Learning objectives
·To describe indications for ablative therapy (AT) in small renal masses, illustrating the various techniques performed in our University-hospital.
·To discuss common complications, post-procedural imaging findings and the expected findings during the follow-up.
Background
Nowadays, the detection of small renal masses (SRMs), ≤4cm, has increased due to the rising use of imaging tests.
SRMs might be simple renal cysts that require no treatment or follow-up (Bosniak classification[1]: category I and II) (Table1) but in a notable proportion of cases these are benign renal lesions (i.e. angiomyolipoma) or malignant renal cell carcinomas that might require additional procedures or interventions[2].
Renal cell carcinoma (RCC) comprises approximately 3.8% of all new cancer in the Western world; the detection rate of RCC has...
Findings and procedure details
To ablate renal cancer several different techniques can be used. In our University-Hospital in the last 15 years 250 patients underwent AT, i.e. radiofrequency ablation (47%), cryoablation (31%) and microwave ablation (22%), performed under CT and US guidance; indications of renal percutaneous AT are displayed in Table 3.
2.1 Procedural and technical considerations
2.1.1Radiofrequency ablation (RFA)
RFA is the most widely used ablative modality, with the longest follow-up results available.
It induces thermal damage through frictional heating due to ionic oscillation by high-frequency alternating current...
Conclusion
AT is now accepted as effective treatment for SRMs. The respect of the actual indications and the collection of results of AT compared to surveillance and surgery would contribute to the evolution of AT indications in the future.
The role of radiologists is essential to diagnose, treat and evaluate post-ablation imaging of SRMs.
Personal information and conflict of interest
R. Stefanucci; Rome/IT - nothing to disclose
E. Faiella; Rome/IT - nothing to disclose
F. Andresciani; Rome/IT - nothing to disclose
R. F. Grasso; Rome/IT - nothing to disclose
B. B. Beomonte Zobel; Rome/IT - nothing to disclose
References
[1] Guidelines on the management of renal cyst disease. Whelan TF. Can Urol Assoc J. 2010 Apr;4(2):98-9.
[2] Imaging Findings of Common Benign Renal Tumors in the Era of Small Renal Masses: Differential Diagnosis from Small Renal Cell Carcinoma: Current Status and Future Perspectives. Woo S, Cho JY. Korean J Radiol. 2015 Jan-Feb;16(1):99–113.
[3] CIRSE Guidelines on Percutaneous Ablation of Small Renal Cell Carcinoma. Krokidis ME, Orsi F, Katsanos K, Helmberger T, Adam A. Cardiovasc Intervent Radiol. 2017 Feb;40(2):177-191.
[4] Percutaneous ablation for small renal...
