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
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
Related Anatomy
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Related Differential Diagnoses
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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)
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
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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