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Thoracic Ablation and Embolization
Jennifer R. Buckley, MD, MBA; Brandt C. Wible, MD; Ashraf Thabet, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • Ablation: Percutaneous direct local tumor destruction
              • Energy-based ablation
                • Radiofrequency ablation (RFA): Heat based
                  • Aerated lung limits energy deposition
                • Cryoablation: Freezing/thawing cycle
                  • Can be done closer to pleura and vessels
                • Microwave ablation: Heat-based cytotoxicity
                  • Less limited by aerated lung than RFA
                  • Risk of bronchopleural fistula along lung periphery
                • Irreversible electroporation: Electrical disruption of integrity of cell membrane
            • Embolization: Transcatheter introduction of intravascular agent for devascularization/occlusion
            • Artificial pneumothorax: Intentional creation of pneumothorax during ablation procedure
              • Displaces ablation zone away from critical structures
                • May be needed if tumor adjacent to large vascular structures (e.g., heart) or phrenic nerve

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          • Things to Avoid

                            • Postprocedure Imaging (Ablation)

                              OUTCOMES

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Cernic S et al: Percutaneous CT-guided renal cryoablation: technical aspects, safety, and long-term oncological outcomes in a single center. Medicina (Kaunas). 57(3):291, 2021
                                  2. Cazzato RL et al: Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 33(12):140, 2016
                                  3. Zhang YS et al: Percutaneous imaging-guided cryoablation for lung cancer. J Thorac Dis. 8(Suppl 9):S705-9, 2016
                                  4. Dupuy DE: Image-guided thermal ablation of lung malignancies. Radiology. 260(3):633-55, 2011
                                  5. Sofocleous CT et al: Ablation for the management of pulmonary malignancies. AJR Am J Roentgenol. 197(4):W581-9, 2011
                                  6. Vogl TJ et al: Radiofrequency, microwave and laser ablation of pulmonary neoplasms: clinical studies and technical considerations--review article. Eur J Radiol. 77(2):346-57, 2011
                                  7. Yamauchi Y et al: Percutaneous cryoablation of pulmonary metastases from colorectal cancer. PLoS One. 6(11):e27086, 2011
                                  8. Beland MD et al: Primary non-small cell lung cancer: review of frequency, location, and time of recurrence after radiofrequency ablation. Radiology. 254(1):301-7, 2010
                                  9. Pua BB et al: Ablation of pulmonary malignancy: current status. J Vasc Interv Radiol. 21(8 Suppl):S223-32, 2010
                                  10. Solomon SB et al: Protection of the mediastinum and chest wall with an artificial pneumothorax during lung ablations. J Vasc Interv Radiol. 19(4):610-5, 2008
                                  11. 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
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  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
                                                  • Aerated lung limits energy deposition
                                                • Cryoablation: Freezing/thawing cycle
                                                  • Can be done closer to pleura and vessels
                                                • Microwave ablation: Heat-based cytotoxicity
                                                  • Less limited by aerated lung than RFA
                                                  • Risk of bronchopleural fistula along lung periphery
                                                • Irreversible electroporation: Electrical disruption of integrity of cell membrane
                                            • Embolization: Transcatheter introduction of intravascular agent for devascularization/occlusion
                                            • Artificial pneumothorax: Intentional creation of pneumothorax during ablation procedure
                                              • Displaces ablation zone away from critical structures
                                                • May be needed if tumor adjacent to large vascular structures (e.g., heart) or phrenic nerve

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Procedure Steps

                                                      • Alternative Procedures/Therapies

                                                        POST PROCEDURE

                                                        • Things to Do

                                                          • Things to Avoid

                                                            • Postprocedure Imaging (Ablation)

                                                              OUTCOMES

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Cernic S et al: Percutaneous CT-guided renal cryoablation: technical aspects, safety, and long-term oncological outcomes in a single center. Medicina (Kaunas). 57(3):291, 2021
                                                                  2. Cazzato RL et al: Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol. 33(12):140, 2016
                                                                  3. Zhang YS et al: Percutaneous imaging-guided cryoablation for lung cancer. J Thorac Dis. 8(Suppl 9):S705-9, 2016
                                                                  4. Dupuy DE: Image-guided thermal ablation of lung malignancies. Radiology. 260(3):633-55, 2011
                                                                  5. Sofocleous CT et al: Ablation for the management of pulmonary malignancies. AJR Am J Roentgenol. 197(4):W581-9, 2011
                                                                  6. Vogl TJ et al: Radiofrequency, microwave and laser ablation of pulmonary neoplasms: clinical studies and technical considerations--review article. Eur J Radiol. 77(2):346-57, 2011
                                                                  7. Yamauchi Y et al: Percutaneous cryoablation of pulmonary metastases from colorectal cancer. PLoS One. 6(11):e27086, 2011
                                                                  8. Beland MD et al: Primary non-small cell lung cancer: review of frequency, location, and time of recurrence after radiofrequency ablation. Radiology. 254(1):301-7, 2010
                                                                  9. Pua BB et al: Ablation of pulmonary malignancy: current status. J Vasc Interv Radiol. 21(8 Suppl):S223-32, 2010
                                                                  10. Solomon SB et al: Protection of the mediastinum and chest wall with an artificial pneumothorax during lung ablations. J Vasc Interv Radiol. 19(4):610-5, 2008
                                                                  11. 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