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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Thermal ablation (TA)
- Radiofrequency ablation (RFA)
- Microwave ablation (MWA)
- Cryoablation (CA)
- Thermal ablation (TA)
Synonyms
- Percutaneous lung ablation
Definitions
- TA: Tissue injury produced by increased tissue temperature: Used to treat limited-stage lung malignancy in medically inoperable patients, oligometastases (< 3-5) and recurrent malignancy after radiation or surgery; CT and CT fluoroscopy used for percutaneous probe placement
- Heat sink: Cooling effect of flowing blood and air in well-perfused lung may lower ablation temperature and impair tumor destruction
- RFA
- Uses electrical current system
- Current frequency: 400-500 kHz
- Single treatment typically lasts 10-12 minutes
- Tissue heating ≥ 60°C → protein denaturation → cell death
- Treatment time 12-15 minutes
- MWA
- Uses electromagnetic radiation
- Frequency: 915 MHz to 2.45 GHz; generates higher temperatures
- Single treatment typically lasts 10 minutes
- Treatment time 2-5 minutes
- CA: Uses compressed argon gas to induce intracellular ice formation and extracellular ice crystals
- Temperatures as low as -140°C within extracellular space → cell dehydration → cell membrane rupture → cell death
- Ice ball may be imaged with CT during procedure; allows assessment of treatment zone
- Longer procedure time: Freeze-thaw cycles
- TA: Tissue injury produced by increased tissue temperature: Used to treat limited-stage lung malignancy in medically inoperable patients, oligometastases (< 3-5) and recurrent malignancy after radiation or surgery; CT and CT fluoroscopy used for percutaneous probe placement
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
Nuclear Medicine Findings
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Halpenny D et al: Imaging of novel oncologic treatments in lung cancer part 2: local ablative therapies. J Thorac Imaging. 35(1):37-48, 2020
- Abtin F et al: Updates on current role and practice of lung ablation. J Thorac Imaging. 34(4):266-77, 2019
- Palussière J et al: Radiofrequency ablation of stage IA non-small cell lung cancer in patients ineligible for surgery: results of a prospective multicenter phase II trial. J Cardiothorac Surg. 13(1):91, 2018
- Yao W et al: Comparison between microwave ablation and lobectomy for stage I non-small cell lung cancer: a propensity score analysis. Int J Hyperthermia. 34(8):1329-36, 2018
- Chou H et al: Percutaneous cryoablation for inoperable malignant lung tumors: Midterm results. Cryobiology. 70(1):60-5, 2014
- Hinshaw JL et al: Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 34(5):1344-62, 2014
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Thermal ablation (TA)
- Radiofrequency ablation (RFA)
- Microwave ablation (MWA)
- Cryoablation (CA)
- Thermal ablation (TA)
Synonyms
- Percutaneous lung ablation
Definitions
- TA: Tissue injury produced by increased tissue temperature: Used to treat limited-stage lung malignancy in medically inoperable patients, oligometastases (< 3-5) and recurrent malignancy after radiation or surgery; CT and CT fluoroscopy used for percutaneous probe placement
- Heat sink: Cooling effect of flowing blood and air in well-perfused lung may lower ablation temperature and impair tumor destruction
- RFA
- Uses electrical current system
- Current frequency: 400-500 kHz
- Single treatment typically lasts 10-12 minutes
- Tissue heating ≥ 60°C → protein denaturation → cell death
- Treatment time 12-15 minutes
- MWA
- Uses electromagnetic radiation
- Frequency: 915 MHz to 2.45 GHz; generates higher temperatures
- Single treatment typically lasts 10 minutes
- Treatment time 2-5 minutes
- CA: Uses compressed argon gas to induce intracellular ice formation and extracellular ice crystals
- Temperatures as low as -140°C within extracellular space → cell dehydration → cell membrane rupture → cell death
- Ice ball may be imaged with CT during procedure; allows assessment of treatment zone
- Longer procedure time: Freeze-thaw cycles
- TA: Tissue injury produced by increased tissue temperature: Used to treat limited-stage lung malignancy in medically inoperable patients, oligometastases (< 3-5) and recurrent malignancy after radiation or surgery; CT and CT fluoroscopy used for percutaneous probe placement
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
Nuclear Medicine Findings
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Halpenny D et al: Imaging of novel oncologic treatments in lung cancer part 2: local ablative therapies. J Thorac Imaging. 35(1):37-48, 2020
- Abtin F et al: Updates on current role and practice of lung ablation. J Thorac Imaging. 34(4):266-77, 2019
- Palussière J et al: Radiofrequency ablation of stage IA non-small cell lung cancer in patients ineligible for surgery: results of a prospective multicenter phase II trial. J Cardiothorac Surg. 13(1):91, 2018
- Yao W et al: Comparison between microwave ablation and lobectomy for stage I non-small cell lung cancer: a propensity score analysis. Int J Hyperthermia. 34(8):1329-36, 2018
- Chou H et al: Percutaneous cryoablation for inoperable malignant lung tumors: Midterm results. Cryobiology. 70(1):60-5, 2014
- Hinshaw JL et al: Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 34(5):1344-62, 2014
