CardioVascular and Interventional Radiology

, Volume 34, Issue 6, pp 1278–1287

Percutaneous Irreversible Electroporation Lung Ablation: Preliminary Results in a Porcine Model

  • Ajita Deodhar
  • Sébastien Monette
  • Gordon W. SingleJr
  • William C. HamiltonJr
  • Raymond H. Thornton
  • Constantinos T. Sofocleous
  • Majid Maybody
  • Stephen B. Solomon
Laboratory Investigation

Abstract

Objective

Irreversible electroporation (IRE) uses direct electrical pulses to create permanent “pores” in cell membranes to cause cell death. In contrast to conventional modalities, IRE has a nonthermal mechanism of action. Our objective was to study the histopathological and imaging features of IRE in normal swine lung.

Materials and Methods

Eleven female swine were studied for hyperacute (8 h), acute (24 h), subacute (96 h), and chronic (3 week) effects of IRE ablation in lung. Paired unipolar IRE applicators were placed under computed tomography (CT) guidance. Some applicators were deliberately positioned near bronchovascular structures. IRE pulse delivery was synchronized with the cardiac rhythm only when ablation was performed within 2 cm of the heart. Contrast-enhanced CT scan was performed immediately before and after IRE and at 1 and 3 weeks after IRE ablation. Representative tissue was stained with hematoxylin and eosin for histopathology.

Results

Twenty-five ablations were created: ten hyperacute, four acute, and three subacute ablations showed alveolar edema and necrosis with necrosis of bronchial, bronchiolar, and vascular epithelium. Bronchovascular architecture was maintained. Chronic ablations showed bronchiolitis obliterans and alveolar interstitial fibrosis. Immediate post-procedure CT images showed linear or patchy density along the applicator tract. At 1 week, there was consolidation that resolved partially or completely by 3 weeks. Pneumothorax requiring chest tube developed in two animals; no significant cardiac arrhythmias were noted.

Conclusion

Our preliminary porcine study demonstrates the nonthermal and extracellular matrix sparing mechanism of action of IRE. IRE is a potential alternative to thermal ablative modalities.

Keywords

Experimental IR Interventional Oncology Ablation Lung/Pulmonary 

References

  1. 1.
    Davalos RV, Mir IL, Rubinsky B (2005) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33(2):223–231PubMedCrossRefGoogle Scholar
  2. 2.
    Edd JF, Horowitz L, Davalos RV et al (2006) In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng 53(7):1409–1415PubMedCrossRefGoogle Scholar
  3. 3.
    Garcia PA, Rossmeisl JH Jr, Robertson J et al (2009) Pilot study of irreversible electroporation for intracranial surgery. Conf Proc IEEE Eng Med Biol Soc 2009:6513–6516PubMedGoogle Scholar
  4. 4.
    Maor E, Ivorra A, Leor J et al (2007) The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat 6(4):307–312PubMedGoogle Scholar
  5. 5.
    Rubinsky B (2007) Irreversible electroporation in medicine. Technol Cancer Res Treat 6(4):255–260PubMedGoogle Scholar
  6. 6.
    Rubinsky B, Onik G, Mikus P (2007) Irreversible electroporation: a new ablation modality―clinical implications. Technol Cancer Res Treat 6(1):37–48PubMedGoogle Scholar
  7. 7.
    Neumann E, Schaefer-Ridder M, Wang Y et al (1982) Gene transfer into mouse lyoma cells by electroporation in high electric fields. EMBO J 1(7):841–845PubMedGoogle Scholar
  8. 8.
    Weaver JC (2000) Electroporation of cells and tissues. IEEE Trans Plasma Sci IEEE Nucl Plasma Sci Soc 28:24–33CrossRefGoogle Scholar
  9. 9.
    Mir LM (2001) Therapeutic perspectives of in vivo cell electropermeabilization. Bioelectrochemistry 53(1):1–10PubMedCrossRefGoogle Scholar
  10. 10.
    Miller L, Leor J, Rubinsky B (2005) Cancer cells ablation with irreversible electroporation. Technol Cancer Res Treat 4(6):699–705PubMedGoogle Scholar
  11. 11.
    Rubinsky J, Onik G, Mikus P et al (2008) Optimal parameters for the destruction of prostate cancer using irreversible electroporation. J Urol 180(6):2668–2674PubMedCrossRefGoogle Scholar
  12. 12.
    Lee EW, Loh CT, Kee ST (2007) Imaging guided percutaneous irreversible electroporation: ultrasound and immunohistological correlation. Technol Cancer Res Treat 6(4):287–294PubMedGoogle Scholar
  13. 13.
    Lencioni R, Cioni D, Pina CD et al (2009) Hepatocellular carcinoma: new options for image-guided ablation. J Hepatobiliary Pancreat Surg 17(4):399–403CrossRefGoogle Scholar
  14. 14.
    Vogl TJ, Naguib NN, Lehnert T et al (2009) Radiofrequency, microwave and laser ablation of pulmonary neoplasms: clinical studies and technical considerations. Eur J Radiol 77(2):346–357PubMedCrossRefGoogle Scholar
  15. 15.
    Wang H, Littrup PJ, Duan Y et al (2005) Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures. Radiology 235(1):289–298PubMedCrossRefGoogle Scholar
  16. 16.
    Sano Y, Kanazawa S, Gobara H et al (2007) Feasibility of percutaneous radiofrequency ablation for intrathoracic malignancies: a large single-center experience. Cancer 109(7):1397–1405PubMedCrossRefGoogle Scholar
  17. 17.
    Sakurai J, Hiraki T, Mukai T et al (2007) Intractable pneumothorax due to bronchopleural fistula after radiofrequency ablation of lung tumors. J Vasc Interv Radiol 18(1 Pt 1):141–145PubMedCrossRefGoogle Scholar
  18. 18.
    Kodama H, Yamakado K, Murashima S et al (2009) Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material. Br J Radiol 82(983):e225–e227PubMedCrossRefGoogle Scholar
  19. 19.
    Steinke K, Haghighi KS, Wulf S et al (2005) Effect of vessel diameter on the creation of ovine lung radiofrequency lesions in vivo: preliminary results. J Surg Res 124(1):85–91PubMedCrossRefGoogle Scholar
  20. 20.
    Steinke K, Arnold C, Wulf S et al (2003) Safety of radiofrequency ablation of myocardium and lung adjacent to the heart: an animal study. J Surg Res 114(2):140–145PubMedCrossRefGoogle Scholar
  21. 21.
    Brace CL, Hinshaw JL, Laeseke PF et al (2009) Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology 251(3):705–711PubMedCrossRefGoogle Scholar
  22. 22.
    Lu DS, Raman SS, Limanond P et al (2003) Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 14(10):1267–1274PubMedGoogle Scholar
  23. 23.
    Oshima F, Yamakado K, Akeboshi M et al (2004) Lung radiofrequency ablation with and without bronchial occlusion: experimental study in porcine lungs. J Vasc Interv Radiol 15(12):1451–1456PubMedGoogle Scholar
  24. 24.
    Deodhar A, Dickfeld T, Single GW et al (2011) Irreversible electroporation near the heart: ventricular arrhythmias can be prevented with ECG synchronization. AJR Am J Roentgenol 196(3):W330–W335PubMedCrossRefGoogle Scholar
  25. 25.
    Davalos RV, Rubinsky B, Mir LM (2003) Theoretical analysis of the thermal effects during in vivo tissue electroporation. Bioelectrochemistry 61(1–2):99–107PubMedCrossRefGoogle Scholar
  26. 26.
    Deodhar A, Monette S, Single GW et al (2011) Renal tissue ablation with irreversible electroporation: preliminary results in a porcine model. Urology 77(3) (in press)Google Scholar
  27. 27.
    Steinke K, Glenn D, King J et al (2004) Percutaneous imaging-guided radiofrequency ablation in patients with colorectal pulmonary metastases: 1-year follow-up. Ann Surg Oncol 11(2):207–212PubMedCrossRefGoogle Scholar
  28. 28.
    Bojarski JD, Dupuy DE, Mayo-Smith WW (2005) CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: results in 32 tumors. AJR Am J Roentgenol 185(2):466–471PubMedGoogle Scholar
  29. 29.
    Smith S, Gillams A (2008) Imaging appearances following thermal ablation. Clin Radiol 63(1):1–11PubMedCrossRefGoogle Scholar
  30. 30.
    Ohno Y, Hatabu H, Takenaka D et al (2003) CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol 180(6):1665–1669PubMedGoogle Scholar
  31. 31.
    Gibson TB (2006) Radiofrequency ablation for patients with colorectal cancer and unresectable liver metastasis. Clin Colorectal Cancer 5(5):318–320PubMedCrossRefGoogle Scholar
  32. 32.
    Steinke K, Gananadha S, King J et al (2003) Dispersive pad site burns with modern radiofrequency ablation equipment. Surg Laparosc Endosc Percutan Technol 13(6):366–371CrossRefGoogle Scholar
  33. 33.
    Wolf FJ, Grand DJ, Machan JT et al (2008) Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 247(3):871–879PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • Ajita Deodhar
    • 1
  • Sébastien Monette
    • 2
  • Gordon W. SingleJr
    • 3
  • William C. HamiltonJr
    • 3
  • Raymond H. Thornton
    • 1
  • Constantinos T. Sofocleous
    • 1
  • Majid Maybody
    • 1
  • Stephen B. Solomon
    • 1
  1. 1.Interventional Radiology and Image-Guided TherapiesMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Laboratory of Comparative PathologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Angiodynamics, IncQueensburyUSA

Personalised recommendations