Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors

Omar

et al. 2022

IJMS

Thyroid nodules can be classified as benign, malignant, or indeterminate, the latter of which make up 10–30% of nodules. Radiofrequency ablation (RFA) has become an attractive and promising therapy for the treatment of benign thyroid nodules. However, few studies have investigated the safety and efficacy of RFA for the management of indeterminate thyroid nodules. In this study, 178 patients with thyroid nodules diagnosed as benign (Bethesda II) or indeterminate (Bethesda III/IV) by preoperative cytopathological analysis were included. Patients in the benign and indeterminate cohorts had similar thyroid nodule volume reduction rates at 65.60% and 64.20%, respectively (p = 0.68). The two groups had similar nodular regrowth rates, at 11.2% for benign nodules and 9.40% for indeterminate nodules (p = 0.72). A total of three cases of transient dysphonia were reported. RFA of indeterminate thyroid nodules was comparable to that of benign thyroid nodules in all parameters of interest, including volume reduction rate. To our best knowledge, our work is the first North American analysis comparing benign and indeterminate thyroid nodules and suggests RFA to be a promising modality for the management of indeterminate thyroid nodules.

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

Omar

et al. 2022

IJMS

Technol Cancer Res Treat

“…These techniques include thermal ablations RFA, MWA, and CA. 22 Since lung tumors may extend 6-8 mm microscopically into adjacent lung parenchyma, ablation techniques are aimed to have margins at least 10 mm. 23 , 24 Other ablation techniques such as chemical (intratumoral ethanol or acetic acid injections), irreversible electroporation, external-energy-delivery-based methods like high-intensity frequency ultrasound and histotripsy, or laser ablation are not typically used in the treatment of lung cancer.…”

Section: Image-guided Percutaneous Therapiesmentioning

confidence: 99%

“…Some of the advantages of using RFA is that there are various electrode shapes, and it is widely available and most studied. 22 Because of air's low electrical and thermal conductivity, the effectiveness of RFA is tissue-specific, which is postulated as to why RFA has larger ablation volumes than in subcutaneous tissue and kidneys. 31 , 32 Some disadvantages with RFA are that the ablation zone is not visible during the ablation itself, it requires more use of anesthesia for pain, requires grounding pads, and is susceptible to the heat sink effect, the phenomenon of reduced ablation volumes in tumors close to large blood vessels that have flowing blood which creates a cooling effect, making it less ideal for central tumors near the pulmonary hilum.…”

Section: Image-guided Percutaneous Therapiesmentioning

confidence: 99%

Image-Guided Percutaneous and Transarterial Therapies for Primary and Metastatic Lung Cancer

Mansur

Garg

Camacho

et al. 2023

Self Cite

Lung cancer is the leading cause of cancer mortality in the world. A significant proportion of patients with lung cancer are not candidates for surgery and must resort to other treatment alternatives. Rapid technological advancements in fields like interventional radiology have paved the way for valid treatment modalities like image-guided percutaneous and transarterial therapies for treatment of both primary and metastatic lung cancer. The rationale of ablative therapies relies on the fact that focused delivery of energy induces tumor destruction and pathological necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid, or uterine lesions. In the lung, the 3 main indications for lung ablation include local curative intent, a strategy to achieve a chemoholiday in oligometastatic disease, and recently, oligoprogressive disease. Transarterial therapies include a set of catheter-based treatments that involve delivering embolic and/or chemotherapeutic agents directed into the target tumor via the supplying arteries. This article provides a comprehensive review of the various techniques available and discusses their applications and associated complications in primary and metastatic lung cancer.

“…It has many advantages, such as a lack of ionizing radiation, real-time MR fluoroscopy placement, high resolution, capacity to display small tumors with increased sensitivity, and the monitoring of thermal effects. It can be combined with diffusion-weighted imaging or MRI contrast agents to visualize more difficult lesions [ 159 , 160 ] ( Figure 2 ).…”

Section: Diagnosis Staging and Risk Assessmentmentioning

confidence: 99%

Diagnostic Management of Gastroenteropancreatic Neuroendocrine Neoplasms: Technique Optimization and Tips and Tricks for Radiologists

Pellegrino¹,

Granata

Fusco

et al. 2023

Tomography

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) comprise a heterogeneous group of neoplasms, which derive from cells of the diffuse neuroendocrine system that specializes in producing hormones and neuropeptides and arise in most cases sporadically and, to a lesser extent, in the context of complex genetic syndromes. Furthermore, they are primarily nonfunctioning, while, in the case of insulinomas, gastrinomas, glucagonomas, vipomas, and somatostatinomas, they produce hormones responsible for clinical syndromes. The GEP-NEN tumor grade and cell differentiation may result in different clinical behaviors and prognoses, with grade one (G1) and grade two (G2) neuroendocrine tumors showing a more favorable outcome than grade three (G3) NET and neuroendocrine carcinoma. Two critical issues should be considered in the NEN diagnostic workup: first, the need to identify the presence of the tumor, and, second, to define the primary site and evaluate regional and distant metastases. Indeed, the primary site, stage, grade, and function are prognostic factors that the radiologist should evaluate to guide prognosis and management. The correct diagnostic management of the patient includes a combination of morphological and functional evaluations. Concerning morphological evaluations, according to the consensus guidelines of the European Neuroendocrine Tumor Society (ENETS), computed tomography (CT) with a contrast medium is recommended. Contrast-enhanced magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), is usually indicated for use to evaluate the liver, pancreas, brain, and bones. Ultrasonography (US) is often helpful in the initial diagnosis of liver metastases, and contrast-enhanced ultrasound (CEUS) can solve problems in characterizing the liver, as this tool can guide the biopsy of liver lesions. In addition, intraoperative ultrasound is an effective tool during surgical procedures. Positron emission tomography (PET-CT) with FDG for nonfunctioning lesions and somatostatin analogs for functional lesions are very useful for identifying and evaluating metabolic receptors. The detection of heterogeneity in somatostatin receptor (SSTR) expression is also crucial for treatment decision making. In this narrative review, we have described the role of morphological and functional imaging tools in the assessment of GEP-NENs according to current major guidelines.