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Comparison of expected imaging findings following percutaneous microwave and cryoablation of pulmonary tumors: ablation zones and thoracic lymph nodes

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Abstract

Objective

To compare temporal changes of ablation zones and lymph nodes following lung microwave ablation (MWA) and cryoablation.

Methods

This retrospective cohort study compared lung ablation zones and thoracic lymph nodes following MWA and cryoablation performed 2006–2020. In the ablation zone cohort, ablation zone volumes were measured on serial CT for 12 months. In the lymph node cohort, the sum of bidimensional products of lymph node diameters was measured before (baseline) and up to 6 months following ablation. Cumulative incidence curves estimated the time to 75% ablation zone reduction and linear mixed-effects regression models compared the temporal distribution of ablation zones and lymph node sizes between modalities.

Results

Ablation zones of 59 tumors treated in 45 sessions (16 MWA, 29 cryoablation) in 36 patients were evaluated. Differences in the time to 75% volume reduction between modalities were not detected. Following MWA, half of the ablation zones required an estimated time of 340 days to achieve a 75% volume reduction compared to 214 days following cryoablation (p = .30). Thoracic lymph node sizes after 33 sessions (13 MWA, 20 cryoablation) differed between modalities (baseline–32 days, p = .01; 32–123 days, p = .001). Following MWA, lymph nodes increased on average by 38 mm2 (95%CI, 5.0–70.7; p = .02) from baseline to 32 days, followed by an estimated decrease of 50 mm2 (32–123 days; p = .001). Following cryoablation, changes in lymph nodes were not detected (baseline–32 days, p = .33).

Conclusion

The rate of ablation zone volume reduction did not differ between MWA and cryoablation. Thoracic lymph nodes enlarged transiently after MWA but not after cryoablation.

Key Points

• Contrary to current belief, the rate of lung ablation zone volume reduction did not differ between microwave and cryoablation.

• Transient enlargement of thoracic lymph nodes after microwave ablation was not associated with regional tumor spread and decreased within six months following ablation.

• No significant thoracic lymph node enlargement was observed following cryoablation.

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Abbreviations

CI:

Confidence interval

ECOG:

Eastern Cooperative Oncology Group

HU:

Hounsfield units

IQR:

Interquartile range

mRECIST:

Modified Response Evaluation Criteria in Solid Tumors

MWA:

Microwave ablation

NE:

Not estimable

RFA:

Radiofrequency ablation

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Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Nathaniel D. Mercaldo and Florian J. Fintelmann contributed equally as co-senior authors.

Authors and Affiliations

  1. Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Maria M. Wrobel, Konstantin S. Leppelmann, Amita Sharma & Florian J. Fintelmann

  2. Department of Radiology, Ludwig-Maximilians-University, München, Germany

    Maria M. Wrobel

  3. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Alexis M. Cahalane & Nathaniel D. Mercaldo

  4. Babson College, Wellesley, MA, USA

    Dessislava Pachamanova

  5. MIT, Cambridge, MA, USA

    Dessislava Pachamanova

  6. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Stuart G. Silverman & Paul B. Shyn

Authors
  1. Maria M. Wrobel
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  2. Alexis M. Cahalane
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  6. Amita Sharma
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  9. Florian J. Fintelmann
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Corresponding author

Correspondence to Florian J. Fintelmann.

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Guarantor

The scientific guarantor of this publication is Florian J. Fintelmann.

Conflict of interest

Florian J. Fintelmann received salary support from the American Roentgen Ray Society and the William M. Wood Foundation during the study period, as well as research support from Boston Scientific. Amita Sharma reports research support from Hummingbird Diagnostics Inc. for unrelated work. The other authors have no relevant conflicts of interest to report.

Statistics and biometry

Nathaniel D. Mercaldo, PhD, is a biostatistician in the Department of Radiology at Massachusetts General Hospital and performed the statistical analysis for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The current study overlaps with two previously published reports (references #21, # 22) in that the clinical outcomes of 28 patients in the current study were previously described. The current study differs significantly because it focuses only on imaging features following percutaneous lung ablation, regardless of clinical outcomes.

Methodology

• retrospective

• observational

• multicenter study

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Wrobel, M.M., Cahalane, A.M., Pachamanova, D. et al. Comparison of expected imaging findings following percutaneous microwave and cryoablation of pulmonary tumors: ablation zones and thoracic lymph nodes. Eur Radiol 32, 8171–8181 (2022). https://doi.org/10.1007/s00330-022-08905-1

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  • DOI: https://doi.org/10.1007/s00330-022-08905-1

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