Skip to main content

Contrast-enhanced CT immediately following percutaneous microwave ablation of cT1a renal cell carcinoma: Optimizing cancer outcomes

Abstract

Objective

To evaluate the effect of intra-procedural contrast-enhanced CT (CECT) and same-session repeat ablation (SSRA) on primary efficacy, the complete eradication of tumor after the first ablation session as confirmed on first imaging follow-up, of clinically localized T1a (cT1a) renal cell carcinoma (RCC).

Methods

398 consecutive patients with cT1a RCC were treated with cryoablation between 10/2003 and 12/2017, radiofrequency (RFA) or microwave ablation (MWA) between 1/2010 and 12/2017. SSRA was performed for residual tumor identified on intra-procedural CECT. Kruskal–Wallis and Pearson’s chi-squared tests were performed to assess differences in continuous and categorical variables, respectively. Multivariate linear regression was used to determine predictors for primary efficacy and decline in estimated glomerular filtration rate.

Results

347 consecutive patients (231 M, mean age 67.5 ± 9.1 years) were included. Median tumor diameter was smaller [2.5 vs 2.7 vs 2.6 (p = 0.03)] and RENAL Nephrometry Score (NS) was lower [6 vs 7 vs 7 (p = 0.009] for MWA compared to the RFA and cryoablation cohorts, respectively. Primary efficacy was higher in the MWA cohort [99.4% (170/171)] compared to the RFA [91.4% (85/93)] and cryoablation [92.8% (77/83)] cohorts (p = 0.001). Microwave ablation and SSRA was associated with higher primary efficacy on multivariate linear regression (p = 0.01–0.03).

Conclusion

MWA augmented by SSRA, when residual tumor is identified on intra-procedural CECT, may improve primary efficacy for cT1a RCC.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

Shane A. Wells is the scientific guarantor of this manuscript. Glenn O. Allen MPH kindly provided statistical advice for this manuscript.

Code availability

Not applicable.

References

  1. Capitanio U, Bensalah K, Bex A, et al (2019) Epidemiology of renal cell carcinoma. Eur Urol 75 (1):74-84.

    Article  Google Scholar 

  2. Wells SA, Wong VK, Wittmann TA, et al (2017) Renal mass biopsy and thermal ablation: Should biopsy be performed before or during the ablation procedure? Abdom Radiol (NY) 42 (6):1773-1780.

    Article  Google Scholar 

  3. Posielski NM, Bui A, Wells SA, et al (2019) Risk factors for complications and nondiagnostic results following 1,155 consecutive percutaneous core renal mass biopsies. J Urol 201 (6):1080-1087.

    Article  Google Scholar 

  4. Maciolek KA, Abel EJ, Posielski NM, et al (2019) Tumor location does not impact oncologic outcomes for percutaneous microwave ablation of clinical T1a renal cell carcinoma. Eur Radiol 29 (11):6319-6329.

    Article  Google Scholar 

  5. Campbell S, Uzzo RG, Allaf ME, et al (2017) Renal mass and localized renal cancer: AUA Guideline. J Urol 198 (3):520-529.

    Article  Google Scholar 

  6. Pierorazio PM, Johnson MH, Patel HD, et al (2016) Management of renal masses and localized renal cancer: Systematic review and meta-analysis. J Urol 196 (4):989-999.

    Article  Google Scholar 

  7. Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA (2013) Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 63 (3):486-492.

    Article  Google Scholar 

  8. Andrews JR, Atwell T, Schmit G, et al (2019) Oncologic outcomes following partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 76 (2):244-251.

    Article  Google Scholar 

  9. Breen DJ, King AJ, Patel N, Lockyer R, Hayes M (2018) Image-guided cryoablation for sporadic renal cell carcinoma: Three- and 5-year outcomes in 220 patients with biopsy-proven renal cell carcinoma. Radiology 289 (2):554-561.

    Article  Google Scholar 

  10. Yu J, Zhang X, Liu H, et al (2020) Percutaneous microwave ablation versus laparoscopic partial nephrectomy for cT1a renal cell carcinoma: A propensity-matched cohort study of 1955 patients. Radiology 294 (3):698-706.

    Article  Google Scholar 

  11. Brace C (2011) Thermal tumor ablation in clinical use. IEEE Pulse 2 (5):28-38.

    CAS  Article  Google Scholar 

  12. McClure TD, Chow DS, Tan N, Sayre JA, Pantuck AJ, Raman SS (2014) Intermediate outcomes and predictors of efficacy in the radiofrequency ablation of 100 pathologically proven renal cell carcinomas. J Vasc Interv Radiol 25 (11):1682-1688.

    Article  Google Scholar 

  13. Ahmed M, Solbiati L, Brace CL, et al (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 273 (1):241-260.

    Article  Google Scholar 

  14. Hinshaw JL, Shadid AM, Nakada SY, Hedican SP, Winter TC, Lee FT (2008) Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses. AJR Am J Roentgenol 191 (4):1159-1168.

    Article  Google Scholar 

  15. Davenport MS, Caoili EM, Cohan RH, et al (2009) MRI and CT characteristics of successfully ablated renal masses: Imaging surveillance after radiofrequency ablation. AJR Am J Roentgenol 192 (6):1571-1578.

    Article  Google Scholar 

  16. Curci NE, Triche BL, Abel EJ, et al (2021) Effect of iodinated contrast material on post-operative eGFR when administered during renal mass ablation. Eur Radiol 31 (8): 5490-5497.

    CAS  Article  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240 (2):205-213.

    Article  Google Scholar 

  18. Yu J, Zhang G, Liang P, et al (2015) Midterm results of percutaneous microwave ablation under ultrasound guidance versus retroperitoneal laparoscopic radical nephrectomy for small renal cell carcinoma. Abdom Imaging 40 (8):3248-3256.

    Article  Google Scholar 

  19. Schmit GD, Thompson RH, Kurup AN, et al (2013) Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors. J Urol 189 (1):30–35.

  20. Dreyfuss LD, Wells SA, Best SL, et al (2019) Development of a risk-stratified approach for follow-up imaging after percutaneous thermal ablation of sporadic stage one renal cell carcinoma. Urology 134:148-153.

    Article  Google Scholar 

  21. Widdershoven CV, Aarts BM, Zondervan PJ, et al (2021) Renal biopsies performed before versus during ablation of T1 renal tumors: Implications for prevention of overtreatment and follow-up. Abdom Radiol (NY) 46 (1):373-379.

    Article  Google Scholar 

  22. McClure T, Pantuck A, Sayer J, Raman S (2018) Efficacy of percutaneous radiofrequency ablation may vary with clear cell renal cell cancer histologic subtype. Abdom Radiol (NY) 43 (6):1472-1477.

    Article  Google Scholar 

  23. Haddad MM, Schmit GD, Kurup AN, et al (2018) Percutaneous cryoablation of solitary, sporadic renal cell carcinoma: Outcome analysis based on clear-cell versus papillary subtypes. J Vasc Interv Radiol 29 (8):1122-1126.

    Article  Google Scholar 

  24. Chan P, Vélasco S, Vesselle G, et al (2017) Percutaneous microwave ablation of renal cancers under CT guidance: Safety and efficacy with a 2-year follow-up. Clin Radiol 72 (9):786-792.

    CAS  Article  Google Scholar 

  25. Ziemlewicz TJ, Hinshaw JL, Lubner MG, et al (2020) Radiofrequency and microwave ablation in a porcine liver model: Non-contrast CT and ultrasound radiologic-pathologic correlation. Int J Hyperthermia 37 (1):799-807.

    Article  Google Scholar 

  26. Kim DK, Won JY, Park SY (2019) Percutaneous cryoablation for renal cell carcinoma using ultrasound-guided targeting and computed tomography-guided ice-ball monitoring: Radiation dose and short-term outcomes. Acta Radiol 60 (6):798-804.

    Article  Google Scholar 

  27. Wetley KA, Abel EJ, Dreyfuss LD, Huang W, Brace CL, Wells SA (2020) CT and MR imaging surveillance of stage 1 renal cell carcinoma after microwave ablation. Abdom Radiol (NY) 45 (9):2810-2824.

    Article  Google Scholar 

  28. Brace CL, Diaz TA, Hinshaw JL, Lee FT (2010) Tissue contraction caused by radiofrequency and microwave ablation: A laboratory study in liver and lung. J Vasc Interv Radiol 21 (8):1280-1286.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the non-author members of the Society of Abdominal Radiology (SAR) Renal Cell Carcinoma Disease-focused Panel (RCC DFP).

Funding

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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shane A. Wells.

Ethics declarations

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Shane A. Wells MD—Ethicon Inc., Consultant, Christopher L. Brace PhD—Ethicon Inc, Consultant, Matthew S. Davenport MD—Wolters Kluwer, Royalties.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Consent for publication

Authors consent for consideration of publication in Abdominal Radiology.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Koebe, S.D., Curci, N.E., Caoili, E.M. et al. Contrast-enhanced CT immediately following percutaneous microwave ablation of cT1a renal cell carcinoma: Optimizing cancer outcomes. Abdom Radiol 47, 2674–2680 (2022). https://doi.org/10.1007/s00261-022-03481-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-022-03481-w

Keywords

  • Renal cell carcinoma
  • Ablation
  • Primary efficacy
  • Microwave
  • Cryoablation