New technologies in tumor ablation

Singla, Nirmish; Gahan, Jeffrey

doi:10.1097/mou.0000000000000284

Cited by 18 publications

(5 citation statements)

References 48 publications

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“…Our workflow could be also extended to transformation models that involve higher degree of freedom. The longitudinal coregistration technique could also be applied to other image-guided procedures like liver ablation 60 or focal kidney-sparing cancer therapy 61 .…”

Section: Discussionmentioning

confidence: 99%

3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

et al. 2017

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Purpose To assess a novel method of 3D co-registration of prostate MRI exams performed before and after prostate cancer focal therapy. Material and method We developed a software platform for automatic 3D deformable coregistration of prostate MRI at different time points and applied this method to ten patients who underwent focal ablative therapy. MRI exams were performed preoperatively, as well as one week and six months posttreatment. Rigid registration served as reference for assessing coregistration accuracy and precision. Results Segmentation of preoperative and postoperative prostate revealed a significant post-operative volume decrease of the gland that averaged 6.49 cc (p=0.017). Applying deformable transformation based upon Mutual Information (MI) from 120 pairs of MRI slices, we refined by 2.9 mm (max 6.25mm) the alignment of the ablation zone (AZ), segmented from contrastenhanced images on the one-week post-operative exam, to the 6-month postoperative T2-weighted images. This represented a 500% improvement over the rigid approach (p=0.001), corrected by volume. The dissimilarity by Dice index of the mapped AZ using deformable transformation vs. rigid control was significantly (p=0.04) higher at the ablation site compared to the whole gland. Conclusion Our findings illustrate our method's ability to correct for deformation at the ablation site. The preliminary analysis suggests that deformable transformation computed from MI of preoperative and follow-up MRI is accurate in co-registration of MRI exams performed before and after focal therapy. The ability to localize the previously ablated tissue in 3D space may improve targeting for image-guided follow-up biopsy within focal therapy protocols.

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Section: Discussionmentioning

confidence: 99%

3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

et al. 2017

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“…Emerging evidence conveys the inferiority of radiofrequency ablation relative to cryoablation (34, 35). Finally, the increased utilization of microwave ablation over the last 5 years and its postulated advantages (36) are likely the product of this productive, concerted relationship.…”

Section: Discussionmentioning

confidence: 99%

Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society

Mohapatra¹,

Potretzke²,

Weaver³

et al. 2017

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Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.

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“…This technique seems to be less affected by the heat sink effect that limits radiofrequency. However, as temperatures higher than with radiofrequency can be rapidly obtained, particular caution should be used for tumours abutting the renal sinus, as urine boiling can be fast obtained with subsequent damage on the collecting system [40, 41]. …”

Section: Introductionmentioning

confidence: 99%

Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation

et al. 2017

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Image-guide thermal ablations are nowadays increasingly used to provide a minimally invasive treatment to patients with renal tumours, with reported good clinical results and low complications rate. Different ablative techniques can be applied, each with some advantages and disadvantages according to the clinical situation. Moreover, percutaneous ablation of renal tumours might be complex in cases where there is limited access for image guidance or a close proximity to critical structures, which can be unintentionally injured during treatment. In the present paper we offer an overview of the most commonly used ablative techniques and of the most important manoeuvres that can be applied to enhance the safety and effectiveness of percutaneous image-guided renal ablation. Emphasis is given to the different technical aspects of cryoablation, radiofrequency ablation, and microwave ablation, on the ideal operating room setting, optimal image guidance, application of fusion imaging and virtual navigation, and contrast enhanced ultrasound in the guidance and monitoring of the procedure. Moreover, a series of protective manoeuvre that can be used to avoid damage to surrounding sensitive structures is presented. A selection of cases of image-guided thermal ablation of renal tumours in which the discussed technique were used is presented and illustrated.Teaching points• Cryoablation, radiofrequency and microwave ablation have different advantages and disadvantages. • US, CT, fusion imaging, and CEUS increase an effective image-guidance. • Different patient positioning and external compression may increase procedure feasibility. • Hydrodissection and gas insufflation are useful to displace surrounding critical structures. • Cold pyeloperfusion can reduce the thermal damage to the collecting system.

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New technologies in tumor ablation

Cited by 18 publications

References 48 publications

3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

3D Registration of mpMRI for Assessment of Prostate Cancer Focal Therapy

Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society

Tips and tricks for a safe and effective image-guided percutaneous renal tumour ablation

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