Skip to main content
SpringerLink
Log in

Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR.

Methods

We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described.

Results

Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up.

Conclusions

Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients.

Clinical relevance statement

Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed.

Key Points

• We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room.

• To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation.

• We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CBCT:

Cone-beam computed tomography

DAP:

Dose area product

GA:

General anaesthesia

GGN:

Ground-glass nodules

HOR:

Hybrid operating room

MWA:

Microwave ablation

RFA:

Radiofrequency ablation

References

  1. National Lung Screening Trial Research Team (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409

    Article  Google Scholar 

  2. de Koning HJ, van der Aalst CM, de Jong PA et al (2020) Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 382:503–513

    Article  PubMed  Google Scholar 

  3. Ettinger DS, Wood DE, Aisner DL et al (2021) NCCN guidelines insights: non-small cell lung cancer, Version 2.2021. J Natl Compr Canc Netw 19:254–266

    Article  CAS  PubMed  Google Scholar 

  4. Gould MK, Donington J, Lynch WR et al (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e93S-e120S

    Article  PubMed  PubMed Central  Google Scholar 

  5. Moyer VA, U.S. Preventive Services Task Force (2014) Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 160:330–338

    PubMed  Google Scholar 

  6. MacMahon H, Naidich DP, Goo JM et al (2017) Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology 284:228–243

    Article  PubMed  Google Scholar 

  7. Postmus PE, Kerr KM, Oudkerk M et al (2017) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:iv1–iv21

    Article  CAS  PubMed  Google Scholar 

  8. Donahoe LL, Nguyen ET, Chung TB et al (2016) CT-guided microcoil VATS resection of lung nodules: a single-centre experience and review of the literature. J Thorac Dis 8:1986–1994

    Article  PubMed  PubMed Central  Google Scholar 

  9. Huang YH, Chen KC, Chen JS (2019) Ultrasound for intraoperative localization of lung nodules during thoracoscopic surgery. Ann Transl Med 7:37

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ko WC, Lee YF, Chen YC et al (2016) CT-guided percutaneous microwave ablation of pulmonary malignant tumors. J Thorac Dis 8:S659–S665

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bhatia S, Pereira K, Mohan P, Narayanan G, Wangpaichitr M, Savaraj N (2016) Radiofrequency ablation in primary non-small cell lung cancer: what a radiologist needs to know. Indian J Radiol Imaging 26:81–91

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chockalingam A, Konstantinidis M, Koo B et al (2022) Surgical resection, radiotherapy and percutaneous thermal ablation for treatment of stage 1 non-small cell lung cancer: protocol for a systematic review and network meta-analysis. BMJ Open 12:e057638

    Article  PubMed  PubMed Central  Google Scholar 

  13. Palussiere J, Catena V, Buy X (2017) Percutaneous thermal ablation of lung tumors - radiofrequency, microwave and cryotherapy: where are we going? Diagn Interv Imaging 98:619–625

    Article  CAS  PubMed  Google Scholar 

  14. Li G, Xue M, Chen W, Yi S (2018) Efficacy and safety of radiofrequency ablation for lung cancers: a systematic review and meta-analysis. Eur J Radiol 100:92–98

    Article  PubMed  Google Scholar 

  15. Healey TT, March BT, Baird G, Dupuy DE (2017) Microwave ablation for lung neoplasms: a retrospective analysis of long-term results. J Vasc Interv Radiol 28:206–211

    Article  PubMed  Google Scholar 

  16. Knavel EM, Brace CL (2013) Tumor ablation: common modalities and general practices. Tech Vasc Interv Radiol 16:192–200

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bailey CW, Sydnor MK Jr (2019) Current state of tumor ablation therapies. Dig Dis Sci 64:951–958

    Article  PubMed  Google Scholar 

  18. Alexander ES, Dupuy DE (2013) Lung cancer ablation: technologies and techniques. Semin Intervent Radiol 30:141–150

    Article  PubMed  PubMed Central  Google Scholar 

  19. Abtin FG, Eradat J, Gutierrez AJ, Lee C, Fishbein MC, Suh RD (2012) Radiofrequency ablation of lung tumors: imaging features of the postablation zone. Radiographics 32:947–969

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mouli SK, Kurilova I, Sofocleous CT, Lewandowski RJ (2017) The role of percutaneous image-guided thermal ablation for the treatment of pulmonary malignancies. AJR Am J Roentgenol 209:740–751

    Article  PubMed  Google Scholar 

  21. Lencioni R, de Baere T, Martin RC, Nutting CW, Narayanan G (2015) Image-guided ablation of malignant liver tumors: recommendations for clinical validation of novel thermal and non-thermal technologies - a western perspective. Liver Cancer 4:208–214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ng CSH, Krimsky WS, Yasufuku K (2021) Editorial: The hybrid operating room in modern thoracic surgery. Front Surg 8:725897

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yang SM, Chung WY, Ko HJ et al (2022) Single-stage augmented fluoroscopic bronchoscopy localization and thoracoscopic resection of small pulmonary nodules in a hybrid operating room. Eur J Cardiothorac Surg 63:ezac541

    Article  PubMed  Google Scholar 

  24. Spenkelink IM, Heidkamp J, Futterer JJ, Rovers MM (2022) Image-guided procedures in the hybrid operating room: a systematic scoping review. PLoS One 17:e0266341

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Harrison OJ, Sarvananthan S, Tamburrini A, Peebles C, Alzetani A (2021) Image-guided combined ablation and resection in thoracic surgery for the treatment of multiple pulmonary metastases: a preliminary case series. JTCVS Tech 9:156–162

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ye X, Fan W, Wang Z et al (2022) Clinical practice guidelines on image-guided thermal ablation of primary and metastatic lung tumors (2022 edition). J Cancer Res Ther 18:1213–1230

    Article  PubMed  Google Scholar 

  27. Tomiyama N, Yasuhara Y, Nakajima Y et al (2006) CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 59:60–64

    Article  PubMed  Google Scholar 

  28. Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM (2014) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 271:291–300

    Article  PubMed  Google Scholar 

  29. Liu Y, Wu K, Xu K, Tian C, Jiao D, Han X (2022) Cone beam computed tomography-guided microwave ablation for hepatocellular carcinoma under the hepatic dome: a retrospective case-control study. Quant Imaging Med Surg 12:4837–4851

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cicenia J, Bhadra K, Sethi S, Nader DA, Whitten P, Hogarth DK (2021) Augmented fluoroscopy: a new and novel navigation platform for peripheral bronchoscopy. J Bronchology Interv Pulmonol 28:116–123

    Article  PubMed  Google Scholar 

  31. Wolf FJ, Grand DJ, Machan JT, Dipetrillo TA, Mayo-Smith WW, Dupuy DE (2008) Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 247:871–879

    Article  PubMed  Google Scholar 

  32. Ni Y, Peng J, Yang X et al (2021) Multicentre study of microwave ablation for pulmonary oligorecurrence after radical resection of non-small-cell lung cancer. Br J Cancer 125:672–678

    Article  PubMed  PubMed Central  Google Scholar 

  33. Aufranc V, Farouil G, Abdel-Rehim M et al (2019) Percutaneous thermal ablation of primary and secondary lung tumors: comparison between microwave and radiofrequency ablation. Diagn Interv Imaging 100:781–791

    Article  CAS  PubMed  Google Scholar 

  34. Emara EHA, Aboelezz MSMO, Rahman HEDMA, Biomy SS, Vogl TJ (2020) Role of microwave ablation in treatment of lung tumors. Med J Cairo Univ 88:1117–1129

    Article  Google Scholar 

  35. Li L, Wu K, Lai H, Zhang B (2017) Clinical application of CT-guided percutaneous microwave ablation for the treatment of lung metastasis from colorectal cancer. Gastroenterol Res Pract 2017:9621585

    Article  PubMed  PubMed Central  Google Scholar 

  36. Palussiere J, Catena V, Gaubert JY, Buy X, de Baere T (2017) Percutaneous lung thermo-ablation. Bull Cancer 104:417–422

    Article  PubMed  Google Scholar 

  37. Chang HC, Yang MC (2018) Systemic air embolism after percutaneous computed tomography-guided lung biopsy due to a kink in the coaxial biopsy system: a case report. BMC Med Imaging 18:1

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fiore L, Frenk NE, Martins GLP, Viana PCC, de Menezes MR (2017) Systemic air embolism after percutaneous lung biopsy: a manageable complication. J Radiol Case Rep 11:6–14

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ramaswamy R, Narsinh KH, Tuan A, Kinney TB (2014) Systemic air embolism following percutaneous lung biopsy. Semin Intervent Radiol 31:375–377

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kramer M, Parekh M, Modi RY, Donuru A (2020) Review of thoracic causes of systemic arterial air embolism on computed tomography. J Thorac Imaging 35:W68–W74

    Article  PubMed  Google Scholar 

  41. Franke M, Reinhardt HC, von Bergwelt-Baildon M, Bangard C (2014) Massive air embolism after lung biopsy. Circulation 129:1046–1047

    Article  PubMed  Google Scholar 

  42. Magnusson L, Spahn DR (2003) New concepts of atelectasis during general anaesthesia. Br J Anaesth 91:61–72

    Article  CAS  PubMed  Google Scholar 

  43. Hedenstierna G, Rothen HU (2000) Atelectasis formation during anesthesia: causes and measures to prevent it. J Clin Monit Comput 16:329–335

    Article  CAS  PubMed  Google Scholar 

  44. Hu B, Ren W, Feng Z et al (2022) Correlation between CT imaging characteristics and pathological diagnosis for subcentimeter pulmonary nodules. Thorac Cancer 13:1067–1075

    Article  PubMed  PubMed Central  Google Scholar 

  45. de Morais AQ, da Silva TPF, Braga JCD et al (2020) Factors associated with subcentimeter pulmonary nodule outcomes followed with computed tomography imaging in oncology patients. Eur J Radiol Open 7:100266

    Article  PubMed  PubMed Central  Google Scholar 

  46. Takenaka T (2017) How to manage patients with subcentimeter non-small cell lung cancer? J Thorac Dis 9:4860–4862

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sanchez M, Benegas M, Vollmer I (2018) Management of incidental lung nodules <8 mm in diameter. J Thorac Dis 10:S2611–S2627

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  49. Pillai K, Akhter J, Chua TC et al (2015) Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore) 94:e580

    Article  PubMed  Google Scholar 

  50. Brace CL (2009) Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: what are the differences? Curr Probl Diagn Radiol 38:135–143

    Article  PubMed  PubMed Central  Google Scholar 

  51. Brace CL (2010) Microwave tissue ablation: biophysics, technology, and applications. Crit Rev Biomed Eng 38:65–78

    Article  PubMed  PubMed Central  Google Scholar 

  52. Radosevic A, Quesada R, Serlavos C et al (2022) Microwave versus radiofrequency ablation for the treatment of liver malignancies: a randomized controlled phase 2 trial. Sci Rep 12:316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Primavesi F, Swierczynski S, Klieser E et al (2018) Thermographic real-time-monitoring of surgical radiofrequency and microwave ablation in a perfused porcine liver model. Oncol Lett 15:2913–2920

    PubMed  Google Scholar 

  54. Dodd GD 3rd, Dodd NA, Lanctot AC, Glueck DA (2013) Effect of variation of portal venous blood flow on radiofrequency and microwave ablations in a blood-perfused bovine liver model. Radiology 267:129–136

    Article  PubMed  Google Scholar 

  55. Abbas G, Pennathur A, Landreneau RJ, Luketich JD (2009) Radiofrequency and microwave ablation of lung tumors. J Surg Oncol 100:645–650

    Article  PubMed  Google Scholar 

  56. Fan W, Li X, Zhang L, Jiang H, Zhang J (2012) Comparison of microwave ablation and multipolar radiofrequency ablation in vivo using two internally cooled probes. AJR Am J Roentgenol 198:W46–W50

    Article  PubMed  Google Scholar 

  57. Andreano A, Huang Y, Meloni MF, Lee FT Jr, Brace C (2010) Microwaves create larger ablations than radiofrequency when controlled for power in ex vivo tissue. Med Phys 37:2967–2973

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Crocetti L, Bozzi E, Faviana P et al (2010) Thermal ablation of lung tissue: in vivo experimental comparison of microwave and radiofrequency. Cardiovasc Intervent Radiol 33:818–827

    Article  PubMed  Google Scholar 

  59. Li HW, Long YJ, Yan GW et al (2022) Microwave ablation vs. cryoablation for treatment of primary and metastatic pulmonary malignant tumors. Mol Clin Oncol 16:62

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Bourgouin PP, Wrobel MM, Mercaldo ND et al (2022) Comparison of percutaneous image-guided microwave ablation and cryoablation for sarcoma lung metastases: a 10-year experience. AJR Am J Roentgenol 218:494–504

    Article  PubMed  Google Scholar 

  61. Pistorius GA, Alexander C, Krisch CM, Feifel G, Schilling MK, Menger MD (2005) Local platelet trapping as the cause of thrombocytopenia after hepatic cryotherapy. World J Surg 29:657–660 (discussion 661)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the Siemens Healthcare marketing manager, Frank Chun-Hsien Wu, PhD, and the application specialist, Maxwell Jiun-Yan Lin, for their technical assistance with the ARTIS Pheno operation and image post processing. They also thank the Siemens Healthcare research scientist Shwetambara Malwade for her helpful advice regarding revision of the manuscript.

Funding

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

Author information

Authors and Affiliations

  1. Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan

    Ling-Kai Chang, Shun-Mao Yang, Lun-Che Chen, Hao-Chun Chang & Chong-Jen Yu

  2. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan

    Ling-Kai Chang, Lun-Che Chen, Hao-Chun Chang & Chong-Jen Yu

  3. Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan

    Shun-Mao Yang, Wen-Yuan Chung & Ming-Chih Ho

  4. Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan

    Yeun-Chung Chang

Authors
  1. Ling-Kai Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shun-Mao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wen-Yuan Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lun-Che Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hao-Chun Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ming-Chih Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yeun-Chung Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chong-Jen Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shun-Mao Yang.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Shun-Mao Yang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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

Some study subjects or cohorts have not been previously reported.

Methodology

• retrospective

• observational

• performed at one institution

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 252 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chang, LK., Yang, SM., Chung, WY. et al. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10360-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00330-023-10360-5

Keywords

Search

Navigation