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Ablation Procedures
Terrance Healey, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Cryoablation = percutaneous cryotherapy (PCT)
            • Synonyms

              • Percutaneous thermal ablation
            • Definitions

              • Thermal ablation: Used to treat primary or metastatic malignant neoplasms in medically inoperable patients; treatment probes placed percutaneously using real-time image guidance, usually CT fluoroscopy
                • Radiofrequency ablation (RFA) uses electrical current to induce coagulative necrosis
                  • 4 commercially available systems in USA
                  • Single treatment typically lasts 10-12 minutes
                • Microwave ablation (MWA) uses high-frequency electromagnetic waves to induce frictional heat and coagulative necrosis
                  • 7 commercially available systems in USA
                  • Single treatment typically lasts 10 minutes
                • PCT uses compressed argon gas to induce intracellular ice formation and cellular necrosis
                  • 2 commercially available systems in USA
                  • Single treatment usually consists of 2 10-minute freeze cycles separated by 8-minute thaw cycle
              • Heat sink effect: Blood flowing in large blood vessels adjacent to tumor may dissipate heat away from tumor and compromise treatment zone

            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

                                          1. Chou H et al: Percutaneous cryoablation for inoperable malignant lung tumors: Midterm results. Cryobiology. ePub, 2014
                                          2. Hinshaw JL et al: Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 34(5):1344-62, 2014
                                          3. Palussiere J et al: Percutaneous Lung Thermal Ablation of Non-surgical Clinical N0 Non-small Cell Lung Cancer: Results of Eight Years' Experience in 87 Patients from Two Centers. Cardiovasc Intervent Radiol. ePub, 2014
                                          4. Quirk MT et al: Current readings: percutaneous ablation for pulmonary metastatic disease. Semin Thorac Cardiovasc Surg. 26(3):239-48, 2014
                                          5. Alexander ES et al: Rib fractures after percutaneous radiofrequency and microwave ablation of lung tumors: incidence and relevance. Radiology. 266(3):971-8, 2013
                                          6. Healey TT et al: Radiofrequency ablation: a safe and effective treatment in nonoperative patients with early-stage lung cancer. Cancer J. 17(1):33-7, 2011
                                          7. Sharma A et al: How I do it: radiofrequency ablation and cryoablation of lung tumors. J Thorac Imaging. 26(2):162-74, 2011
                                          8. Brace CL et al: Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology. 251(3):705-11, 2009
                                          9. Goldberg SN et al: Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 20(7 Suppl):S377-90, 2009
                                          10. Wolf FJ et al: Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology. 247(3):871-9, 2008
                                          11. Pennathur A et al: Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. J Thorac Cardiovasc Surg. 134(4):857-64, 2007
                                          12. Simon CJ et al: Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 243(1):268-75, 2007
                                          13. Bojarski JD et al: CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: results in 32 tumors. AJR Am J Roentgenol. 185(2):466-71, 2005
                                          14. Wang H et al: Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures. Radiology. 235(1):289-98, 2005
                                          15. Yamamoto A et al: Radiofrequency ablation in a porcine lung model: correlation between CT and histopathologic findings. AJR Am J Roentgenol. 185(5):1299-306, 2005
                                          16. Gadaleta C et al: Radiofrequency ablation of 40 lung neoplasms: preliminary results. AJR Am J Roentgenol. 183(2):361-8, 2004
                                          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

                                                      • Cryoablation = percutaneous cryotherapy (PCT)
                                                    • Synonyms

                                                      • Percutaneous thermal ablation
                                                    • Definitions

                                                      • Thermal ablation: Used to treat primary or metastatic malignant neoplasms in medically inoperable patients; treatment probes placed percutaneously using real-time image guidance, usually CT fluoroscopy
                                                        • Radiofrequency ablation (RFA) uses electrical current to induce coagulative necrosis
                                                          • 4 commercially available systems in USA
                                                          • Single treatment typically lasts 10-12 minutes
                                                        • Microwave ablation (MWA) uses high-frequency electromagnetic waves to induce frictional heat and coagulative necrosis
                                                          • 7 commercially available systems in USA
                                                          • Single treatment typically lasts 10 minutes
                                                        • PCT uses compressed argon gas to induce intracellular ice formation and cellular necrosis
                                                          • 2 commercially available systems in USA
                                                          • Single treatment usually consists of 2 10-minute freeze cycles separated by 8-minute thaw cycle
                                                      • Heat sink effect: Blood flowing in large blood vessels adjacent to tumor may dissipate heat away from tumor and compromise treatment zone

                                                    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

                                                                                  1. Chou H et al: Percutaneous cryoablation for inoperable malignant lung tumors: Midterm results. Cryobiology. ePub, 2014
                                                                                  2. Hinshaw JL et al: Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics. 34(5):1344-62, 2014
                                                                                  3. Palussiere J et al: Percutaneous Lung Thermal Ablation of Non-surgical Clinical N0 Non-small Cell Lung Cancer: Results of Eight Years' Experience in 87 Patients from Two Centers. Cardiovasc Intervent Radiol. ePub, 2014
                                                                                  4. Quirk MT et al: Current readings: percutaneous ablation for pulmonary metastatic disease. Semin Thorac Cardiovasc Surg. 26(3):239-48, 2014
                                                                                  5. Alexander ES et al: Rib fractures after percutaneous radiofrequency and microwave ablation of lung tumors: incidence and relevance. Radiology. 266(3):971-8, 2013
                                                                                  6. Healey TT et al: Radiofrequency ablation: a safe and effective treatment in nonoperative patients with early-stage lung cancer. Cancer J. 17(1):33-7, 2011
                                                                                  7. Sharma A et al: How I do it: radiofrequency ablation and cryoablation of lung tumors. J Thorac Imaging. 26(2):162-74, 2011
                                                                                  8. Brace CL et al: Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology. 251(3):705-11, 2009
                                                                                  9. Goldberg SN et al: Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 20(7 Suppl):S377-90, 2009
                                                                                  10. Wolf FJ et al: Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology. 247(3):871-9, 2008
                                                                                  11. Pennathur A et al: Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. J Thorac Cardiovasc Surg. 134(4):857-64, 2007
                                                                                  12. Simon CJ et al: Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 243(1):268-75, 2007
                                                                                  13. Bojarski JD et al: CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: results in 32 tumors. AJR Am J Roentgenol. 185(2):466-71, 2005
                                                                                  14. Wang H et al: Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures. Radiology. 235(1):289-98, 2005
                                                                                  15. Yamamoto A et al: Radiofrequency ablation in a porcine lung model: correlation between CT and histopathologic findings. AJR Am J Roentgenol. 185(5):1299-306, 2005
                                                                                  16. Gadaleta C et al: Radiofrequency ablation of 40 lung neoplasms: preliminary results. AJR Am J Roentgenol. 183(2):361-8, 2004