European Radiology

, Volume 18, Issue 7, pp 1519–1525 | Cite as

Image-guided radiofrequency ablation of Bosniak category III or IV cystic renal tumors: initial clinical experience

  • Byung Kwan Park
  • Chan Kyo Kim
  • Hyun Moo Lee


The purpose of this study was to assess the efficacy of image-guided radiofrequency (RF) ablation of cystic renal tumors. Between November 2005 and August 2007, computed tomography (CT) or ultrasound-guided RF ablation was performed in nine patients with 14 Bosniak category III (n = 5) or IV (n = 9) cystic renal tumors using an internally cooled RF ablation system. We evaluated the number of sessions, cycles and duration of energy application, treatment results, lesion size change, and complications. Together the cystic renal tumors required 15 sessions and 23 cycles of energy application. The duration of energy application per one tumor ablation ranged from 1 to 12 min (mean 6 min). The last follow-up CT indicated complete coagulation of 14/14 (100%) lesions. None of these tumors had recurred within 1–19 months (mean 8 months). The maximum diameter of the cystic renal tumors was significantly reduced from 2.5 ± 0.6 cm before ablation to 1.7 ± 0.7 cm at the last follow-up CT (P < 0.01). Complications were pneumothorax (n = 2), inguinal paresthesia (n = 1), and arteriovenous fistula (n = 1). Image-guided RF ablation is an effective treatment for Bosniak category III or IV cystic renal tumors, which might need relatively shorter duration of energy application than purely solid renal tumors of the same size.


Renal cell carcinoma Radiofrequency ablation Computed tomography Ultrasound 


  1. 1.
    Pavlovich CP, Walther MM, Choyke PL, Pautler SE, Chang R, Linehan WM, Wood BJ (2002) Percutaneous radio frequency ablation of small renal tumors: initial results. J Urol 167:10–15CrossRefPubMedGoogle Scholar
  2. 2.
    Farrell MA, Charboneau WJ, DiMarco DS, Chow GK, Zincke H, Callstrom MR, Lewis BD, Lee RA, Reading CC (2003) Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol 180:1509–1513PubMedGoogle Scholar
  3. 3.
    Mayo-Smith WW, Dupuy DE, Parikh PM, Pezzullo JA, Cronan JJ (2003) Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients. AJR Am J Roentgenol 180:1503–1508PubMedGoogle Scholar
  4. 4.
    Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR (2005) Radiofrequency ablation of renal cell carcinoma, part 1. Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 185:64–71PubMedGoogle Scholar
  5. 5.
    Boss A, Clasen S, Kuczyk M, Schick F, Pereira PL (2007) Image-guided radiofrequency ablation of renal cell carcinoma. Eur Radiol 17:725–733CrossRefPubMedGoogle Scholar
  6. 6.
    Brunetti E, Filice C (2001) Radiofrequency thermal ablation of echinococcal liver cysts. Lancet 358:1464CrossRefPubMedGoogle Scholar
  7. 7.
    Kim YS, Rhim H, Tae K, Park DW, Kim ST (2006) Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience. Thyroid 16:361–367CrossRefPubMedGoogle Scholar
  8. 8.
    Rhim H, Kim YS, Heo JN, Koh BH, Cho OK, Kim Y, Seo HS (2004) Radiofrequency thermal ablation of hepatic cyst. J Vasc Interv Radiol 15:95–96PubMedGoogle Scholar
  9. 9.
    Harisinghani MG, Maher MM, Gervais DA, McGovern F, Hahn P, Jhaveri K, Varghese J, Mueller PR (2003) Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery? AJR Am J Roentgenol 180:755–758PubMedGoogle Scholar
  10. 10.
    Lang EK, Macchia RJ, Gayle B, Richter F, Watson RA, Thomas R, Myers L (2002) CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management. Eur Radiol 12:2518–2524PubMedGoogle Scholar
  11. 11.
    Hora M, Hes O, Michal M, Boudova L, Chudacek Z, Kreuzberg B, Klecka J (2005) Extensively cystic renal neoplasms in adults (Bosniak classification II or III)–possible “common” histological diagnoses: multilocular cystic renal cell carcinoma, cystic nephroma, and mixed epithelial and stromal tumor of the kidney. Int Urol Nephrol 37:743–750CrossRefPubMedGoogle Scholar
  12. 12.
    Warren KS, McFarlane J (2005) The Bosniak classification of renal cystic masses. BJU Int 95:939–942CrossRefPubMedGoogle Scholar
  13. 13.
    Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10PubMedGoogle Scholar
  14. 14.
    Israel GM, Bosniak MA (2005) How I do it: evaluating renal masses. Radiology 236:441–450CrossRefPubMedGoogle Scholar
  15. 15.
    Renshaw AA, Granter SR, Cibas ES (1997) Fine-needle aspiration of the adult kidney. Cancer 81:71–88CrossRefPubMedGoogle Scholar
  16. 16.
    Clark TW, Millward SF, Gervais DA, Goldberg SN, Grassi CJ, Kinney TB, Phillips DA, Sacks D, Cardella JF (2006) Reporting standards for percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 17:1563–1570PubMedCrossRefGoogle Scholar
  17. 17.
    Gervais DA, McGovern FJ, Wood BJ, Goldberg SN, McDougal WS, Mueller PR (2000) Radio-frequency ablation of renal cell carcinoma: early clinical experience. Radiology 217:665–672PubMedGoogle Scholar
  18. 18.
    Merkle EM, Nour SG, Lewin JS (2005) MR imaging follow-up after percutaneous radiofrequency ablation of renal cell carcinoma: findings in 18 patients during first 6 months. Radiology 235:1065–1071CrossRefPubMedGoogle Scholar
  19. 19.
    Choyke PL, Glenn GM, Walther MM, Zbar B, Linehan WM (2003) Hereditary renal cancers. Radiology 226:33–46CrossRefPubMedGoogle Scholar
  20. 20.
    Choi D, Lim HK, Rhim H, Kim YS, Lee WJ, Paik SW, Koh KC, Lee JH, Choi MS, Yoo BC (2007) Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series. Eur Radiol 17:684–692CrossRefPubMedGoogle Scholar
  21. 21.
    Choi D, Lim HK, Rhim H, Kim YS, Yoo BC, Paik SW, Joh JW, Park CK (2007) Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol 14:2319–2329CrossRefPubMedGoogle Scholar
  22. 22.
    Dechet CB, Zincke H, Sebo TJ, King BF, LeRoy AJ, Farrow GM, Blute ML (2003) Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol 169:71–74CrossRefPubMedGoogle Scholar
  23. 23.
    Rybicki FJ, Shu KM, Cibas ES, Fielding JR, vanSonnenberg E, Silverman SG (2003) Percutaneous biopsy of renal masses: sensitivity and negative predictive value stratified by clinical setting and size of masses. AJR Am J Roentgenol 180:1281–1287PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • Byung Kwan Park
    • 1
  • Chan Kyo Kim
    • 1
  • Hyun Moo Lee
    • 2
  1. 1.Department of Radiology and Center for Imaging Science, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
  2. 2.Department of Urology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea

Personalised recommendations