Abstract:This article reviews the current indications for image-guided thermal ablation of pulmonary metastatic disease. It also summarizes data regarding the efficacy and complications of lung cryoablation and present techniques for performing lung cryoablation as informed by the recent literature.
“…Towards the end of the procedure, the melted ice induces necrosis, hemorrhage, and edema, which manifest as a peripheral ground-glass halo surrounding a central consolidation, very similar to that observed in heat-based ablations (Fig. 12 ) [ 30 ]. Fig.…”
Section: Postablation Imaging Follow-upmentioning
confidence: 83%
“…As for its disadvantages, CA is not recommended in patients with coagulopathies since a higher rate and severity of lung bleeding. Higher hemoptysis rates have also been reported compared to heat-based modalities [ 30 ] (Table 1 ).…”
Section: Ablative Modalities Available For Lung Ablationmentioning
Image-guided percutaneous lung ablation has proven to be a valid treatment alternative in patients with early-stage non-small cell lung carcinoma or oligometastatic lung disease. Available ablative modalities include radiofrequency ablation, microwave ablation, and cryoablation. Currently, there are no sufficiently representative studies to determine significant differences between the results of these techniques. However, a common feature among them is their excellent tolerance with very few complications. For optimal treatment, radiologists must carefully select the patients to be treated, perform a refined ablative technique, and have a detailed knowledge of the radiological features following lung ablation. Although no randomized studies comparing image-guided percutaneous lung ablation with surgery or stereotactic radiation therapy are available, the current literature demonstrates equivalent survival rates. This review will discuss image-guided percutaneous lung ablation features, including available modalities, approved indications, possible complications, published results, and future applications.
“…Towards the end of the procedure, the melted ice induces necrosis, hemorrhage, and edema, which manifest as a peripheral ground-glass halo surrounding a central consolidation, very similar to that observed in heat-based ablations (Fig. 12 ) [ 30 ]. Fig.…”
Section: Postablation Imaging Follow-upmentioning
confidence: 83%
“…As for its disadvantages, CA is not recommended in patients with coagulopathies since a higher rate and severity of lung bleeding. Higher hemoptysis rates have also been reported compared to heat-based modalities [ 30 ] (Table 1 ).…”
Section: Ablative Modalities Available For Lung Ablationmentioning
Image-guided percutaneous lung ablation has proven to be a valid treatment alternative in patients with early-stage non-small cell lung carcinoma or oligometastatic lung disease. Available ablative modalities include radiofrequency ablation, microwave ablation, and cryoablation. Currently, there are no sufficiently representative studies to determine significant differences between the results of these techniques. However, a common feature among them is their excellent tolerance with very few complications. For optimal treatment, radiologists must carefully select the patients to be treated, perform a refined ablative technique, and have a detailed knowledge of the radiological features following lung ablation. Although no randomized studies comparing image-guided percutaneous lung ablation with surgery or stereotactic radiation therapy are available, the current literature demonstrates equivalent survival rates. This review will discuss image-guided percutaneous lung ablation features, including available modalities, approved indications, possible complications, published results, and future applications.
“…The only requirement for the thermal ablation patient is their ability to lie flat, no need of supplemental oxygen at rest 9 and the absence of uncontrollable coagulation disorder. Life expectancy should ideally be 6 months or longer.…”
Section: Thermal Ablation Therapy For Lung Tumoursmentioning
confidence: 99%
“…Pleural effusions requiring drainage occurs in less than 7% 31,32 . Alveolar haemorrhage with or without accompanying haemoptysis is also usually self‐limiting; cryoablation is associated with a higher haemoptysis rate than RFA or MWA 9,33 . CTCAE grade 3 and 4 complications range below 3% in studies originating from large centres with high ablation numbers, and include bronchopleural fistula (Figure 5), aseptic pleuritis, pneumonia, abscess, pleural seeding and nerve damage 31,34,35 .…”
Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image-guided procedural techniques. The image guidance allows real-time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image-guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.
“…Because there is no difference in outcome for this indication between wedge resection, lobar resection and pneumonectomy, the ideal treatment would destroy the tumor with minimal parenchymal loss [40][41][42]. Image-guided ablation delivers precisely-placed tumor destruction without being limited by the segmental anatomy of the lungs, thereby enabling providers to spare tissue peripheral to the lesion [43][44][45]. Given the frequency of recurrence after local therapy for metastatic disease, the repeatability of lung ablation is a significant asset [38].…”
Tumors of the lung, including primary cancer and metastases, are notoriously common and difficult to treat. Although surgical resection of lung lesions is often indicated, many conditions disqualify patients from being surgical candidates. Percutaneous image-guided lung ablation is a relatively new set of techniques that offers a promising treatment option for a variety of lung tumors. Although there have been no clinical trials to definitively compare its efficacy to those of traditional treatments, lung ablation is widely practiced and generally accepted to be safe and effective. Especially encouraging results have recently emerged for cryoablation, one of the newer ablative techniques. This article reviews the indications, techniques, contraindications, and complications of percutaneous image-guided ablation of lung tumors with special attention to cryoablation and its recent developments in protocol optimization.
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