Semin intervent Radiol 2014; 31(01): 033-041
DOI: 10.1055/s-0033-1363841
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Percutaneous Ablation of the Small Renal Mass—Techniques and Outcomes

Andrew J. Gunn
1   Department of Radiology, Massachusetts General Hospital/Harvard Medical School
,
Debra A. Gervais
2   Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
20 February 2014 (online)

Abstract

An increasing number of T1a renal cell carcinomas are being diagnosed in recent years, in part due to incidental detection from the increased use of cross-sectional imaging. Although partial nephrectomy is still considered the primary treatment for these small renal masses, percutaneous ablation is now being performed as a standard therapeutic, nephron-sparing approach in patients who are poor surgical candidates. Clinical studies to date have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical settings. This article will review various clinical aspects regarding the percutaneous ablation of small renal masses, including patient selection, preprocedural preparations, and the procedural considerations of commonly employed ablative technologies. Specific techniques such as radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, and high-intensity focused ultrasound will be addressed in detail. In addition, the technical and oncologic outcomes of percutaneous ablation will be discussed and referenced to that of partial nephrectomy.

 
  • References

  • 1 National Cancer Institute. Kidney cancer home page. Available at: http://www.cancer.gov/cancertopics/types/kidney . Accessed September 25, 2013
  • 2 Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001; 166 (5) 1611-1623
  • 3 Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. 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 2005; 185 (1) 64-71
  • 4 Zagoria RJ, Hawkins AD, Clark PE , et al. Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success. AJR Am J Roentgenol 2004; 183 (1) 201-207
  • 5 Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology 1998; 51 (2) 203-205
  • 6 Levinson AW, Su L-M, Agarwal D , et al. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J Urol 2008; 180 (2) 499-504 , discussion 504
  • 7 Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes?. J Urol 2009; 181 (1) 55-61 , discussion 61–62
  • 8 Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS ; Urologic Diseases in America Project. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer 2008; 112 (3) 511-520
  • 9 Bandi G, Hedican SP, Nakada SY. Current practice patterns in the use of ablation technology for the management of small renal masses at academic centers in the United States. Urology 2008; 71 (1) 113-117
  • 10 Hinshaw JL, Shadid AM, Nakada SY, Hedican SP, Winter III TC, Lee Jr FT. Comparison of percutaneous and laparoscopic cryoablation for the treatment of solid renal masses. AJR Am J Roentgenol 2008; 191 (4) 1159-1168
  • 11 Zlotta AR, Wildschutz T, Raviv G , et al. Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 1997; 11 (4) 251-258
  • 12 Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013; 63 (3) 486-492
  • 13 Zagoria RJ. Imaging-guided radiofrequency ablation of renal masses. Radiographics 2004; 24 (Suppl. 01) S59-S71
  • 14 American Cancer Society. Kidney cancer home page. Available at: http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-staging . Accessed September 25, 2013
  • 15 Zagoria RJ. Imaging of small renal masses: a medical success story. AJR Am J Roentgenol 2000; 175 (4) 945-955
  • 16 Uppot RN, Silverman SG, Zagoria RJ, Tuncali K, Childs DD, Gervais DA. Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol 2009; 192 (6) 1558-1570
  • 17 Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003; 170 (6 Pt 1) 2217-2220
  • 18 Tuncali K, vanSonnenberg E, Shankar S, Mortele KJ, Cibas ES, Silverman SG. Evaluation of patients referred for percutaneous ablation of renal tumors: importance of a preprocedural diagnosis. AJR Am J Roentgenol 2004; 183 (3) 575-582
  • 19 Wood BJ, Khan MA, McGovern F, Harisinghani M, Hahn PF, Mueller PR. Imaging guided biopsy of renal masses: indications, accuracy and impact on clinical management. J Urol 1999; 161 (5) 1470-1474
  • 20 Beland MD, Mayo-Smith WW, Dupuy DE, Cronan JJ, DeLellis RA. Diagnostic yield of 58 consecutive imaging-guided biopsies of solid renal masses: should we biopsy all that are indeterminate?. AJR Am J Roentgenol 2007; 188 (3) 792-797
  • 21 Silverman SG, Gan YU, Mortele KJ, Tuncali K, Cibas ES. Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 2006; 240 (1) 6-22
  • 22 DeBenedectis CM, Beland MD, Dupuy DE, Mayo-Smith WW. Utility of iodinated contrast medium in hydrodissection fluid when performing renal tumor ablation. J Vasc Interv Radiol 2010; 21 (5) 745-747
  • 23 Goldberg SN, Gazelle GS. Radiofrequency tissue ablation: physical principles and techniques for increasing coagulation necrosis. Hepatogastroenterology 2001; 48 (38) 359-367
  • 24 Best SL, Park SK, Youssef RF , et al. Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters. J Urol 2012; 187 (4) 1183-1189
  • 25 Zorn KC, Orvieto MA, Mikhail AA , et al. Case report: radiofrequency ablation-induced renal-pelvic obstruction resulting in nephrectomy. J Endourol 2007; 21 (9) 1059-1063
  • 26 Chen SH, Mouraviev V, Raj GV, Marguet CG, Polascik TJ. Ureteropelvic junction obliteration resulting in nephrectomy after radiofrequency ablation of small renal cell carcinoma. Urology 2007; 69 (5) e3-e5
  • 27 Johnson DB, Saboorian MH, Duchene DA, Ogan K, Cadeddu JA. Nephrectomy after radiofrequency ablation-induced ureteropelvic junction obstruction: potential complication and long-term assessment of ablation adequacy. Urology 2003; 62 (2) 351-352
  • 28 Cantwell CP, Wah TM, Gervais DA , 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 2008; 19 (7) 1034-1040
  • 29 Wah TM, Koenig P, Irving HC, Gervais DA, Mueller PR. Radiofrequency ablation of a central renal tumor: protection of the collecting system with a retrograde cold dextrose pyeloperfusion technique. J Vasc Interv Radiol 2005; 16 (11) 1551-1555
  • 30 Neuhaus J, Blachut L, Rabenalt R , et al. Efficiency analysis of bipolar and multipolar radiofrequency ablation in an in vivo porcine kidney model using three-dimensional reconstruction of histologic section series. J Endourol 2011; 25 (5) 859-867
  • 31 Levy D, Avallone A, Jones JS. Current state of urological cryosurgery: prostate and kidney. BJU Int 2010; 105 (5) 590-600
  • 32 Clark PE, Woodruff RD, Zagoria RJ, Hall MC. Microwave ablation of renal parenchymal tumors before nephrectomy: phase I study. AJR Am J Roentgenol 2007; 188 (5) 1212-1214
  • 33 Carrafiello G, Mangini M, Fontana F , et al. Single-antenna microwave ablation under contrast-enhanced ultrasound guidance for treatment of small renal cell carcinoma: preliminary experience. Cardiovasc Intervent Radiol 2010; 33 (2) 367-374
  • 34 Castle SM, Salas N, Leveillee RJ. Initial experience using microwave ablation therapy for renal tumor treatment: 18-month follow-up. Urology 2011; 77 (4) 792-797
  • 35 Olweny EO, Cadeddu JA. Novel methods for renal tissue ablation. Curr Opin Urol 2012; 22 (5) 379-384
  • 36 Nabi G, Goodman C, Melzer A. High intensity focused ultrasound treatment of small renal masses: Clinical effectiveness and technological advances. Indian J Urol 2010; 26 (3) 331-337
  • 37 Gehl J. Electroporation: theory and methods, perspectives for drug delivery, gene therapy and research. Acta Physiol Scand 2003; 177 (4) 437-447
  • 38 Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B. In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng 2006; 53 (7) 1409-1415
  • 39 Tracy CR, Kabbani W, Cadeddu JA. Irreversible electroporation (IRE): a novel method for renal tissue ablation. BJU Int 2011; 107 (12) 1982-1987
  • 40 Deodhar A, Monette S, Single Jr GW , et al. Renal tissue ablation with irreversible electroporation: preliminary results in a porcine model. Urology 2011; 77 (3) 754-760
  • 41 Pech M, Janitzky A, Wendler JJ , et al. Irreversible electroporation of renal cell carcinoma: a first-in-man phase I clinical study. Cardiovasc Intervent Radiol 2011; 34 (1) 132-138
  • 42 Zagoria RJ, Traver MA, Werle DM, Perini M, Hayasaka S, Clark PE. Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol 2007; 189 (2) 429-436
  • 43 Mayo-Smith WW, Dupuy DE, Parikh PM, Pezzullo JA, Cronan JJ. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients. AJR Am J Roentgenol 2003; 180 (6) 1503-1508
  • 44 Breen DJ, Rutherford EE, Stedman B , et al. Management of renal tumors by image-guided radiofrequency ablation: experience in 105 tumors. Cardiovasc Intervent Radiol 2007; 30 (5) 936-942
  • 45 Farrell MA, Charboneau WJ, DiMarco DS , et al. Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol 2003; 180 (6) 1509-1513
  • 46 Su Li, Jarrett TW, Chan DY, Kavoussi LR, Solomon SB. Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results. Urology 2003; 61 (4) (Suppl. 01) 26-33
  • 47 Atwell TD, Farrell MA, Leibovich BC , et al. Percutaneous renal cryoablation: experience treating 115 tumors. J Urol 2008; 179 (6) 2136-2140 , discussion 2140–2141
  • 48 Georgiades CS, Hong K, Bizzell C, Geschwind JF, Rodriguez R. Safety and efficacy of CT-guided percutaneous cryoablation for renal cell carcinoma. J Vasc Interv Radiol 2008; 19 (9) 1302-1310
  • 49 Zagoria RJ, Pettus JA, Rogers M, Werle DM, Childs D, Leyendecker JR. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology 2011; 77 (6) 1393-1397
  • 50 Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer 2010; 116 (13) 3135-3142
  • 51 McDougal WS, Gervais DA, McGovern FJ, Mueller PR. Long-term followup of patients with renal cell carcinoma treated with radiofrequency ablation with curative intent. J Urol 2005; 174 (1) 61-63
  • 52 Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol 2012; 61 (6) 1156-1161
  • 53 Choueiri TK, Schutz FA, Hevelone ND , et al. Thermal ablation vs surgery for localized kidney cancer: a Surveillance, Epidemiology, and End Results (SEER) database analysis. Urology 2011; 78 (1) 93-98
  • 54 Gervais DA. Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess?. J Vasc Interv Radiol 2013; 24 (8) 1135-1138
  • 55 Kunkle DA, Uzzo RG. Cryoablation or radiofrequency ablation of the small renal mass : a meta-analysis. Cancer 2008; 113 (10) 2671-2680
  • 56 El Dib R, Touma NJ, Kapoor A. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110 (4) 510-516
  • 57 Kowalczyk KJ, Choueiri TK, Hevelone ND , et al. Comparative effectiveness, costs and trends in treatment of small renal masses from 2005 to 2007. BJU Int 2013; 112 (4) E273-E280
  • 58 Yang G, Villalta JD, Meng MV, Whitson JM. Evolving practice patterns for the management of small renal masses in the USA. BJU Int 2012; 110 (8) 1156-1161