Simultaneous Computed Tomography-Guided Biopsy and Radiofrequency Ablation of Solitary Pulmonary Malignancy in High-Risk Patients

Abstract

Background: In recent years experience has been accumulated in percutaneous radiofrequency ablation (RFA) of lung malignancies in nonsurgical patients. Objectives: In this study, we retrospectively evaluated a simultaneous diagnostic and therapeutic approach including CT-guided biopsy followed immediately by RFA of solitary malignant pulmonary lesions. Methods: CT-guided transthoracic core needle biopsy of solitary pulmonary lesions suspicious for malignancy was performed and histology was proven based on immediate frozen sections. RFA probes were placed into the pulmonary tumors under CT guidance and the ablation was performed subsequently. The procedure-related morbidity was analyzed. Follow-up included a CT scan and pulmonary function parameters. Results: A total of 33 CT-guided biopsies and subsequent RFA within a single procedure were performed. Morbidity of CT-guided biopsy included pulmonary hemorrhage (24%) and a mild pneumothorax (12%) without need for further interventions. The RFA procedure was not aggravated by the previous biopsy. The rate of pneumothorax requiring chest tube following RFA was 21%. Local tumor control was achieved in 77% with a median follow-up of 12 months. The morbidity of the CT-guided biopsy had no statistical impact on the local recurrence rate. Conclusions: The simultaneous diagnostic and therapeutic approach including CT-guided biopsy followed immediately by RFA of solitary malignant pulmonary lesions is a safe procedure. The potential of this combined approach is to avoid unnecessary therapies and to perform adequate therapies based on histology. Taking the local control rate into account, this approach should only be performed in those patients who are unable to undergo or who refuse surgery.

Sublobar Resection, Radiofrequency Ablation or Radiotherapy in Stage I Non-Small Cell Lung Cancer

“…Twenty-one patients (43%) underwent CFRT with a median total dose of 66 Gy, a median of 31 fractions and a median dose of 2 Gy/fraction. We performed bipolar RFA under general anesthesia as previously described [5]. …”

Prevalence, risk factors, and impact of lung Cancer on outcomes of idiopathic pulmonary fibrosis: a study from the Middle East

“…Despite those patients who received radio-, or radio-chemotherapy had non-fibrotic ground in HRCT still, the reported rates of radiation pneumonitis and pulmonary infections were high, but with no impact on mortality. Local tumor ablation might be an attractive option in some of those severely pulmonary compromised patients, while it has been used safely in patients with severe emphysema [ 29 ]. Disappointingly, it seems that chemotherapy is not a safe therapeutic option for patients with LC-IPF.…”

The diagnostic yield of preoperative staging computed tomography of the thorax in colorectal cancer patients without hepatic metastases

“…This is because none of these individuals met the criteria for metastasectomy, which include absence of extrathoracic disease (or extrathoracic disease that is resectable), pulmonary disease that is completely resectable, or adequate cardiopulmonary reserve [11][12][13]. Fine-needle biopsy/aspiration also carries its own morbidity including 24% risk of haemorrhage [19], 12% chance of pneumothorax [19] and a 5% chance of a 3-day hospital admission as well as costing £468 to perform [20]. It has been reported that the incidence of synchronous lung and CRC primary malignancies is less than 0.6% [14], which is in keeping with the results of our study.…”