animal models. The effective elimination of tumors is successfully realized by PTT under the guidance of digital subtraction angiography, computed tomography, and thermal imaging, which provides a new way for tumor-targeting delivery and cancer theranostic application.

[Dynamic assembly of intercalated disc during postnatal development in the rat myocardium].

The intercalated disc (ICD) complex of cardiomyocyte consists of fascia adherens, desmosomes and gap junctions which are mainly constructed by their transmembrane proteins: N-cadherin (N-cad), desmoglein-2 (DSG2) and connexin 43 (Cx43), respectively. The aim of this study was to observe the dynamic changes in colocalization of N-cad, DSG2 and Cx43 with each other in the rat left ventricular myocardium at 1, 7, 14, 28 and 90 day(s) after birth (P1, P7, P14, P28 and P90) using immunofluorescent staining. The results showed that, N-cad, DSG2 and Cx43 located all around the plasma membrane at the P1. These proteins accumulated to the long ends of cardiomyocytes, indicating preliminary formation of the ICD at the P7. The localization of three proteins at the ICD increased progressively, but their lateral localization showed an inverse trend from the P14 to P90. However, Cx43 still kept a certain amount of lateral localization in cardiomyocytes even at the P90 as compared with N-cad and DSG2. Quantitative colocalization of proteins was analyzed by the stereological method. Total percentage of colocalization of N-cad with DSG2 was 33.5% at the P1, and increased to 38.6% at the P7, 9.4% in ICD and 29.2% in lateral side. The total percentage of colocalization of N-cad with DSG2 increased to 65.7% at the P90, ICD colocalization increasing to 60.5% and lateral colocalization decreasing to 5.2%. Total percentage of colocalization of N-cad with Cx43 increased from 10.3% at the P1 to 37.1% at the P90, and only ICD colocalization increased, but lateral colocalization kept about 5%. The colocalization pattern of DSG2 with Cx43 was similar to that of N-cad with Cx43. Total percentage of colocalization of N-cad with DSG2 was higher than those of N-cad or DSG2 with Cx43. The above results suggest that the formation of mechanical junctions at the ICD of cardiomyocyte is prior to that of electrochemistry junctions during postnatal development. In other words, cardiomyocyte growth needs a stable mechanical environment at first.

Microwave ablation versus liver resection for primary intrahepatic cholangiocarcinoma within Milan criteria: a long-term multicenter cohort study.

Background: Ablation has been recommended by worldwide guidelines as first-line treatment for hepatocellular carcinoma (HCC), while evidence regarding its efficacy for primary intrahepatic cholangiocarcinoma (iCCA) is lacking. We aimed to study the efficacy of ablation in treating iCCA by comparing its prognosis with surgery. Methods: In this real-world multicenter cohort study from January 2009 to June 2022, 10,441 iCCA patients from ten tertiary hospitals were identified. Patients who underwent curative-intent microwave ablation (MWA) or liver resection (LR) for tumors within Milan criteria were included. One-to-many propensity score matching (PSM) at variable ratios (1:n ≤4) was used to balance baseline characteristics. Mediation analysis was applied to identify potential mediators of the survival difference. Findings: 944 patients were finally enrolled in this study, with 221 undergoing MWA and 723 undergoing LR. After PSM, 203 patients in the MWA group were matched with 588 patients in the LR group. The median follow-up time was 4.7 years. Compared with LR, MWA demonstrated similar overall survival (5-year 44.8% versus 40.4%; HR 0.96, 95% CI 0.71-1.29, P = .761). There was an improvement in the 5-year disease-free survival rate for MWA from 17.1% during the period of 2009-2016 to 37.3% during 2017-2022, becoming comparable to the 40.8% of LR (P = .129). The proportion of ablative margins ≥5 mm increased from 25% to 61% over the two periods, while this proportion of surgical margins was 62% and 77%, respectively. 34.5% of DFS disparity can be explained by the mediation effect of margins (P < .0001). Similar DFS was observed when both ablative and surgical margins exceeded 5 mm (HR 0.83, 95% CI 0.52-1.32, P = .41). Interpretation: MWA may be considered as a viable alternative to LR for iCCA within Milan criteria when an adequate margin can be obtained. Funding: National Natural Science Foundation of China.