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Chan VWS, Ng HHL, Abdulrauf K, Zaman H, Ahmed A, Zhong J, Wah TM. Percutaneous Image-Guided Ablation of Renal Cancer: Traditional and Emerging Indications, Energy Sources, Techniques, and Future Developments. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:438. [PMID: 40142250 PMCID: PMC11943572 DOI: 10.3390/medicina61030438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 02/12/2025] [Accepted: 02/27/2025] [Indexed: 03/28/2025]
Abstract
Percutaneous image-guided ablation (IGA) has emerged as an established alternative to surgical management for small renal masses. This comprehensive review examines traditional and emerging indications, energy sources, techniques, and future developments in IGA for renal cancer treatment. Traditionally, IGA has been indicated for frail or comorbid patients, those with solitary kidneys or chronic kidney disease, and those with histologically proven renal cell carcinomas less than 4 cm in size. Recent evidence supports expanding these indications to include T1b or T2 tumours and hereditary or recurrent renal cell carcinomas. The use of IGA combined with pre-ablation transarterial embolisation is discussed herein. This review then explores traditional energy sources including radiofrequency ablation, cryoablation, and microwave ablation, highlighting their respective advantages and limitations. Emerging technologies such as irreversible electroporation and histotripsy, as promising alternatives, are then presented, highlighting their advantage of being able to treat tumours near critical structures. Future research priorities highlight the need to establish high-quality evidence through innovative trial designs, as well as taking patient-reported outcome measures into account. Health economic considerations are key to ensuring that ablation therapies are cost-effective. The integration of artificial intelligence and radiomics shows vast potential for improving patient selection and treatment outcomes. Additionally, the immunomodulatory effects of ablative therapies suggest possible synergistic benefits when combined with immunotherapy which also require exploration in future research. Technological advancement and research developments will continue to broaden the role of IGA in clinical practice.
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Affiliation(s)
- Vinson Wai-Shun Chan
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
- Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Helen Hoi-Lam Ng
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
- Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | | | - Hira Zaman
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Aisha Ahmed
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Jim Zhong
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
- Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Tze Min Wah
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
- Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
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Fazlollahi F, Makary MS. Precision oncology: The role of minimally-invasive ablation therapy in the management of solid organ tumors. World J Radiol 2025; 17:98618. [PMID: 39876886 PMCID: PMC11755905 DOI: 10.4329/wjr.v17.i1.98618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/16/2024] [Accepted: 01/18/2025] [Indexed: 01/21/2025] Open
Abstract
Solid organ tumors present a significant healthcare challenge, both economically and logistically, due to their high incidence and treatment complexity. In 2023, out of the 1.9 million new cancer cases in the United States, over 73% were solid organ tumors. Ablative therapies offer minimally invasive solutions for malignant tissue destruction in situ, often with reduced cost and morbidity compared to surgical resection. This review examines the current Food and Drug Administration-approved locoregional ablative therapies (radiofrequency, microwave, cryogenic, high-intensity focused ultrasound, histotripsy) and their evolving role in cancer care. Data were collected through a comprehensive survey of the PubMed-indexed literature on tumor ablation techniques, their clinical indications, and outcomes. Over time, emerging clinical data will help establish these therapies as the standard of care in solid organ tumor treatment, supported by improved long-term outcomes and progression-free survival.
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Affiliation(s)
- Farbod Fazlollahi
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Arciga BM, Walters DM, Kimchi ET, Staveley-O'Carroll KF, Li G, Teixeiro E, Rachagani S, Kaifi JT. Pulsed electric field ablation as a candidate to enhance the anti-tumor immune response to immune checkpoint inhibitors. Cancer Lett 2025; 609:217361. [PMID: 39608443 PMCID: PMC11625606 DOI: 10.1016/j.canlet.2024.217361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 11/23/2024] [Accepted: 11/25/2024] [Indexed: 11/30/2024]
Abstract
Cancer ablation with pulsed electric fields (PEFs) involves the delivery of high-voltage, short-duration electrical pulses that destabilize tumor cells, leading to cellular death. Unlike most conventional ablation technologies, PEF ablation is non-thermal, allowing for safe and targeted energy delivery to the tumor without damaging surrounding tissue and critical structures. PEFs allow for specific dosing, predictable treatment zones, and preservation of the extracellular matrix and adjacent vascular tissues. Preclinical and preliminary clinical data suggest that PEF ablation may induce inflammatory changes in the tumor microenvironment (TME) that engage host innate and adaptive immune cells, stimulating an anti-tumor response. Specifically, PEF promotes local and systemic anti-tumor immune activation through immunogenic cell death and the release of damage-associated molecular patterns (DAMPs) and tumor antigens. This tumor-specific immune activation could potentially enhance response to immune checkpoint inhibitor (ICI) therapies. Furthermore, PEF ablation induces the formation of tertiary lymphoid structures (TLSs) in the TME, which are predictive biomarkers for responsiveness to ICI across several solid tumors. This combination of effects activates antigen-presenting cells and stimulates the effector T cell response, which is often inhibited in ICI-resistant cancer patients. In this review, the onco-immunological characteristics of PEF ablation are discussed, with special emphasis placed on the clinical potential of PEF ablation to induce anti-cancer immune responses and enhance responsiveness to ICI therapy in ablated and non-ablated (abscopal) tumors.
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Affiliation(s)
- Blake M Arciga
- Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO, USA; Hugh E. Stephenson Jr., M.D., Department of Surgery, University of Missouri, Columbia, MO, USA
| | - Dustin M Walters
- Department of Surgery, University of Connecticut, Farmington, CT, USA
| | - Eric T Kimchi
- Department of Surgery, University of Connecticut, Farmington, CT, USA
| | | | - Guangfu Li
- Department of Surgery, University of Connecticut, Farmington, CT, USA
| | - Emma Teixeiro
- Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO, USA; Hugh E. Stephenson Jr., M.D., Department of Surgery, University of Missouri, Columbia, MO, USA; Department of Molecular Microbiology and Immunology, University of Missouri, Columbia, MO, USA; Siteman Cancer Center, Washington University, St. Louis, MO, USA
| | - Satyanarayana Rachagani
- Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO, USA; Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA; Siteman Cancer Center, Washington University, St. Louis, MO, USA; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA.
| | - Jussuf T Kaifi
- Roy Blunt NextGen Precision Health Institute, University of Missouri, Columbia, MO, USA; Hugh E. Stephenson Jr., M.D., Department of Surgery, University of Missouri, Columbia, MO, USA; Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA; Siteman Cancer Center, Washington University, St. Louis, MO, USA; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA.
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Hasani Z, Abedini R, Saber Jahromi M. Performance optimization of vessel sealing using a hemostatic ultrasonic scalpel. Proc Inst Mech Eng H 2025; 239:83-91. [PMID: 39589213 DOI: 10.1177/09544119241298544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
Using ultrasound technology as one of the therapeutic methods, in which ultrasound waves of different frequencies and intensities are employed, has significantly contributed to enhancing and facilitating the treatment process of various diseases. A Hemostatic Ultrasonic Scalpel can entail considerable advantages by simultaneously performing two operations tissue cutting and coagulation of biological tissues. In the present study, employing experimental design through response surface methodology, the effect of ultrasonic power and the duration of vibration application on the tissue has been investigated. Two parameters, namely the burst pressure of the sealed vessel and the length of the thermal seal zone, were measured by pressure testing and analysis image of the thermal effect region at the sealed vessel area, respectively. The pressure test results demonstrated that an input power of 52 W and the application of vibrations for 8 s under a constant force of 10 N, showed the optimized maximum burst pressure equal to 1100 mmHg. Examination of the sealed vessel images revealed a linear increase in thermal damage with increasing input power.
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Affiliation(s)
- Zahra Hasani
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Rezvan Abedini
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Saber Jahromi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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Du QW, Xiao F, Zheng L, Chen RD, Dong LN, Liu FY, Cheng ZG, Yu J, Liang P. Importance of the enhanced cooling system for more spherical ablation zones: Numerical simulation, ex vivo and in vivo validation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 257:108383. [PMID: 39260163 DOI: 10.1016/j.cmpb.2024.108383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION This study aimed to investigate the efficacy of a small-gauge microwave ablation antenna (MWA) with an enhanced cooling system (ECS) for generating more spherical ablation zones. METHODS A comparison was made between two types of microwave ablation antennas, one with ECS and the other with a conventional cooling system (CCS). The finite element method was used to simulate in vivo ablation. Two types of antennas were used to create MWA zones for 5, 8, 10 min at 50, 60, and 80 W in ex vivo bovine livers (n = 6) and 5 min at 60 W in vivo porcine livers (n = 16). The overtreatment ratio, ablation aspect ratio, carbonization area, and other characteristcs of antennas were measured and compared using numerical simulation and gross pathologic examination. RESULTS In numerical simulation, the ECS antenna demonstrated a lower overtreatment ratio than the CCS antenna (1.38 vs 1.43 at 50 W 5 min, 1.19 vs 1.35 at 50 W 8 min, 1.13 vs 1.32 at 50 W 10 min, 1.28 vs 1.38 at 60 W 5 min, 1.14 vs 1.32 at 60 W 8 min, 1.10 vs 1.30 at 60 W 10 min). The experiments revealed that the ECS antenna generated ablation zones with a more significant aspect ratio (0.92 ± 0.03 vs 0.72 ± 0.01 at 50 W 5 min, 0.95 ± 0.02 vs 0.70 ± 0.01 at 50 W 8 min, 0.96 ± 0.01 vs 0.71 ± 0.04 at 50 W 10 min, 0.96 ± 0.01 vs 0.73 ± 0.02 at 60 W 5 min, 0.94 ± 0.03 vs 0.71 ± 0.03 at 60 W 8 min, 0.96 ± 0.02 vs 0.69 ± 0.04 at 60 W 10 min) and a smaller carbonization area (0.00 ± 0.00 cm2 vs 0.54 ± 0.06 cm2 at 50 W 5 min, 0.13 ± 0.03 cm2 vs 0.61 ± 0.09 cm2 at 50 W 8 min, 0.23 ± 0.05 cm2 vs 0.73 ± 0.05 m2 at 50 W 10 min, 0.00 ± 0.00 cm2 vs 1.59 ± 0.41 cm2 at 60 W 5 min, 0.23 ± 0.22 cm2 vs 2.11 ± 0.63 cm2 at 60 W 8 min, 0.57 ± 0.09 cm2 vs 2.55 ± 0.51 cm2 at 60 W 10 min). Intraoperative ultrasound images revealed a hypoechoic area instead of a hyperechoic area near the antenna. Hematoxylin-eosin staining of the dissected tissue revealed a correlation between the edge of the ablation zone and that of the hypoechoic area. CONCLUSIONS The ECS antenna can produce more spherical ablation zones with less charring and a clearer intraoperative ultrasound image of the ablation area than the CCS antenna.
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Affiliation(s)
- Qiao-Wei Du
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Fan Xiao
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Ren-Dong Chen
- The Yuquan Campus, Zhejiang University, Hangzhou, Zhejiang, China
| | - Li-Nan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China.
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Ding S, Ding W, Zhang Y, Chen Y, Tang H, Jiang X, Chen J. Serum HIF-1α, IGF-1 and IGFBP-3 correlate to recurrence and overall survival in early-stage hepatocellular carcinoma patients. Biomark Med 2024; 18:1027-1036. [PMID: 39552593 PMCID: PMC11633424 DOI: 10.1080/17520363.2024.2421149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/22/2024] [Indexed: 11/19/2024] Open
Abstract
Aim: Recurrence of hepatocellular carcinoma (HCC) after ultrasound-guided microwave ablation (UGMWA) was a critical issue. Therefore, it is significant to identify the role of hypoxia-inducible factor 1 α (HIF-1α), insulin-like growth factor-1 (IGF-1) and IGF binding protein-3 (IGFBP-3) in recurrence.Materials & methods: HCC patients receiving UGMWA were divided into recurrence and no-recurrence groups. The preoperative and postoperative risk factors were compared between these two groups.Results: Preoperative and postoperative serum levels of HIF-1α, IGF-1 and IGFBP-3 were closely associated with the recurrence of HCC. Serum HIF-1α level was increased, while serum levels of IGF-1 and IGFBP-3 were decreased in HCC patients with recurrence.Conclusion: HIF-1α, IGF-1 and IGFBP-3 were associated with and predicted the recurrence of HCC after UGMWA, respectively or in combination.
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Affiliation(s)
- Shujun Ding
- Department of Ultrasonography, Wuxi People's Hospital Affiliated to Nanjing Medical University, Qingyang Road, Wuxi, 214023, Jiangsu, China
| | - Wei Ding
- Department of Interventional Radiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Qingyang Road, Wuxi, 214023, Jiangsu, China
| | - Ye Zhang
- Department of General Surgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Qingyang Road, Wuxi, 214023, Jiangsu, China
| | - Yunbao Chen
- Department of Ultrasonography, Wuxi People's Hospital Affiliated to Nanjing Medical University, Qingyang Road, Wuxi, 214023, Jiangsu, China
| | - Hongtao Tang
- Department of Ultrasonography, Wuxi People's Hospital Affiliated to Nanjing Medical University, Qingyang Road, Wuxi, 214023, Jiangsu, China
| | - Xiao Jiang
- Department of Ultrasonography, Shanghai Yangpu District Shidong Hospital, No. 999 Shiguang Road, Shanghai, 200438, China
| | - Jun Chen
- Department of Ultrasonography, Wuxi People's Hospital Affiliated to Nanjing Medical University, Qingyang Road, Wuxi, 214023, Jiangsu, China
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Susman S, Santoso B, Makary MS. Locoregional Therapies for Hepatocellular Carcinoma in Patients with Nonalcoholic Fatty Liver Disease. Biomedicines 2024; 12:2226. [PMID: 39457538 PMCID: PMC11504147 DOI: 10.3390/biomedicines12102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 09/17/2024] [Accepted: 09/23/2024] [Indexed: 10/28/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide with an average five-year survival rate in the US of 19.6%. With the advent of HBV and HCV treatment and prevention, along with the rising rates of obesity, nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome are set to overtake infectious causes as the most common cause of HCC. While surgical resection and transplantation can be curative when amenable, the disease is most commonly unresectable on presentation, and other treatment approaches are the mainstay of therapy. In these patients, locoregional therapies have evolved as a vital tool in both palliation for advanced disease and as a bridge to surgical resection and transplantation. In this review, we will be exploring the primary locoregional therapies for HCC in patients with NAFLD, including transarterial chemoembolization (TACE), bland transarterial embolization (TAE), transarterial radioembolization (TARE), and percutaneous ablation.
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Affiliation(s)
- Stephen Susman
- Department of Radiology, Yale University Medical Center, New Haven, CT 06510, USA
| | - Breanna Santoso
- Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH 43016, USA
| | - Mina S. Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
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Zhang Q, Liang X, Chen Z. An Updated Review of Thermal Ablation Technology for Uterine Fibroids and Adenomyosis: Focusing on Protecting Fertility. Int J Womens Health 2024; 16:1551-1563. [PMID: 39346931 PMCID: PMC11430362 DOI: 10.2147/ijwh.s473005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/15/2024] [Indexed: 10/01/2024] Open
Abstract
There is a growing trend towards minimally invasive or noninvasive alternatives for gynecological disorders due to their rapid alleviation of symptom, expedited recovery, and minimal risks of postoperative complications. Thermal ablation technology has been commonly advocated as a minimally invasive therapeutic methods in recent years, including microwave ablation, radiofrequency ablation, and high-intensity focused ultrasound. The increasing application scenarios require updated and systematic research, and more evidence to promote their appropriate use. The objective of this review is to summarize the latest views of ablation from a prospective of fertility protection, endeavor to clarify the clinical value of thermal ablation technology in protecting fertility by assessing parameters such as ablation rates, alleviation of disease symptoms, re-intervention rates and post-treatment pregnancy rates. We review the clinical studies of ablation for uterine fibroids and adenomyosis treatment in the past 10 years, summarize the limitation and the prospects of its development in the treatment process, so as to provide clinicians with advice on the best practice. In the management of uterine fibroids and adenomyosis, thermal ablation technology offers improved fertility preservation and minimizes normal tissue injury compared to traditional surgical approaches for patients pursuing reproductive goals. In the future, thermal ablation technology will play a significantly enhanced role in preserving fertility for individuals requiring treatment for uterine fibroids and adenomyosis, guided by indications. But further research is still needed in the form of more extensive randomized prospective trials to provide stronger evidence supporting this perspective.
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Affiliation(s)
- Qing Zhang
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Xiaowen Liang
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
| | - Zhiyi Chen
- Key Laboratory of Medical Imaging Precision Theranostics and Radiation Protection, College of Hunan Province, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
- Department of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, People's Republic of China
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Peltier A, van Velthoven R, Baudewyns A, Assenmacher G, Lemort M, Lefebvre Y, Sirtaine N, Diamand R. Targeted microwave ablation for prostate cancer (FOSTINE1b): a prospective 'ablate-and-resect' study. BJU Int 2024; 134:258-267. [PMID: 38742416 DOI: 10.1111/bju.16385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To assess histopathological outcomes, as well as feasibility and safety of targeted microwave ablation (TMA) via the Trinity® system (KOELIS, La Tronche, France). PATIENTS AND METHODS Prospective, single-institution, interventional Phase IIa study with an 'ablate-and-resect' design. In all, 11 patients diagnosed with localised prostate cancer (PCa) underwent TMA via the Trinity system under conscious sedation in an outpatient setting using a single transrectal TATO® 18-G antenna with different treatment regimens. Magnetic resonance imaging (MRI) and robot-assisted radical prostatectomy (RARP) were conducted at 7 days and 1 month after TMA, respectively. Nine patients received RARP, and two patients chose to withdraw their consent following TMA. These men chose an active surveillance protocol upon confirmation of a low-risk prostate cancer diagnosis. Functional outcomes and adverse events were evaluated at baseline and follow-up visits using validated questionnaires. Prostate volumetry and confirmation of necrosis were carried out through MRI and whole-mount histopathological examination. RESULTS The TMA was successfully executed, and all patients were discharged on the same day. No severe adverse events (Common Terminology Criteria for Adverse Events Grade ≥3) were reported at the 7-day and 1-month follow-up visits. Additionally, no declines were observed in urinary, sexual and ejaculation functional outcomes. T1-weighted MRI revealed clear and well-defined ablation zones. The RARP was executed without difficulty, particularly during the dissection of the posterior plane. As a result, no intraoperative complications were encountered. Histopathological assessment on surgical specimens confirmed the absence of viable cells, indicating complete necrosis of the ablative zone if a power intensity >10 W was used during TMA. Ablation zone volumetry revealed no notable distinctions between the three-dimensional segmentation of the virtual ablation zone at TMA (median volume: 2 mL) and MRI (median volume: 1.923 mL). Conversely, a significant reduction was noted in the surgical specimen (median volume: 0.221 mL). CONCLUSIONS Targeted microwave ablation via the Trinity system for localised PCa treatment proves to be a secure and feasible procedure, with complete necrosis evidence within the ablation zone on surgical specimens.
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Affiliation(s)
- Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Roland van Velthoven
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Arthur Baudewyns
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Grégoire Assenmacher
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Lemort
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolene Lefebvre
- Department of Radiology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Sirtaine
- Department of Pathology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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Keum H, Cevik E, Kim J, Demirlenk YM, Atar D, Saini G, Sheth RA, Deipolyi AR, Oklu R. Tissue Ablation: Applications and Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2310856. [PMID: 38771628 PMCID: PMC11309902 DOI: 10.1002/adma.202310856] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/05/2024] [Indexed: 05/22/2024]
Abstract
Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.
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Affiliation(s)
- Hyeongseop Keum
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Enes Cevik
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Jinjoo Kim
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Yusuf M Demirlenk
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Dila Atar
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Gia Saini
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Amy R Deipolyi
- Interventional Radiology, Department of Surgery, West Virginia University, Charleston Area Medical Center, Charleston, WV 25304, USA
| | - Rahmi Oklu
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, Arizona 85054, USA
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Chiang J, Sparks H, Hao F, Lee EW, Sung K. Numerical modeling and validation of combination embolization-ablation therapy in the liver using dynamic contrast-enhanced (DCE)-MRI. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2024; 2024:1-5. [PMID: 40039695 DOI: 10.1109/embc53108.2024.10781570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
Combination transarterial embolization and ablation is an increasingly common strategy for treating solitary, non-resectable hepatocellular carcinomas (HCCs) greater than 3 cm in size. However, manufacturer guidelines do not provide information as to the size of the ablation zone after embolization. This can put the patient at risk for inadvertent thermal damage to nearby anatomy such as the liver capsule, biliary ducts, diaphragm, and body wall. Thus, while combination therapy is associated with improved clinical outcomes, it is also associated with a higher complication rate. The goal of this study was to create a numerical model to evaluate the change in perfusion in embolization and correlate the perfusional change with final microwave ablation volume. This relationship was then validated in combination embolization ablation therapy in an in-vivo porcine liver model, using a novel MR perfusion sequence.
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12
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Zhang Y, Gao H, He H, Liu J, Xu F, Wu S, Zhou J, Cheng Z. Microwave ablation on ex vivo porcine pancreas: The influence of ablation parameters on ablation results and fat liquefaction. Proc Inst Mech Eng H 2024; 238:814-826. [PMID: 39045922 DOI: 10.1177/09544119241261891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The pancreas is adjacent to critical organs; excessive microwave ablation (MWA) can result in serious complications. The purpose of this paper is to provide the reference data of pancreas MWA for clinicians, analyze the ablation outcomes under different ablation parameters, and determine the critical temperature of pancreatic surface fat liquefaction outflow. Combinations of two power levels (30 W and 55 W), three antenna diameters (1.3 mm, 1.6 mm, and 1.9 mm), and three ablation times (1 min, 1.5 min, and 2 min) were applied to an ex vivo pig pancreas. Temperature measurements were taken at four thermocouple points. The center point is located 5 mm horizontally from the antenna slot, with a temperature measurement point located 5 mm above, below, and to the right of the center point. Main effect analysis and variance analysis were used to quantify the influences of each factor on the ablation outcomes. At 30 W, the antenna diameter contributing the most at 48.5%. At 30 W-1.3 mm-1 min, the spherical index (1.41) is closest to 1. At 55 W, the coagulation zone size was almost only affected by the ablation time, with a contribution rate of 28.7%, the temperature at point C exceeds point B. On the surface of the ex vivo porcine pancreas, the fat outflow temperature was 54ã. Ablation combinations with low power, short duration, and small antenna diameter results in a more nearly spherical coagulation zone. When performing MWA on the pancreas, it is advisable to avoid areas with higher fat content, while keeping the pancreatic surface temperature below 54°C.
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Affiliation(s)
- Yubo Zhang
- Faculty of Environmental and Life Sciences, Beijing University of Technology, Beijing, China
| | - Hongjian Gao
- Faculty of Environmental and Life Sciences, Beijing University of Technology, Beijing, China
| | - Huijing He
- Faculty of Environmental and Life Sciences, Beijing University of Technology, Beijing, China
| | - Ju Liu
- Faculty of Environmental and Life Sciences, Beijing University of Technology, Beijing, China
| | - Fan Xu
- Faculty of Environmental and Life Sciences, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- Faculty of Environmental and Life Sciences, Beijing University of Technology, Beijing, China
| | - Jie Zhou
- Interventional Ultrasound Department, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Interventional Ultrasound Department, Chinese PLA General Hospital, Beijing, China
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Pelicano AC, Gonçalves MCT, Castela T, Orvalho ML, Araújo NAM, Porter E, Conceição RC, Godinho DM. Repository of MRI-derived models of the breast with single and multiple benign and malignant tumors for microwave imaging research. PLoS One 2024; 19:e0302974. [PMID: 38758760 PMCID: PMC11101032 DOI: 10.1371/journal.pone.0302974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
The diagnosis of breast cancer through MicroWave Imaging (MWI) technology has been extensively researched over the past few decades. However, continuous improvements to systems are needed to achieve clinical viability. To this end, the numerical models employed in simulation studies need to be diversified, anatomically accurate, and also representative of the cases in clinical settings. Hence, we have created the first open-access repository of 3D anatomically accurate numerical models of the breast, derived from 3.0T Magnetic Resonance Images (MRI) of benign breast disease and breast cancer patients. The models include normal breast tissues (fat, fibroglandular, skin, and muscle tissues), and benign and cancerous breast tumors. The repository contains easily reconfigurable models which can be tumor-free or contain single or multiple tumors, allowing complex and realistic test scenarios needed for feasibility and performance assessment of MWI devices prior to experimental and clinical testing. It also includes an executable file which enables researchers to generate models incorporating the dielectric properties of breast tissues at a chosen frequency ranging from 3 to 10 GHz, thereby ensuring compatibility with a wide spectrum of research requirements and stages of development for any breast MWI prototype system. Currently, our dataset comprises MRI scans of 55 patients, but new exams will be continuously added.
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Affiliation(s)
- Ana C. Pelicano
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Maria C. T. Gonçalves
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Tiago Castela
- Departamento de Radiologia, Hospital da Luz Lisboa, Luz Saúde, Lisboa, Portugal
| | - M. Lurdes Orvalho
- Departamento de Radiologia, Hospital da Luz Lisboa, Luz Saúde, Lisboa, Portugal
| | - Nuno A. M. Araújo
- Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Centro de Física Teórica e Computacional, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Emily Porter
- Chandra Family Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX, United States of Ameirca
- Department of Biomedical Engineering, McGill University, Montréal, Canada
| | - Raquel C. Conceição
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Daniela M. Godinho
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
- Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
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Chang LK, Yang SM, Chung WY, Chen LC, Chang HC, Ho MC, Chang YC, Yu CJ. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol 2024; 34:3309-3319. [PMID: 37926741 DOI: 10.1007/s00330-023-10360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR. METHODS We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described. RESULTS Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up. CONCLUSIONS Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients. CLINICAL RELEVANCE STATEMENT Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed. KEY POINTS • We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room. • To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation. • We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan.
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
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15
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Zhou M, Li Z, Liu Y, Fang Y, Qin L, Yang W, Yan F, Zhao Q. Transapical intramyocardial septal microwave ablation in treatment of hypertrophic obstructive cardiomyopathy: 12-month outcomes of a swine model. J Cardiothorac Surg 2024; 19:205. [PMID: 38615019 PMCID: PMC11015544 DOI: 10.1186/s13019-024-02677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/23/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND To date, the extended Morrow procedure is considered the gold standard treatment for patients with obstructive hypertrophic cardiomyopathy who experience severe symptoms and are unresponsive to medication treatment. We therefore aimed to perform transapical intramyocardial septal microwave ablation to reduce the thickness of the interventricular septum myocardium in a minimally invasive method. METHODS Fourteen swine were divided to form either a microwave ablation group (n = 7) or a sham group (n = 7). In the microwave ablation group, a transapical microwave antenna was inserted into the septum to ablate each myocardial segment at 40 W for 1 min, while in the sham group, the same operation was performed but without power output. We used echocardiography, electrocardiogram, during the operation. And added computerized tomography, cardiac nuclear magnetic resonance during follow-up. RESULTS Segment hypokinesis was observed in all swine immediately following ablation. Compared with the sham group, the thickness of ablated segments in the ablation group decreased significantly 1 month post-operation (ablation group, 5.53 ± 1.00 mm vs. 8.03 ± 1.15 mm, respectively, P < 0.01; sham group, 8.40 ± 0.94 mm vs. 8.21 ± 1.09 mm, respectively, P = 0.081), and the outcome was still observed 1 year post-operation (ablation group, 3.36 ± 0.85 mm vs. 8.03 ± 1.15 mm, respectively, P < 0.01). No perforation of the septum was observed during the procedure or follow-up, and no heart failure or sudden cardiac death occurred during postoperative feeding. CONCLUSIONS Transapical intramyocardial septal microwave ablation can effectively and safely produce a large region of necrosis. This technique can potentially mimic surgical myectomy while avoiding cardiopulmonary bypass and median sternotomy in high-risk hypertrophic obstructive cardiomyopathy patients.
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Affiliation(s)
- Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhaolong Li
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yun Liu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yuehua Fang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Li XL, Li JX, Yu SY, Fan PL, Jin YJ, Xu EJ, Guan SN, Deng EY, Li QY, Ji ZB, Qi JL, Xu HX, China Alliance of Multi-Center Clinical Study for Ultrasound (Ultra-Chance). Value of contrast-enhanced ultrasonography in microwave ablation treatment of symptomatic focal uterine adenomyosis. Ultrasonography 2024; 43:68-77. [PMID: 38109892 PMCID: PMC10766881 DOI: 10.14366/usg.23145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023] Open
Abstract
PURPOSE This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine adenomyosis. METHODS This retrospective study was conducted between March 2020 and January 2023, enrolling 52 patients with symptomatic focal uterine adenomyosis who had undergone MWA. All patients were examined with CEUS before and after MWA. The non-perfused volume (NPV) was compared between CEUS and dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) following ablation. Therapeutic efficacy and safety were evaluated at 3-, 6-, and 12-month follow-ups. Additionally, this study explored the correlations between pre-treatment CEUS features and a volume reduction ratio indicating sufficient ablation, defined as 50% or more at the 3-month follow-up. RESULTS No significant differences in NPV were noted between CEUS and DCE-MRI immediately after MWA and during follow-up (all P>0.05). At the 3-month follow-up, the median VRRs for the uterus and adenomyosis were 33.2% and 63.9%, respectively. Sufficient ablation was achieved in 69.2% (36/52) of adenomyosis cases, while partial ablation was observed in the remaining 30.8% (16/52). The identification of non-enhancing areas on pre-treatment CEUS was associated with sufficient ablation (P=0.016). At the 12-month follow-up, significant decreases were observed in both the uterine and adenomyosis volumes (all P<0.001). Dysmenorrhea and menorrhagia were significantly alleviated at 12 months, and no major complications were encountered. CONCLUSION CEUS can be used to evaluate the ablation zone of focal adenomyosis that has been treated with MWA, similarly to DCE-MRI. The identification of non-enhancing areas on pretreatment CEUS indicates satisfactory treatment outcomes.
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Affiliation(s)
- Xiao-Long Li
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Jia-Xin Li
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - Pei-Li Fan
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Yun-Jie Jin
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Er-Jiao Xu
- Department of Ultrasound, Eighth Affiliated Hospital of Sun Yat-Sen University, Zhongshan University, Shenzhen, China
| | - Sai-Nan Guan
- Department of Ultrasound, Eighth Affiliated Hospital of Sun Yat-Sen University, Zhongshan University, Shenzhen, China
| | - Er-Ya Deng
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - Qiu-Yan Li
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - Zheng-Biao Ji
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Jiu-Ling Qi
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - China Alliance of Multi-Center Clinical Study for Ultrasound (Ultra-Chance)
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Department of Ultrasound, Eighth Affiliated Hospital of Sun Yat-Sen University, Zhongshan University, Shenzhen, China
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17
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Crocetti L, Scalise P, Bozzi E, Candita G, Cioni R. Thermal ablation of hepatocellular carcinoma. J Med Imaging Radiat Oncol 2023; 67:817-831. [PMID: 38093656 DOI: 10.1111/1754-9485.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/29/2023] [Indexed: 01/14/2024]
Abstract
Percutaneous treatment of hepatocellular carcinoma (HCC) by means of thermal ablation (TA) has been introduced in clinical guidelines as a potentially curative treatment for the early stages of the disease since the early 2000s. Due to its safety profile and cost-effectiveness, TA can be offered as a first-line treatment for patients with HCC smaller than 3 cm. Thermal ablative techniques are in fact widely available at many centres worldwide and include radiofrequency (RF) and microwave (MW) ablation, with the latter increasingly applied in clinical practice in the last decade. Pre-clinical studies highlighted, as potential advantages of MW-based ablation, the ability to achieve higher temperatures (>100°C) and larger ablation zones in shorter times, with less susceptibility to blood flow-induced heat sink effects. Despite these advantages, there is no evidence of superior overall survival in patients treated with MW as compared to those treated with RF ablation. Local control has been proven to be superior to MW ablation with a similar complication rate. It is expected that further improvement of TA results in the treatment of HCC will result from the refinement of guidance and monitoring tools and the careful assessment of ablation margins. Thermal ablative treatments may also be performed on nodules larger than 3 cm by applying multiple devices or combining percutaneous and intra-arterial approaches. The role of novel immunotherapy regimens in combination with ablation is also currently under evaluation in clinical trials, with several potential benefits. In this review, indications, technical principles, results, and future prospects of TA for the treatment of HCC will be examined.
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Affiliation(s)
- Laura Crocetti
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Paola Scalise
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Elena Bozzi
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gianvito Candita
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Chiang J, Rajendran PS, Hao F, Sayre J, Raman SS, Lu DSK, McWilliams JP. Combination transarterial chemoembolization and microwave ablation vs. microwave ablation monotherapy for hepatocellular carcinomas greater than 3 cm: a comparative study. Diagn Interv Radiol 2023; 29:805-812. [PMID: 37665139 PMCID: PMC10679555 DOI: 10.4274/dir.2023.232159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/01/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To evaluate the efficacy of combination therapy using transarterial chemoembolization with microwave ablation (MWA) therapy vs. MWA monotherapy for hepatocellular carcinomas (HCCs) >3 cm in size. METHODS This two-arm retrospective observational study included patients with HCCs >3 cm who underwent either combination therapy (29 patients) or MWA monotherapy (35 patients) between 2014 and 2020. The treatment outcomes related to primary treatment efficacy, local tumor progression (LTP), tumor control rate, and overall survival were compared between each cohort. RESULTS The technical success and primary efficacy were 96.56% and 100.00% in the combination therapy cohort, and 91.42% and 100.00% in the MWA cohort, respectively, over a mean follow-up period of 27.6 months. The 1- and 3-year rates of LTP-free survival were 78.57% and 69.56% in the combination therapy cohort, vs. 72.45% and 35.44% in the MWA cohort, respectively (P = 0.001). The overall progression-free survival was longer in the combination therapy cohort compared with the MWA cohort (median: 56.0 vs. 13.0 months; P = 0.017). With the incorporation of additional locoregional therapy, the overall survival rates were not significantly different, with 1- and 3-year overall survival rates of 100.00% and 88.71% in the combination therapy cohort and rates of 90.15% and 82.76% in the MWA cohort, respectively (P = 0.235). CONCLUSION The combination therapy provided significantly longer upfront LTP-free survival in HCCs >3 cm when compared with the MWA treatment alone, albeit with similar local tumor control and overall survival rates when accounting for additional locoregional therapies.
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Affiliation(s)
- Jason Chiang
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Pradeep S. Rajendran
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Frank Hao
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - James Sayre
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Steven S. Raman
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - David S. K. Lu
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Justin P. McWilliams
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
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Falk KL, Laeseke PF, Kisting MA, Zlevor AM, Knott EA, Smolock AR, Bradley C, Vlaisavljevich E, Lee FT, Ziemlewicz TJ. Clinical translation of abdominal histotripsy: a review of preclinical studies in large animal models. Int J Hyperthermia 2023; 40:2272065. [PMID: 37875279 PMCID: PMC10629829 DOI: 10.1080/02656736.2023.2272065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
Histotripsy is an emerging noninvasive, non-thermal, and non-ionizing focused ultrasound (US) therapy that can be used to destroy targeted tissue. Histotripsy has evolved from early laboratory prototypes to clinical systems which have been comprehensively evaluated in the preclinical environment to ensure safe translation to human use. This review summarizes the observations and results from preclinical histotripsy studies in the liver, kidney, and pancreas. Key findings from these studies include the ability to make a clinically relevant treatment zone in each organ with maintained collagenous architecture, potentially allowing treatments in areas not currently amenable to thermal ablation. Treatments across organ capsules have proven safe, including in anticoagulated models which may expand patients eligible for treatment or eliminate the risk associated with taking patients off anti-coagulation. Treatment zones are well-defined with imaging and rapidly resorb, which may allow improved evaluation of treatment zones for residual or recurrent tumor. Understanding the effects of histotripsy in animal models will help inform physicians adopting histotripsy for human clinical use.
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Affiliation(s)
- Katrina L Falk
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Emily A Knott
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Amanda R Smolock
- Department of Radiology, Division of Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Charles Bradley
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Fred T Lee
- Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
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20
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. First validation of a model-based hepatic percutaneous microwave ablation planning on a clinical dataset. Sci Rep 2023; 13:16862. [PMID: 37803064 PMCID: PMC10558472 DOI: 10.1038/s41598-023-42543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actual ablation ground truth from a clinical dataset in liver. The biophysical model uses a simplified formulation of heat deposition on the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined to assess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model prediction compared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculature shortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermal prediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be used as liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermal ablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate its integration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands.
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin, 5656 AE, Eindhoven, The Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
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21
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Nguyen HN, Yamada A, Naka S, Mukaisho KI, Tani T. Comparison of off-clamp microwave scissors-based sutureless partial nephrectomy versus on-clamp conventional partial nephrectomy in a canine model. Front Surg 2023; 10:1255929. [PMID: 37795145 PMCID: PMC10546044 DOI: 10.3389/fsurg.2023.1255929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023] Open
Abstract
Objectives To compare the usefulness and safety of off-clamp microwave scissors-based sutureless partial nephrectomy (MSPN) with on-clamp conventional partial nephrectomy (cPN) in dogs. Methods We performed off-clamp MSPN using microwave scissors (MWS) in six dogs, and on-clamp cPN in three dogs, in two-stage experiments. The bilateral kidney upper poles were resected via a midline incision under general anesthesia. After 14 days of follow-up, the lower pole resections were performed. The renal calyces exposed during renal resections were sealed and transected using MWS in off-clamp MSPN and were sutured in on-clamp cPN. In the off-clamp MSPN group, the generator's power output of MWS was set as either 50 W or 60 W for each kidney side. We compared the procedure time (PT), ischemic time (IT), blood loss (BL), and normal nephron loss (NNL) between the two techniques using the Mann-Whitney U-test. Results We successfully performed 24 off-clamp MSPNs and 12 on-clamp cPNs. The off-clamp MSPN was significantly superior to on-clamp cPN in avoiding renal ischemia (median IT, 0 min vs. 8.6 min, p < 0.001) and reducing PT (median PT, 5.8 min vs. 11.5 min, p < 0.001) and NNL (median NNL, 5.3 mm vs. 6.0 mm, p = 0.006) with comparable BL (median BL, 20.9 ml vs. 23.2 ml, p = 0.804). No bleeding and major urine leakage were noted during the reoperations. Conclusions Off-clamp MSPN outperforms on-clamp cPN in lowering the risks of postoperative renal function impairment in dogs.
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Affiliation(s)
- Ha Ngoc Nguyen
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Atsushi Yamada
- Medical Innovation Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Shigeyuki Naka
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
- Department of Surgery, Hino Memorial Hospital, Shiga, Japan
| | - Ken-Ichi Mukaisho
- Division of Pathology, Shiga University of Medical Science, Shiga, Japan
| | - Tohru Tani
- Department of Advanced Medical Research and Development, Shiga University of Medical Science, Shiga, Japan
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22
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Varble NA, Bakhutashvili I, Reed SL, Delgado J, Tokoutsi Z, Frackowiak B, Baragona M, Karanian JW, Wood BJ, Pritchard WF. Morphometric characterization and temporal temperature measurements during hepatic microwave ablation in swine. PLoS One 2023; 18:e0289674. [PMID: 37540658 PMCID: PMC10403086 DOI: 10.1371/journal.pone.0289674] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE Heat-induced destruction of cancer cells via microwave ablation (MWA) is emerging as a viable treatment of primary and metastatic liver cancer. Prediction of the impacted zone where cell death occurs, especially in the presence of vasculature, is challenging but may be achieved via biophysical modeling. To advance and characterize thermal MWA for focal cancer treatment, an in vivo method and experimental dataset were created for assessment of biophysical models designed to dynamically predict ablation zone parameters, given the delivery device, power, location, and proximity to vessels. MATERIALS AND METHODS MWA zone size, shape, and temperature were characterized and monitored in the absence of perfusion in ex vivo liver and a tissue-mimicking thermochromic phantom (TMTCP) at two power settings. Temperature was monitored over time using implanted thermocouples with their locations defined by CT. TMTCPs were used to identify the location of the ablation zone relative to the probe. In 6 swine, contrast-enhanced CTs were additionally acquired to visualize vasculature and absence of perfusion along with corresponding post-mortem gross pathology. RESULTS Bench studies demonstrated average ablation zone sizes of 4.13±1.56cm2 and 8.51±3.92cm2, solidity of 0.96±0.06 and 0.99±0.01, ablations centered 3.75cm and 3.5cm proximal to the probe tip, and temperatures of 50 ºC at 14.5±13.4s and 2.5±2.1s for 40W and 90W ablations, respectively. In vivo imaging showed average volumes of 9.8±4.8cm3 and 33.2±28.4cm3 and 3D solidity of 0.87±0.02 and 0.75±0.15, and gross pathology showed a hemorrhagic halo area of 3.1±1.2cm2 and 9.1±3.0cm2 for 40W and 90W ablations, respectfully. Temperatures reached 50ºC at 19.5±9.2s and 13.0±8.3s for 40W and 90W ablations, respectively. CONCLUSION MWA results are challenging to predict and are more variable than manufacturer-provided and bench predictions due to vascular stasis, heat-induced tissue changes, and probe operating conditions. Accurate prediction of MWA zones and temperature in vivo requires comprehensive thermal validation sets.
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Affiliation(s)
- Nicole A. Varble
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Philips, Best, The Netherlands
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Sheridan L. Reed
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Jose Delgado
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | | | | | | | - John W. Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Bioengineering and National Cancer Institute Center, Bethesda, Maryland, United States of America
| | - William F. Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
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23
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Blain M, Narayanan G, Ricoeur A, Kobe A, Mahendra AM, Jacks B, Letty Q, Bonnet B, Tselikas L, Deschamps F, de Baère T. Safety and Efficacy of Percutaneous Liver Microwave Ablation Using a Fully Water-Cooled Choke Ring Antenna: First Multicenter Clinical Report. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03481-3. [PMID: 37430015 PMCID: PMC10382338 DOI: 10.1007/s00270-023-03481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/25/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION The safety and efficacy of a microwave ablation (MWA) system for the liver with novel technologies in field control, antenna cooling through the inner part of the choke ring, and dual temperature monitoring were evaluated in this multicenter retrospective study. MATERIAL AND METHODS Ablation characteristics and efficacy were assessed on follow-up imaging (computed tomography or magnetic resonance imaging). Safety was evaluated according to CTCAE classification. RESULTS Eighty-seven liver tumors (65 metastases and 22 hepatocellular carcinomas) measuring 17.8 ± 7.9 mm were treated in 68 patients. Ablation zones measured 35.6 ± 11 mm in longest diameter. The coefficients of variation of the longest and shortest ablation diameters were 30.1% and 26.4%, respectively. The mean sphericity index of the ablation zone was 0.78 ± 0.14. Seventy-one ablations (82%) had a sphericity index above 0.66. At 1 month, all tumors demonstrated complete ablation with margins of 0-5 mm, 5-10 mm, and greater than 10 mm achieved in 22%, 46%, and 31% of tumors, respectively. After a median follow-up of 10 months, local tumor control was achieved in 84.7% of treated tumors after a single ablation and in 86% after one patient received a second ablation. One grade 3 complication (stress ulcer) occurred, but was unrelated to the procedure. Ablation zone size and geometry in this clinical study were in accordance with previously reported in vivo preclinical findings. CONCLUSION Promising results were reported for this MWA device. The high spherical index, reproducibility, and predictability of the resulting treatment zones translated to a high percentage of adequate safety margins, providing good local control rate.
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Affiliation(s)
- Maxime Blain
- Department of Interventional Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Miami Cardiac and Vascular, Baptist Health South Florida, Miami, FL, USA
| | - Alexis Ricoeur
- Interventional Radiology Unit, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
- Department of Interventional Radiology, Centre Léon Berard, Lyon, France
| | - Adrian Kobe
- Department of Interventional Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Ashwin M Mahendra
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Miami, FL, USA
| | | | - Quentin Letty
- Department of Interventional Radiology, Centre Léon Berard, Lyon, France
| | - Baptiste Bonnet
- Department of Interventional Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
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Ishikawa T, Hasegawa I, Hirosawa H, Honmou T, Sakai N, Igarashi T, Yamazaki S, Kobayashi T, Sato T, Iwanaga A, Sano T, Yokoyama J, Honma T. Comparison of Ablation Volume Between Emprint ® and Mimapro ® Systems for Hepatocellular Carcinoma -A Preliminary Study. J Hepatocell Carcinoma 2023; 10:979-985. [PMID: 37377842 PMCID: PMC10292608 DOI: 10.2147/jhc.s412642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Microwave ablation (MWA) is a standard percutaneous local therapy for hepatocellular carcinoma (HCC). Next-generation MWA is reported to create a more spherical ablation zone than radiofrequency ablation (RFA). We compared the ablation zone and aspect ratio of two 2.45 GHz MWA ablation probes; Emprint® (13G) and Mimapro® (17G). We compared the ablation zone to the applied energy after MWA in patients with hepatocellular carcinoma (HCC). Furthermore, we investigated local recurrence. MATERIALS AND METHODS We included 20 patients with HCC, with an average tumour diameter of 33.2 ± 12.2 mm, who underwent MWA using Emprint®, and 9 patients who underwent MWA using Mimapro® with an average tumour diameter of 31.1 ± 10.5 mm. Both groups underwent the same ablation protocol using the same power settings. The images obtained after MWA showed the treatment ablation zone and aspect ratio, which were measured and compared using three-dimensional image analysis software. RESULTS The aspect ratios in the Emprint® and Mimapro® groups were 0.786 ± 0.105 and 0.808 ± 0.122, respectively, with no significant difference (p = 0.604). The ablation time was significantly shorter in the Mimapro® group than in the Emprint® group, and there was no significant difference in the frequency of popping or the ablation volume. There were no significant differences in local recurrence between the two groups. CONCLUSION There was no significant difference in the aspect ratios of the ablation diameter, and the ablation zone was almost spherical in both cases. Mimapro® at 17G was less invasive than Emprint® at 13G.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Iori Hasegawa
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hiroshi Hirosawa
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Tsubasa Honmou
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Nobuyuki Sakai
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takanori Igarashi
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shun Yamazaki
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takamasa Kobayashi
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Toshifumi Sato
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Akito Iwanaga
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Tomoe Sano
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Junji Yokoyama
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Terasu Honma
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
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25
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Corona J, Kandadai N. Recent Progress in Modulated Photothermal Radiometry. SENSORS (BASEL, SWITZERLAND) 2023; 23:4935. [PMID: 37430847 DOI: 10.3390/s23104935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/12/2023]
Abstract
In this review, the emerging work using a technique known as modulated photothermal radiometry (MPTR) is evaluated. As MPTR has matured, the previous discussions on theory and modeling have become increasingly limited in their applicability to the current state of the art. After a brief history of the technique, the currently used thermodynamic theory is explained, highlighting the commonly applied simplifications. The validity of the simplifications is explored via modeling. Various experimental designs are compared, and the differences are explored. New applications, as well as emerging analysis techniques, are presented to emphasize the trajectory of MPTR.
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Affiliation(s)
- Javier Corona
- College of Engineering, Oregon State University, Corvallis, OR 97331, USA
| | - Nirmala Kandadai
- College of Engineering, Oregon State University, Corvallis, OR 97331, USA
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26
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Jiang M, Fiering S, Shao Q. Combining energy-based focal ablation and immune checkpoint inhibitors: preclinical research and clinical trials. Front Oncol 2023; 13:1153066. [PMID: 37251920 PMCID: PMC10211342 DOI: 10.3389/fonc.2023.1153066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023] Open
Abstract
Energy-based focal therapy (FT) uses targeted, minimally invasive procedures to destroy tumors while preserving normal tissue and function. There is strong emerging interest in understanding how systemic immunity against the tumor can occur with cancer immunotherapy, most notably immune checkpoint inhibitors (ICI). The motivation for combining FT and ICI in cancer management relies on the synergy between the two different therapies: FT complements ICI by reducing tumor burden, increasing objective response rate, and reducing side effects of ICI; ICI supplements FT by reducing local recurrence, controlling distal metastases, and providing long-term protection. This combinatorial strategy has shown promising results in preclinical study (since 2004) and the clinical trials (since 2011). Understanding the synergy calls for understanding the physics and biology behind the two different therapies with distinctive mechanisms of action. In this review, we introduce different types of energy-based FT by covering the biophysics of tissue-energy interaction and present the immunomodulatory properties of FT. We discuss the basis of cancer immunotherapy with the emphasis on ICI. We examine the approaches researchers have been using and the results from both preclinical models and clinical trials from our exhaustive literature research. Finally, the challenges of the combinatory strategy and opportunities of future research is discussed extensively.
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Affiliation(s)
- Minhan Jiang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Steven Fiering
- Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Dartmouth Cancer Center, Dartmouth Geisel School of Medicine and Dartmouth Health, Lebanon, NH, United States
| | - Qi Shao
- Department of Radiology, University of Minnesota, Minneapolis, MN, United States
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27
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Frackowiak B, Van den Bosch V, Tokoutsi Z, Baragona M, de Greef M, Elevelt A, Isfort P. Model-based hepatic percutaneous microwaveablation planning. First validation on a clinical dataset. RESEARCH SQUARE 2023:rs.3.rs-2781339. [PMID: 37131766 PMCID: PMC10153367 DOI: 10.21203/rs.3.rs-2781339/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A model-based planning tool, integrated in an imaging system, is envisioned for CT-guided percutaneous microwave ablation. This study aims to evaluate the biophysical model performance, by comparing its prediction retrospectively with the actualablation ground truth from a clinical data set in liver. The biophysical model uses a simplified formulation of heat depositionon the applicator and a heat sink related to vasculature to solve the bioheat equation. A performance metric is defined toassess how the planned ablation overlaps the actual ground truth. Results demonstrate superiority of this model predictioncompared to manufacturer tabulated data and a significant influence of the vasculature cooling effect. Nevertheless, vasculatureshortage due to branches occlusion and applicator misalignment due to registration error between scans affects the thermalprediction. With a more accurate vasculature segmentation, occlusion risk can be estimated, whereas branches can be usedas liver landmarks to improve the registration accuracy. Overall, this study emphasizes the benefit of a model-based thermalablation solution in better planning the ablation procedures. Contrast and registration protocols must be adapted to facilitate itsintegration into the clinical workflow.
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Affiliation(s)
- Bruno Frackowiak
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, 52074, Germany
| | - Zoi Tokoutsi
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Marco Baragona
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Martijn de Greef
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Aaldert Elevelt
- Philips Research, Data Science & Digital Twin,Eindhoven,5656AE, Netherlands
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, 52074, Germany
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28
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Ohaegbulam KC, Koethe Y, Fung A, Mayo SC, Grossberg AJ, Chen EY, Sharzehi K, Kardosh A, Farsad K, Rocha FG, Thomas CR, Nabavizadeh N. The multidisciplinary management of cholangiocarcinoma. Cancer 2023; 129:184-214. [PMID: 36382577 DOI: 10.1002/cncr.34541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
Cholangiocarcinoma is a lethal malignancy of the biliary epithelium that can arise anywhere along the biliary tract. Surgical resection confers the greatest likelihood of long-term survivability. However, its insidious onset, difficult diagnostics, and resultant advanced presentation render the majority of patients unresectable, highlighting the importance of early detection with novel biomarkers. Developing liver-directed therapies and emerging targeted therapeutics may offer improved survivability for patients with unresectable or advanced disease. In this article, the authors review the current multidisciplinary standards of care in resectable and unresectable cholangiocarcinoma, with an emphasis on novel biomarkers for early detection and nonsurgical locoregional therapy options.
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Affiliation(s)
- Kim C Ohaegbulam
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Yilun Koethe
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Aaron J Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Emerson Y Chen
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kaveh Sharzehi
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Adel Kardosh
- Division of Hematology/Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Flavio G Rocha
- Department of Surgical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Department of Radiation Oncology, Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | - Nima Nabavizadeh
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
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29
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Ortiz CB, Dang A, Derrick K, O'Donnell B, Bitar R, Parker M, Veraza R, Bunegin L, Borrego M, Yamaguchi S, Walker JA, Lopera J. Creation of an Ex Vivo Renal Perfusion Model to Investigate Microwave Ablation. J Vasc Interv Radiol 2023; 34:40-45.e2. [PMID: 36244634 DOI: 10.1016/j.jvir.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
This study hypothesized that an ex vivo renal perfusion model can create smaller microwave ablation (MWA) measurements during perfused states compared with nonperfused states across multiple device settings. Nine bovine kidneys, a fluoroscopic compatible perfusion model, and a commercially-available clinical MWA system were used to perform 72 ablations (36 perfused and 36 nonperfused) at 9 different device settings. Comparing perfused and nonperfused ablations at each device setting, significant differences in volume existed for 6 of 9 settings (P < .05). Collapsed across time settings, the ablation volumes by power were the following (perfused and nonperfused, P value): 60 W, 2.3 cm3 ± 1.0 and 7.2 cm3 ± 2.7, P < .001; 100 W, 5.4 cm3 ± 2.1 and 11.5 cm3 ± 5.6, P < .01; and 140 W, 11.2 cm3 ± 3.7 and 18.7 cm3 ± 6.3, P < .01. Applied power correlated with ablation volume: perfused, 0.021 cm3/W and R = 0.462, P = .004, and nonperfused, 0.029 cm3/W and R = 0.565, P < .001. These results support that an ex vivo perfused organ system can evaluate MWA systems and demonstrate heat sink perfusion effects of decreased ablation size.
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Affiliation(s)
- Carlos B Ortiz
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas.
| | - Annie Dang
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Kade Derrick
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Barrett O'Donnell
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Ryan Bitar
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Matthew Parker
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | | | - Leonid Bunegin
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Vascular Perfusion Solutions, San Antonio, Texas
| | - Marina Borrego
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Seiji Yamaguchi
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Transplant Surgery, Department of Surgery, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - John A Walker
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Jorge Lopera
- Long School of Medicine, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas; Division of Interventional Radiology, Department of Radiology, The University of Texas Health Sciences Center San Antonio, San Antonio, Texas
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Dual-Applicator MR Imaging-Guided Microwave Ablation with Real-Time MR Thermometry: Phantom and Porcine Tissue Model Experiments. J Vasc Interv Radiol 2023; 34:46-53.e4. [PMID: 36202337 DOI: 10.1016/j.jvir.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the effect of simultaneous use of dual applicators on the image quality of real-time magnetic resonance (MR) thermometry and to characterize the dual-applicator treatment zone pattern during MR imaging-guided microwave ablation (MWA). MATERIALS AND METHODS MWA experiments were performed on a 1.5-T MR scanner with 2 commercial microwave systems (902-928 MHz). Phantom experiments were first performed to evaluate the effect of dual-applicator MWA on the image quality of MR. Then, porcine tissue model experiments were conducted with real-time MR thermometry using either a single applicator or dual applicators inserted 2.6, 3.6, and 4.6 cm apart. Fiberoptic thermal probes were used to measure the temperature changes at the tissue surface. RESULTS Simultaneous use of dual applicators resulted in a decrease in the relative signal-to-noise ratio (SNR) in the MR thermometry images to 55% ± 2.9% when compared with that of a single applicator (86.2% ± 2.0%). Despite the lower SNR, the temperature and ablation zone maps were of adequate quality to allow visualization of the ablation zone(s). The extents of increase in the temperature at the tissue surface using dual applicators (19.7 °C ± 2.6 °C) and a single applicator (18.2 °C ± 3.3 °C) were not significantly different (P = .40). Treatment zones were significantly larger (P < .05) in dual-applicator ablations (29.4 ± 0.4, 39.9 ± 0.6, and 42.6 ± 0.9 cm2 with 2.6-, 3.6-, and 4.6-cm spacing, respectively) at the end of the ablation procedure than in the single-applicator MWA (18.6 ± 0.9 cm2). CONCLUSIONS MR imaging-guided dual-applicator MWA produced larger ablation zones while allowing adequate real-time MR thermometry image quality for monitoring the evolution of the treatment zone.
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Kernot D, Yang J, Williams N, Thomas T, Ledger P, Arora H, van Loon R. Transient changes during microwave ablation simulation : a comparative shape analysis. Biomech Model Mechanobiol 2023; 22:271-280. [PMID: 36287313 PMCID: PMC9957862 DOI: 10.1007/s10237-022-01646-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/04/2022] [Indexed: 11/02/2022]
Abstract
Microwave ablation therapy is a hyperthermic treatment for killing cancerous tumours whereby microwave energy is dispersed into a target tissue region. Modelling can provide a prediction for the outcome of ablation, this paper explores changes in size and shape of temperature and Specific absorption rate fields throughout the course of simulated treatment with different probe concepts. Here, an axisymmetric geometry of a probe embedded within a tissue material is created, solving coupled electromagnetic and bioheat equations using the finite element method, utilizing hp discretisation with the NGSolve library. Results show dynamic changes across all metrics, with different responses from different probe concepts. The sleeve probe yielded the most circular specific absorption rate pattern with circularity of 0.81 initially but suffered the largest reduction throughout ablation. Similarly, reflection coefficients differ drastically from their initial values, with the sleeve probe again experiencing the largest change, suggesting that it is the most sensitive the changes in the tissue dielectric properties in these select probe designs. These collective characteristic observations highlight the need to consider dielectric property changes and probe specific responses during the design cycle.
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Affiliation(s)
- Dale Kernot
- School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Fabian Way, Swansea, Glamorgan, SA1 8EN, UK.
| | - Jimmy Yang
- Olympus Surgical Technologies Europe, Fortran road, Cardiff, Glamorgan CF3 0LT UK
| | - Nicholas Williams
- Olympus Surgical Technologies Europe, Fortran road, Cardiff, Glamorgan CF3 0LT UK
| | - Tudor Thomas
- Olympus Surgical Technologies Europe, Fortran road, Cardiff, Glamorgan CF3 0LT UK
| | - Paul Ledger
- grid.9757.c0000 0004 0415 6205School of Computing and Mathematics, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Hari Arora
- grid.4827.90000 0001 0658 8800School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Fabian Way, Swansea, Glamorgan SA1 8EN UK
| | - Raoul van Loon
- grid.4827.90000 0001 0658 8800School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Fabian Way, Swansea, Glamorgan SA1 8EN UK
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程 超, 钟 建, 仇 书, 杨 李, 刘 大. [Application of multimodal combined surgical strategy in children with intractable laryngeal airway obstruction]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:592-596. [PMID: 35959576 PMCID: PMC10128205 DOI: 10.13201/j.issn.2096-7993.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Indexed: 06/15/2023]
Abstract
Objective:To explore the selection of surgical methods and intraoperative strategies for the treatment of children with intractable laryngeal airway obstruction, and to provide new options for the diagnosis and treatment of children with intractable laryngeal airway obstruction. Methods:The clinical data of 12 children with intractable laryngeal airway obstruction treated by our team from January 2005 to December 2021 were retrospective analyzed. All the children were treated with minimally invasive surgery under rigid bronchoscope or suspension laryngoscope combined with electronic endoscope. The surgical methods included laryngeal microsurgery, plasma ablation, balloon dilatation, drug-eluting stents, laser ablation, endoscopic snare, etc. The patients were followed up after operation. Results:All patients completed the operation under general anesthesia, and there were no intraoperative or postoperative complications. Except for one patient with bilateral vocal cord paralysis who failed to extubation due to restenosis, the others were successfully extubated after operation. Among them, 9 cases of benign space-occupying obstruction were followed up for 5-60 months without recurrence, and 2 cases of malignant tumor-induced obstruction were followed up for 24 months（acinar cell carcinoma） and 36 months（mucoepidermoid carcinoma） without recurrence. Conclusion:Endoscopic multi-operation is effective for children with intractable obstruction. Compared with traditional thoracotomy, endoscopic multi-operation strategies has the advantages of less trauma, faster and safer. For different sizes, locations and pathological types of obstruction, different surgical equipment and methods should be combined.
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Affiliation(s)
- 超 程
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳，510000)Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510000, China
| | - 建文 钟
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳，510000)Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510000, China
| | - 书要 仇
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳，510000)Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510000, China
| | - 李强 杨
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳，510000)Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510000, China
| | - 大波 刘
- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳，510000)Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510000, China
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Badawi MI, Hafez KS. The significance of nanoparticles in brain cancer diagnosis and treatment: modeling and simulation. Biomed Phys Eng Express 2022; 8. [PMID: 35405668 DOI: 10.1088/2057-1976/ac6629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/11/2022] [Indexed: 11/12/2022]
Abstract
A numerical analysis of specific absorption rate (SAR) and temperature distributions in a realistic human head model is presented in this study. The key challenge is to rise cancer temperature to an optimal temperature without heating nearby healthy tissues. The model's uniqueness is that it captures the effect of nanoparticles on both brain cancer diagnosis and treatment. A realistic human head model with a cancerous brain segmented from 2D magnetic resonance imaging (MRI) gained from an actual patient using 3D Slicer, modeled, and simulated using CST-Microwave Studio, and illuminated by Archimedes spiral antenna. At frequencies of 2450 MHz and 915 MHz, the model simulated the absence and presence of various nanoparticles. The obtained results suggest that when using nanoparticles, it is possible to achieve sufficient energy deposition and temperature rise to therapeutic values (greater than 42 °C) in brain cancers using the proposed noninvasive hyperthermia system at 915 MHz frequency, especially for gold nanoparticles, without harming surrounding healthy tissue. Our research might pave the way for a clinical applicator prototype that can heat brain cancer.
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Affiliation(s)
- Mohamed I Badawi
- Biomedical Equipment Technology Department, Faculty of Applied Health Sciences Technology, Pharos University, Alexandria, Egypt
| | - Karim S Hafez
- Biomedical Equipment Technology Department, Faculty of Applied Health Sciences Technology, Pharos University, Alexandria, Egypt
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Evans AL, Ma C, Hagness SC. Microwave-induced thermoacoustic signal characteristics in a dynamic temperature environment. Biomed Phys Eng Express 2022; 8. [PMID: 35325886 DOI: 10.1088/2057-1976/ac60c6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/24/2022] [Indexed: 11/12/2022]
Abstract
We conduct a simulation-based study to investigate the impact of a dynamic temperature environment on the characteristics of microwave-induced thermoacoustic signals. We investigate thermoacoustic signals that are generated using an interstitial microwave ablation antenna powered by a microsecond pulsed microwave source. Two temperature regimes are examined: first, a spatially uniform temperature throughout the medium to experimentally validate the simulation model, and second, the realistic, spatially nonuniform temperature profiles that arise during microwave ablation. We employ a multi-physics model that considers electromagnetics, heat transfer, and acoustic physics to simulate the coupled processes of microwave absorption and heating of the medium and thermoacoustic signal generation and propagation. An interstitial coaxial antenna is used to generate microsecond microwave pulses that simultaneously induce microwave heating and excite thermoacoustic signals via microwave pulse absorption. We find that thermoacoustic signal characteristics are highly temperature-dependent and thus change significantly within an environment where temperature varies through space and time. Furthermore, the temperature-dependent properties within the active region of the antenna drive the evolution of thermoacoustic signal characteristics. Temperature-dependent thermoacoustic signal characteristics can be exploited to track the progress of microwave ablation. Consequently, microwave-induced thermoacoustic imaging is a promising method for monitoring microwave ablation in real-time.
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Affiliation(s)
- Audrey L Evans
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706 United States of America
| | - Chu Ma
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706 United States of America
| | - Susan C Hagness
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706 United States of America
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Lee J, Rhim H, Lee MW, Kang TW, Song KD, Lee JK. Direction of Tissue Contraction after Microwave Ablation: A Comparative Experimental Study in Ex Vivo Bovine Liver. Korean J Radiol 2022; 23:42-51. [PMID: 34983092 PMCID: PMC8743151 DOI: 10.3348/kjr.2021.0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/11/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the direction of tissue contraction after microwave ablation in ex vivo bovine liver models. Materials and Methods Ablation procedures were conducted in a total of 90 sites in ex vivo bovine liver models, including the surface (n = 60) and parenchyma (n = 30), to examine the direction of contraction of the tissue in the peripheral and central regions from the microwave antenna. Three commercially available 2.45-GHz microwave systems (Emprint, Neuwave, and Surblate) were used. For surface ablation, the lengths of two overlapped square markers were measured after 2.5- and 5-minutes ablations (n = 10 ablations for each system for each ablation time). For parenchyma ablation, seven predetermined distances between the markers were measured on the cutting plane after 5- and 10-minutes ablations (n = 5 ablations for each system for each ablation time). The contraction in the radial and longitudinal directions and the sphericity index (SI) of the ablation zones were compared between the three systems using analysis of variance. Results In the surface ablation experiment, the mean longitudinal contraction ratio and SI from a 5-minutes ablation using the Emprint, Neuwave, and Surblate systems were 28.92% and 1.04, 20.10% and 0.53, and 24.90% and 0.45, respectively (p < 0.001). A positive correlation between longitudinal contraction and SI was noted, and a similar radial contraction was observed. In the parenchyma ablation experiment, the mean longitudinal contraction ratio and SI from a 10-minutes ablation using the three pieces of equipment were 38.60% and 1.06, 32.45% and 0.61, and 28.50% and 0.50, respectively (p < 0.001). There was a significant difference in the longitudinal contraction properties, whereas there was no significant difference in the radial contraction properties. Conclusion The degree of longitudinal contraction showed significant differences depending on the microwave ablation equipment, which may affect the SI of the ablation zone.
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Affiliation(s)
- Junhyok Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hyunchul Rhim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Kyong Lee
- Department of Radiology, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Korea
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Tabacelia D, Stroescu C, Dumitru R, Grigorescu RR, Martiniuc A, Husar-Sburlan IA, Copca N. New approach for hepatocellular carcinoma treatment. J Med Life 2022; 15:138-143. [PMID: 35186148 PMCID: PMC8852628 DOI: 10.25122/jml-2021-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer, with an increasing incidence in recent years. The prognosis is unfavorable, representing the third most frequent cause of cancer-related death worldwide. This is because it generally develops in patients with pre-existing liver pathology, thus limiting therapeutic options. The role of ablative therapies is well-established in nodules smaller than 3 cm, but for nodules from 3 to 5 cm, the best therapeutic management is not well defined. Recent studies reported that combining minimally invasive procedures like transarterial chemoembolization (TACE) with microwave ablation (MWA) or radiofrequency ablation is superior to each alone. However, there is no consensus regarding the timing and the order in which each procedure should be performed. We report a case of an 86 years old male with HCV-related compensated hepatic cirrhosis and multiple cardiac comorbidities diagnosed with a 47/50 mm HCC. Pre-surgical evaluation of the associated pathologies determined that the risk for the surgical approach outweighs the benefits, so the committee decided to treat it in a less invasive manner. We performed MWA and TACE in a single session with technical success according to the modified Response Evaluation Criteria in Solid Tumors (m-RECIST). This case illustrates the first case of simultaneous MWA and TACE performed in our center. This new approach of hepatocellular carcinoma appears to be a good alternative to more invasive methods, with good results even in older people that are unfit for surgery.
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Affiliation(s)
- Daniela Tabacelia
- Department of Gastroenterology, Sfanta Maria Clinical Hospital, Bucharest, Romania,Corresponding Author: Tabacelia Daniela, Department of Gastroenterology, Sfanta Maria Clinical Hospital, Bucharest, Romania. E-mail:
| | - Cezar Stroescu
- Department of Surgery, Sfanta Maria Clinical Hospital, Bucharest, Romania,Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania,Stroescu Cezar, Department of Surgery, Sfanta Maria Clinical Hospital, Bucharest, Romania. E-mail:
| | - Radu Dumitru
- Radiology Department, Sfanta Maria Clinical Hospital, Bucharest, Romania,Radiology Department, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | | | - Narcis Copca
- Department of Surgery, Sfanta Maria Clinical Hospital, Bucharest, Romania
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Radiofrequency Ablation for Liver: Comparison between Expert Eye and Hyperspectral Imaging Assessment. Photodiagnosis Photodyn Ther 2021; 37:102699. [PMID: 34942401 DOI: 10.1016/j.pdpdt.2021.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022]
Abstract
Liver/hepatic cancer (HC) is a disease that roughly afflicts 10% of cancer patients worldwide. HC is in charge of the death of 0.8 million patients on the earth. Multiple approaches, including thermal ablation, target the treatment of HC. In this study, we investigated radiofrequency (RF) ablation. Expert clinicians' visual assessment (VA) dominantly evaluated the outcome of ablation. Inattentively, the disfavors of VA are being subjective and eye-acuity dependent. In support, we propose hyperspectral imaging (HSI) for objective assessment of liver ablation. To verify our proposal, we computed the ablated liver area using VA and HSI. Unfortunately, HSI is a time-intensive technique. To make it less intensive, we present a way of reducing data analysis time. Saving time permits medical decisions, likewise continue or stop RF ablation, to be taken safer and faster. The way to reduce the time for HSI data analysis depends on narrowing the spectral bands of interest to only the most relevant ones to liver chromophores. Liver chromophores change in concentration because of thermal ablation. VA hardly senses these changes, however, HSI does it. Ultimately, the spectral band centered at 630 nm is optimal for objectively support RF ablation decision-makers.
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Ezzat R, Eltabbakh M, El Kassas M. Unique situation of hepatocellular carcinoma in Egypt: A review of epidemiology and control measures. World J Gastrointest Oncol 2021; 13:1919-1938. [PMID: 35070033 PMCID: PMC8713321 DOI: 10.4251/wjgo.v13.i12.1919] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/17/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common primary malignancy worldwide, and the third most common cause of death among cancers worldwide. HCC occurs in several pre-existing conditions, including hepatitis C, hepatitis B virus, and non-alcoholic cirrhosis. Egypt used to be the country with the heaviest hepatitis C virus (HCV) burden. The relationship between HCV and HCC is an important research area. In Egypt, HCC is a significant public health problem. A possible cause for the increasing rates of detection of HCC in Egypt is the mass screening program that was carried by the government for detecting and treating HCV. A multidisciplinary approach is now widely applied to HCC management in health centers all over Egypt. Different treatment modalities are available in Egypt, with success rates comparable to global rates. The Egyptian health authorities have made the elimination of HCV from Egypt a special priority, and this approach should lead to a decrease in number of HCC cases in the near future. In this article we review the current situation of HCC in Egypt, including epidemiological aspects, relevant risk factors for HCC development, strategies, and efforts established by health authorities for the screening and prevention of both HCV and HCC in Egypt. We highlight the different modalities for HCC treatment.
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Affiliation(s)
- Reem Ezzat
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohamed Eltabbakh
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo 11795, Cairo, Egypt
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Development of 3D MRI-Based Anatomically Realistic Models of Breast Tissues and Tumours for Microwave Imaging Diagnosis. SENSORS 2021; 21:s21248265. [PMID: 34960354 PMCID: PMC8708261 DOI: 10.3390/s21248265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 12/29/2022]
Abstract
Breast cancer diagnosis using radar-based medical MicroWave Imaging (MWI) has been studied in recent years. Realistic numerical and physical models of the breast are needed for simulation and experimental testing of MWI prototypes. We aim to provide the scientific community with an online repository of multiple accurate realistic breast tissue models derived from Magnetic Resonance Imaging (MRI), including benign and malignant tumours. Such models are suitable for 3D printing, leveraging experimental MWI testing. We propose a pre-processing pipeline, which includes image registration, bias field correction, data normalisation, background subtraction, and median filtering. We segmented the fat tissue with the region growing algorithm in fat-weighted Dixon images. Skin, fibroglandular tissue, and the chest wall boundary were segmented from water-weighted Dixon images. Then, we applied a 3D region growing and Hoshen-Kopelman algorithms for tumour segmentation. The developed semi-automatic segmentation procedure is suitable to segment tissues with a varying level of heterogeneity regarding voxel intensity. Two accurate breast models with benign and malignant tumours, with dielectric properties at 3, 6, and 9 GHz frequencies have been made available to the research community. These are suitable for microwave diagnosis, i.e., imaging and classification, and can be easily adapted to other imaging modalities.
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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Zia G, Sebek J, Prakash P. Temperature-dependent dielectric properties of human uterine fibroids over microwave frequencies. Biomed Phys Eng Express 2021; 7. [PMID: 34534970 DOI: 10.1088/2057-1976/ac27c2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022]
Abstract
Microwave ablation is under investigation as a minimally-invasive treatment for uterine fibroids. Computational models play a vital role in the development, evaluation and characterization of candidate ablation devices. The temperature-dependent dielectric properties of fibroid tissue are essential for accurate computational modeling.Objective:To measure the broadband temperature-dependent dielectric properties of uterine fibroids excised during hysterectomy procedures.Methods: The open-ended coaxial probe method was employed for measuring the broadband dielectric properties of freshly excised human uterine fibroid samples (n = 6) obtained from an IRB-approved tissue bank. The dielectric properties (relative permittivity,εr, and effective electrical conductivity,σeff) were evaluated at temperatures ranging from 23 °C-150 °C, over the frequency range of 0.5-6 GHz. Linear piecewise parametrization with respect to temperature and quadratic parametrization with respect to frequency was applied to characterize broadband temperature-dependent dielectric properties of fibroid tissue.Results: The baseline room temperature values ofεrvary from 57.5 ± 5.29 to 44.5 ± 5.77 units andσeffchanges from 0.91 ± 0.19 to 6.02 ± 0.7 S m-1over the frequency range of 0.5-6 GHz. At temperatures close to the water vaporization point,εr, drops considerably i.e. to 12%-14% of its baseline value for all measured frequencies.σeffvalues initially rise till 98 °C and then fall to 11%-13% of their baseline values at 125 °C for frequencies ≤2.45 GHz. Theσefffollows a decreasing trend for frequencies >2.45 GHz and drops to ∼6 % of their baseline room temperature values.Conclusion:The temperature dependent dielectric properties of uterine fibroid tissues over microwave frequency range are reported for the first time in this study. Parametric models of uterine fibroid dielectric properties are also presented for incorporation within computational models of microwave ablation of fibroids.
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Affiliation(s)
- Ghina Zia
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, United States of America
| | - Jan Sebek
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, United States of America.,Department of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, United States of America
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Huber TC, Bochnakova T, Koethe Y, Park B, Farsad K. Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies. J Hepatocell Carcinoma 2021; 8:1181-1193. [PMID: 34589446 PMCID: PMC8476177 DOI: 10.2147/jhc.s268300] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
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Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Brian Park
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
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Cazalas G, Jambon E, Coussy A, Le Bras Y, Petitpierre F, Berhnard JC, Grenier N, Marcelin C. Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis. Int J Hyperthermia 2021; 38:1295-1303. [PMID: 34461802 DOI: 10.1080/02656736.2021.1970826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE A systematic review of clinical trials on thermal ablation of T1b RCC was conducted to assess oncologic outcomes of those procedures. The primary endpoint was the rate of local recurrence. Secondary endpoints included technical efficacy, progression to metastatic disease, cancer-specific mortality, complications and renal function decrease. METHODS PubMed (MEDLINE) and Embase databases were searched in June 2020 for eligible trials following the PRISMA selection process. Prevalence of local recurrence and per procedural major adverse effects were calculated using double arcsine transformation and a random-effects model. RESULTS Nine clinical trials (all retrospective) involving 288 patients with T1b renal clear cell carcinoma treated with either percutaneous microwave ablation, cryoablation or radiofrequency ablation were analyzed. Using a random-effects model, the overall prevalence of local recurrence following percutaneous ablation was 0.08 (0.04-0.14; p = 0.05). Primary technical efficacy was 226/263 (86%) patients and secondary technical efficacy was 247/263 (94%). Overall, 10/176 (6%) patients presented metastatic locations following the ablation. Major adverse effects prevalence was 0.09 (0.06-0.14; p = 0.05). CONCLUSIONS Thermal ablations are feasible, safe, and effective to treat T1b renal clear cell carcinoma. More trials are necessary to determine the rate of the evidence of the benefit.HighlightsThermal ablations are feasible and safe to treat T1b renal clear cell carcinoma.Oncologic outcomes appear to be very good on both local control and distant progression.Due to small number and heterogeneity of studies more trials are necessary to determine the rate of the evidence of the benefit.
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Affiliation(s)
- Grégoire Cazalas
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Eva Jambon
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Alexis Coussy
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Yann Le Bras
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - François Petitpierre
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Jean Christophe Berhnard
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
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Liu M, Jin K, Sun J, Lou Z. Postoperative ethmoid sinus mucoceles: Late complication of endoscopic ethmoidectomy and MWA management in outpatient. Am J Otolaryngol 2021; 42:103120. [PMID: 34167833 DOI: 10.1016/j.amjoto.2021.103120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/14/2021] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the feasibility of intranasal endoscopic microwave ablation (MWA) on the management of postoperative ethmoid sinus mucoceles. METHODS AND MATERIALS The patients with postoperative ethmoid sinus mucoceles were ablated through intranasal endoscopic MWA. Postoperative pain intensity was measured via visual analogue scale (VAS), post-operative complications were recorded. RESULTS Of the 26 patients with unilateral postoperative ethmoid sinus mucoceles, the mucoceles were diagnosed 3 to 11 years with average time of time of 6.9 ± 2.7 years after endoscopic ethmoidectomy. The ipsilateral middle turbinate was present and intact in 24 patients and partially resected during the original surgery in the remaining 2. There were adhesions in the middle meatus in one case. All 26 patients were successfully treated with the intranasal endoscopic ablation technique in outpatient. The ablation time was 6 to 11 min, with an average duration of 6.84 ± 1.27 min. The mean VAS pain score was 2.41 ± 1.22. There were no perioperative complications reported in this series. No evidence of recurrence was observed in any patients during follow-up periods. CONCLUSIONS The present study demonstrates the safety and efficacy of intranasal endoscopic MWA in the office. The procedure is well tolerated by patients with low complication rates. Thus, it is alternative to conventional endonasal endoscopic marsupialization for treatment of postsurgical ethmoid sinus mucoceles.
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Habibi M, Berger RD, Calkins H. Radiofrequency ablation: technological trends, challenges, and opportunities. Europace 2021; 23:511-519. [PMID: 33253390 DOI: 10.1093/europace/euaa328] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022] Open
Abstract
More than three decades have passed since utilization of radiofrequency (RF) ablation in the treatment of cardiac arrhythmias. Although several limitations and challenges still exist, with improvements in catheter designs and delivery of energy the way we do RF ablation now is much safer and more efficient. This review article aims to give an overview on historical advances on RF ablation and challenges in performing safe and efficient ablation.
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Affiliation(s)
- Mohammadali Habibi
- Division of Cardiology, Section for Cardiac Electrophysiology, The Johns Hopkins University, 1800 Orleans Street, Sheikh Zayed Tower 7125R, Baltimore, MD 21287, USA
| | - Ronald D Berger
- Division of Cardiology, Section for Cardiac Electrophysiology, The Johns Hopkins University, 1800 Orleans Street, Sheikh Zayed Tower 7125R, Baltimore, MD 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Section for Cardiac Electrophysiology, The Johns Hopkins University, 1800 Orleans Street, Sheikh Zayed Tower 7125R, Baltimore, MD 21287, USA
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Pohlman RM, Hinshaw JL, Ziemlewicz TJ, Lubner MG, Wells SA, Lee FT, Alexander ML, Wergin KL, Varghese T. Differential Imaging of Liver Tumors before and after Microwave Ablation with Electrode Displacement Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2138-2156. [PMID: 34011451 PMCID: PMC8243838 DOI: 10.1016/j.ultrasmedbio.2021.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 05/17/2023]
Abstract
Liver cancer is a leading cause of cancer-related deaths; however, primary treatment options such as surgical resection and liver transplant may not be viable for many patients. Minimally invasive image-guided microwave ablation (MWA) provides a locally effective treatment option for these patients with an impact comparable to that of surgery for both cancer-specific and overall survival. MWA efficacy is correlated with accurate image guidance; however, conventional modalities such as B-mode ultrasound and computed tomography have limitations. Alternatively, ultrasound elastography has been used to demarcate post-ablation zones, yet has limitations for pre-ablation visualization because of variability in strain contrast between cancer types. This study attempted to characterize both pre-ablation tumors and post-ablation zones using electrode displacement elastography (EDE) for 13 patients with hepatocellular carcinoma or liver metastasis. Typically, MWA ablation margins of 0.5-1.0 cm are desired, which are strongly correlated with treatment efficacy. Our results revealed an average estimated ablation margin inner quartile range of 0.54-1.21 cm with a median value of 0.84 cm. These treatment margins lie within or above the targeted ablative margin, indicating the potential to use EDE for differentiating index tumors and ablated zones during clinical ablations. We also obtained a high correlation between corresponding segmented cross-sectional areas from contrast-enhanced computed tomography, the current clinical gold standard, when compared with EDE strain images, with r2 values of 0.97 and 0.98 for pre- and post-ablation regions.
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Affiliation(s)
- Robert M Pohlman
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - James L Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marci L Alexander
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kelly L Wergin
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tomy Varghese
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Lou Z, Lou Z, Sun J, Chen Z, Yin S. Microwave ablation eustachian tuboplasty: a preliminary investigation with long-term follow-up. J Otolaryngol Head Neck Surg 2021; 50:39. [PMID: 34167591 PMCID: PMC8223355 DOI: 10.1186/s40463-021-00520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/14/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to evaluate the efficacy of microwave ablation (MWA) eustachian tuboplasty for the treatment of patients with retracted tympanic membrane (TM) due to eustachian tube dysfunction (ETD). Methods This was a prospective study of 20 patients with ETD (middle ear atelectasis) who underwent MWA eustachian tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, audiometry results, tympanometry results, ETD Questionnaire (ETDQ-7) score, and TM status. Results Eighteen patients (18 ears) were included in this study. There were statistically and clinically significant improvements in the mean ETDQ-7 score at 6 months postoperatively (change in mean score of 16.7 ± 3.6, P < 0.001) and at 30 months postoperatively (change in mean score of 18.9 ± 2.9, P < 0.001). Type A tympanogram was obtained in 27.8% of patients (5/18) at 6 months postoperatively, and in 77.7% at 30 months postoperatively. A Valsalva maneuver was possible in 72.2% of patients at 6 months postoperatively and in 88.9% of patients at 30 months postoperatively. In addition, the ears of 13 patients (72.2%) showed both normal tympanograms and TM at 30 months postoperatively. Interestingly, 38.5% of patients (5/13) exhibited complete sclerosis of the pars tensa. None of the patients experienced severe MWA-related complications during follow-up. Conclusions MWA eustachian tuboplasty is a feasible alternative to conventional tuboplasty, and can improve subjective and objective outcomes in patients with ETD for up to 30 months following treatment. In addition, this study showed that the extent of sclerotic plaque increased over time, whereas the extents of atrophy and tensa retraction decreased following tuboplasty in most patients. Graphical abstract ![]()
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China. .,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Otolaryngology Institute of Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
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Dang KT, Naka S, Yamada A, Tani T. Feasibility of Microwave-Based Scissors and Tweezers in Partial Hepatectomy: An Initial Assessment on Canine Model. Front Surg 2021; 8:661064. [PMID: 34222315 PMCID: PMC8247922 DOI: 10.3389/fsurg.2021.661064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: This study aimed to assess the feasibility of partial hepatectomy (PH) simplified by using microwave-based devices in animal experiments. Methods: PH was performed on 16 beagles using either Acrosurg Scissors (AS) or Acrosurg Tweezers (AT) without hepatic pedicle (HP) control. Parenchymal transection time, Glissonean pedicle (GP) seal time, bleeding volume, bile leak, and burst pressure were recorded. Probable complications were investigated after 4 weeks. Results: Transection time (6.5 [6.0–7.6] vs. 11.8 [10.5–20.2] min, p < 0.001) with AT were significantly shorter than with AS. GP sealing times (60 [55–60] vs. 57 [46–91] s, p = 0.859) by both devices were nearly similar. Bleeding volume in the AT group was approximately one-fourth of that in the AS group (6.7 [1.4–22] vs. 28.8 [5.8–48] mL, p = 0.247). AT created higher burst pressure on the bile duct stumps (p = 0.0161). The two devices did not differ significantly in morbidity and mortality after four-week follow-up. Conclusion: Acrosurg devices achieved a safe PH without HP control owing to microwave-based sealing. AS could be used alone in PH, whereas the clamp-crushing function of AT seemed more advantageous in reducing the transection time and blood loss.
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Affiliation(s)
- Khiem Tran Dang
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Japan.,Department of Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Shigeyuki Naka
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan.,Department of Surgery, Hino Memorial Hospital, Hino, Japan
| | - Atsushi Yamada
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Japan
| | - Tohru Tani
- Department of Research and Development for Innovative Medical Devices and Systems, Shiga University of Medical Science, Otsu, Japan
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Donlon P, Dennedy MC. Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future. Curr Opin Endocrinol Diabetes Obes 2021; 28:291-302. [PMID: 33741778 PMCID: PMC8183491 DOI: 10.1097/med.0000000000000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. RECENT FINDINGS Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. SUMMARY Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
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Affiliation(s)
- Padraig Donlon
- Adrenal Research Laboratory, The Discipline of Pharmacology and Therapeutics, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Ireland
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Abdlaty R, Abbass MA, Awadallah AM. High Precision Monitoring of Radiofrequency Ablation for Liver Using Hyperspectral Imaging. Ann Biomed Eng 2021; 49:2430-2440. [PMID: 34075450 DOI: 10.1007/s10439-021-02797-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
Minimally invasive procedures are achieving better satisfaction for treating liver cancers. Energy-based techniques were studied as prospective alternatives to the gold standard of liver transplantation. Among these techniques, radiofrequency (RF) was investigated for the selective ablation of liver tissue. In addition to optimizing the RF settings for the purpose of overcoming tissue perforation or inadequate ablation, an instrument collecting quantitative data regarding the intraoperative tissue status can aid the treatment procedure. This study demonstrates an innovative noninvasive technique using hyperspectral imaging (HSI) for monitoring RF ablative therapy in ex-vivo liver tissue. The cubic data generated by HSI provides spectral as well as spatial properties of the liver tissue included in each pixel of the field of view. In our study, the applied statistical analysis saves the computational burdens of multivariate analysis techniques. For this purpose, spectral angle mapper, logistic regression algorithm, and principal component analysis were applied. Of all spectral bands captured by the HSI camera, bands centered at 760 and 960 nm were identified for predicting the ablated area. Based on statistical analysis, the threshold for predicting the ablated area of the liver samples was determined, provided that the specificity is kept at 90%.
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Affiliation(s)
- Ramy Abdlaty
- Department of Biomedical Engineering, Military Technical College, Cairo, Egypt.
| | - Mohamed A Abbass
- Department of Biomedical Engineering, Military Technical College, Cairo, Egypt
| | - Ahmed M Awadallah
- Department of Biomedical Engineering, Military Technical College, Cairo, Egypt
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