Radiological and Pathological Correlation of Lung Malignant Tumors Treated with Percutaneous Radiofrequency Ablation

Hataji, Osamu; Yamakado, Koichiro; Nakatsuka, Atsuhiro; Murashima, Shuichi; Fujimoto, Hajime; Nishii, Yoichi; Nakahara, Hiroki; Kobayashi, Hiroyasu; Gabazza, Esteban C.; Taguchi, Osamu

doi:10.2169/internalmedicine.44.865

Cited by 18 publications

(5 citation statements)

References 13 publications

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“…25,26 Thereafter, coagulative necrosis is increasingly visible in standard H & E staining. [25][26][27][28] Thermal injury induced by RF ablation is supposed to manifest as irreversible damage to mitochondrial and cytosolic enzymes of the cells. 29,30 Necrosis is characterized by cell swelling and early plasma membrane rupture with a major loss or change in cellular structure.…”

Section: Discussionmentioning

confidence: 99%

Pathomorphologic evaluation of pulmonary radiofrequency ablation

Clasen

Kröber

Kosan

et al. 2008

Cancer

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BACKGROUND.Radiofrequency (RF) ablation is an increasingly applied technique. Promising results of hepatic RF ablation raised expectations of its capabilities for treatment of primary and secondary lung tumors. Because of different thermal and electrical properties of lung tissue, compared with liver tissue, a simple analogy of tissue response is not possible. The authors aimed to evaluate the effectiveness of image‐guided pulmonary RF ablation and to characterize pathomorphology of tissue response.METHODS.RF ablations of 11 pulmonary malignancies in 9 patients were performed under computed tomography (CT)‐guidance. Three days after RF ablation, surgical resection was performed followed by pathologic examination. Specimens were evaluated macroscopically, histologically by hematoxylin and eosin (H & E) staining, terminal deoxy‐nucleotidyl transferase‐mediated nick end‐labeling (TUNEL), and electron microscopy.RESULTS.Tumor tissues and adjacent lung tissues were characterized by double‐strand fragmentation as determined by TUNEL. Ultrastructurally apoptotic bodies were found, indicating apoptotic cells. Criteria for tissue necrosis were not fulfilled by standard histological staining (H & E), showing preserved tissue architecture and only few microscopic cellular details suggestive of tumor regression. Because of DNA fragmentation, as determined by TUNEL and results from electron microscopy, the authors confirmed the tumor tissue to be completely ablated in 10 (90.9%) cases. However, in 2 cases, a safety margin was absent.CONCLUSIONS.CT‐guided pulmonary RF ablation of pulmonary malignancies is a locally effective treatment. Three days after RF ablation, tumor tissue seemed to be thermally fixed still showing characteristics of vital tumor tissue in standard histological staining; however the tissue proved to be in regression toward coagulative necrosis verified ultrastructurally and by TUNEL. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Pathomorphologic evaluation of pulmonary radiofrequency ablation

Clasen

Kröber

Kosan

et al. 2008

Cancer

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“…Today, contrast-enhanced CT is the standard approach to image early post-ablative changes in the liver [ 5 , 6 ], kidney [ 7 ], and lung [ 8 ]. However, some investigators have reported that although complete necrosis may appear clearly on contrast-enhanced CT, these findings do not always correlate with histopathological conclusions, which suggests that there is limited diagnostic accuracy in the detection of residual tumours [ 9 – 12 ].…”

Section: Rf Ablationmentioning

confidence: 99%

Dual-energy CT after radiofrequency ablation of liver, kidney, and lung lesions: a review of features

Vandenbroucke¹,

Hedent²,

Gompel³

et al. 2015

Insights Imaging

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Early detection of residual tumour and local tumour progression (LTP) after radiofrequency (RF) ablation is crucial in the decision whether or not to re-ablate. In general, standard contrast-enhanced computed tomography (CT) is used to evaluate the technique effectiveness; however, it is difficult to differentiate post-treatment changes from residual tumour. Dual-energy CT (DECT) is a relatively new technique that enables more specific tissue characterisation of iodine-enhanced structures because of the isolation of iodine in the imaging data. Necrotic post-ablation zones can be depicted as avascular regions by DECT on greyscale- and colour-coded iodine images. Synthesised monochromatic images from dual-energy CT with spectral analysis can be used to select the optimal keV to achieve the highest contrast-to-noise ratio between tissues. This facilitates outlining the interface between the ablation zone and surrounding tissue. Post-processing of DECT data can lead to an improved characterisation and delineation of benign post-ablation changes from LTP. Radiologists need to be familiar with typical post-ablation image interpretations when using DECT techniques. Here, we review the spectrum of changes after RF ablation of liver, kidney, and lung lesions using single-source DECT imaging, with the emphasis on the additional information obtained and pitfalls encountered with this relatively new technique.Teaching Points•Technical success of RF ablation means complete destruction of the tumour.•Assessment of residual tumour on contrast-enhanced CT is hindered by post-ablative changes.•DECT improves material differentiation and may improve focal lesion characterisation.•Iodine maps delineate the treated area from the surrounding parenchyma well.

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“…Yoshimatsu et al [15] found that the principal-specific risk factor for delayed or recurrent pneumothoraces was the contact of ground-glass opacity with the pleura, which corresponds histologically to coagulation necrosis [38], and presumed that this could be explained by necrotic changes of the pleura around the site of needle insertion. In another article [37], those changes evolved to a fistula between the ablation zone and the visceral pleura, which was easily seen on CT scan.…”

Section: Limitations and Advantages Of Bilateral Lung Rfamentioning

confidence: 99%