Ablation: Percutaneous direct local tumor destruction
Energy-based ablation
Radiofrequency ablation (RFA): Heat based
Initially most common modality used for renal ablation
Microwave ablation (MWA): Heat-based cytotoxicity
Offers faster ablation times; less susceptibility to thermal heat sink effect
Cryoablation: Freezing/thawing cycle
Frequently used modality for renal ablation
Least risk of injury to renal collecting system
High-intensity focused US: Coagulation necrosis caused by high-intensity US beam focused on small tissue volume
Respiratory motion/overlying ribs problematic
Irreversible electroporation: Electrical disruption of integrity of cell membrane
Promising preliminary animal/human data, still investigational
Chemical ablation
Inconsistent cellular necrosis in renal tumors
Not routinely used for renal ablation
Embolization: Transcatheter introduction of intravascular agent for devascularization/occlusion
Bland embolization: Transcatheter arterial embolization without chemotherapeutic agent
Transcatheter ethanol injection: Denatures cellular proteins/causes small vessel thrombosis
Thermal heat sink effect: Thermal energy needed to achieve cytotoxicity is dissipated
Convective heat transfer to adjacent structures
Blood flow in vessels abutting tumor prevents adequate heat generation for effective ablation
Possible with all modalities, but least risk with MWA
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Avoid
Postprocedure Imaging (Ablation)
OUTCOMES
Complications
Expected Outcomes
Selected References
Abdelsalam ME et al: Ablation of small renal masses. Tech Vasc Interv Radiol. 23(2):100674, 2020
Mershon JP et al: Thermal ablation of the small renal mass: a critical analysis of current literature. Minerva Urol Nefrol. 72(2):123-34, 2020
Zhong J et al: Renal ablation: current management strategies and controversies. Chin Clin Oncol. 8(6):63, 2019
Sanchez A et al: Current management of small renal masses, including patient selection, renal tumor biopsy, active surveillance, and thermal ablation. J Clin Oncol. 36(36):3591-600, 2018
Omodon M et al: Review of renal artery embolization for treatment of renal angiomyolipoma. Clin Nephrol Urol Sci. 3:1, 2016
Potretzke AM et al: Re: Thompson RH et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015;67:252-9. Eur Urol. 67(2):e19-20, 2015
Moreland AJ et al: High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol. 28(9):1046-52, 2014
Sahni VA et al: Imaging management of incidentally detected small renal masses. Semin Intervent Radiol. 31(1):9-19, 2014
Gervais DA: Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 24(8):1135-8, 2013
Chan CK et al: The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology. 77(3):642-8, 2011
Hong K et al. Percutaneous Tumor Ablation, Strategies and Techniques. Thieme, 2011
Breen DJ et al: Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol. 33(5):896-908, 2010
Thumar AB et al: Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 21(8 Suppl):S233-41, 2010
Arellano RS et al: Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 193(6):1686-90, 2009
Gervais DA et al: Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 34(5):593-609, 2009
Uppot RN et al: Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol. 192(6):1558-70, 2009
Cantwell CP et al: Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 19(7):1034-40, 2008
Lokken RP et al: Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 189(4):845-8, 2007
Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 185(1):64-71, 2005
Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 2, lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 185(1):72-80, 2005
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Preprocedure
Procedure
Post Procedure
Outcomes
TERMINOLOGY
Definitions
Ablation: Percutaneous direct local tumor destruction
Energy-based ablation
Radiofrequency ablation (RFA): Heat based
Initially most common modality used for renal ablation
Microwave ablation (MWA): Heat-based cytotoxicity
Offers faster ablation times; less susceptibility to thermal heat sink effect
Cryoablation: Freezing/thawing cycle
Frequently used modality for renal ablation
Least risk of injury to renal collecting system
High-intensity focused US: Coagulation necrosis caused by high-intensity US beam focused on small tissue volume
Respiratory motion/overlying ribs problematic
Irreversible electroporation: Electrical disruption of integrity of cell membrane
Promising preliminary animal/human data, still investigational
Chemical ablation
Inconsistent cellular necrosis in renal tumors
Not routinely used for renal ablation
Embolization: Transcatheter introduction of intravascular agent for devascularization/occlusion
Bland embolization: Transcatheter arterial embolization without chemotherapeutic agent
Transcatheter ethanol injection: Denatures cellular proteins/causes small vessel thrombosis
Thermal heat sink effect: Thermal energy needed to achieve cytotoxicity is dissipated
Convective heat transfer to adjacent structures
Blood flow in vessels abutting tumor prevents adequate heat generation for effective ablation
Possible with all modalities, but least risk with MWA
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Patient Position/Location
Equipment Preparation
Procedure Steps
Alternative Procedures/Therapies
POST PROCEDURE
Things to Avoid
Postprocedure Imaging (Ablation)
OUTCOMES
Complications
Expected Outcomes
Selected References
Abdelsalam ME et al: Ablation of small renal masses. Tech Vasc Interv Radiol. 23(2):100674, 2020
Mershon JP et al: Thermal ablation of the small renal mass: a critical analysis of current literature. Minerva Urol Nefrol. 72(2):123-34, 2020
Zhong J et al: Renal ablation: current management strategies and controversies. Chin Clin Oncol. 8(6):63, 2019
Sanchez A et al: Current management of small renal masses, including patient selection, renal tumor biopsy, active surveillance, and thermal ablation. J Clin Oncol. 36(36):3591-600, 2018
Omodon M et al: Review of renal artery embolization for treatment of renal angiomyolipoma. Clin Nephrol Urol Sci. 3:1, 2016
Potretzke AM et al: Re: Thompson RH et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015;67:252-9. Eur Urol. 67(2):e19-20, 2015
Moreland AJ et al: High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol. 28(9):1046-52, 2014
Sahni VA et al: Imaging management of incidentally detected small renal masses. Semin Intervent Radiol. 31(1):9-19, 2014
Gervais DA: Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 24(8):1135-8, 2013
Chan CK et al: The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology. 77(3):642-8, 2011
Hong K et al. Percutaneous Tumor Ablation, Strategies and Techniques. Thieme, 2011
Breen DJ et al: Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol. 33(5):896-908, 2010
Thumar AB et al: Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol. 21(8 Suppl):S233-41, 2010
Arellano RS et al: Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol. 193(6):1686-90, 2009
Gervais DA et al: Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. Abdom Imaging. 34(5):593-609, 2009
Uppot RN et al: Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol. 192(6):1558-70, 2009
Cantwell CP et al: Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 19(7):1034-40, 2008
Lokken RP et al: Inflammatory nodules mimic applicator track seeding after percutaneous ablation of renal tumors. AJR Am J Roentgenol. 189(4):845-8, 2007
Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 185(1):64-71, 2005
Gervais DA et al: Radiofrequency ablation of renal cell carcinoma: part 2, lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 185(1):72-80, 2005
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.