Poster: ECR 2020 / C-15267 / Ablative therapy in small renal masses: our experience by: R. Stefanucci 1, E. Faiella1, F. Andresciani1, R. F. Grasso1, B. Beomonte Zobel2; 1Roma/IT, 2Rome/IT
Renal medullary carcinoma (RMC) is a rare, highly aggressive tumor recognized as an independent pathological entity. African-descent adolescents and young adults with sickle cell hemoglobinopathy are the most affected groups. This rare subtype of renal cell carcinoma has its own morphogenetic and pathological characteristics. The major clinical manifestations include gross hematuria, abdominal or flank pain, and weight loss. The prognosis is very poor, with 95% of cases diagnosed at an advanced stage of the disease. In this review, we summarize the morphologic and dynamic characteristics of RMC under various imaging modalities such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis and management strategies are also discussed.
Background: to evaluate the contribution of edema associated with histological features to the prediction of breast cancer (BC) prognosis using T2-weighted MRI radiomics. Methods: 160 patients who underwent staging 3T-MRI from January 2015 to January 2019, with 164 histologically proven invasive BC lesions, were retrospectively reviewed. Patient data (age, menopausal status, family history, hormone therapy), tumor MRI-features (location, margins, enhancement) and histological features (histological type, grading, ER, PgR, HER2, Ki-67 index) were collected. Of the 160 MRI exams, 120 were considered eligible, corresponding to 127 lesions. T2-MRI were used to identify edema, which was classified in four groups: peritumoral, pre-pectoral, subcutaneous, or diffuse. A semi-automatic segmentation of the edema was performed for each lesion, using 3D Slicer open-source software. Main radiomics features were extracted and selected using a wrapper selection method. A Random Forest type classifier was trained to measure the performance of predicting histological factors using semantic features (patient data and MRI features) alone and semantic features associated with edema radiomics features. Results: edema was absent in 37 lesions and present in 127 (62 peritumoral, 26 pre-pectoral, 16 subcutaneous, 23 diffuse). The AUC-classifier obtained by associating edema radiomics with semantic features was always higher compared to the AUC-classifier obtained from semantic features alone, for all five histological classes prediction (0.645 vs. 0.520 for histological type, 0.789 vs. 0.590 for grading, 0.487 vs. 0.466 for ER, 0.659 vs. 0.546 for PgR, and 0.62 vs. 0.573 for Ki67). Conclusions: radiomic features extracted from tumor edema contribute significantly to predicting tumor histology, increasing the accuracy obtained from the combination of patient clinical characteristics and breast imaging data.
Abstract Background: Minimally ablative therapies are now available for the treatment of lung malignancies. However, selection of the appropriate technique is not always easy and requires accurate preoperative planning. Aims: To describe the treatment of lung tumors with cryoablation. Settings and Design: We report three cases of lung malignancies that recurred close to surgical clips after surgical treatment, successfully treated by cryoablation. Materials and Methods: An initial freezing cycle was performed for 10 min, followed by a 5-min thawing cycle, and an additional 10-min freezing cycle. A final 5-min thaw was necessary to remove the needle from the iceball formed during the freezing cycle. Results: The procedures were completed successfully with no signs of surgical-clip misplacement, and excellent ablation of the lesions. Conclusion: Cryoablation is a relatively new procedure that potentially permits the local treatment of lung tumors with minimal loss of lung parenchyma.
Interventional radiology techniques have become pivotal in recent years in managing metastatic bone disease, which frequently results in skeletal complications such as fractures and severe pain. Thermoablative methods like radiofrequency ablation (RFA) and microwave ablation (MWA), when combined with vertebroplasty (VP), are proving increasingly beneficial for these patients.
Radiofrequency ablation (RFA) is a minimally invasive procedure that utilizes localized heat to treat tumors by inducing localized tissue thermal damage. The present study aimed to evaluate the temperature evolution and spatial distribution, ablation size, and reproducibility of ablation zones in ex vivo liver, kidney, and lung using a commercial device, i.e., Dophi™ R150E RFA system (Surgnova, Beijing, China), and to compare the results with the manufacturer’s specifications. Optical fibers embedding arrays of fiber Bragg grating (FBG) sensors, characterized by 0.1 °C accuracy and 1.2 mm spatial resolution, were employed for thermometry during the procedures. Experiments were conducted for all the organs in two different configurations: single-electrode (200 W for 12 min) and double-electrode (200 W for 9 min). Results demonstrated consistent and reproducible ablation zones across all organ types, with variations in temperature distribution and ablation size influenced by tissue characteristics and RFA settings. Higher temperatures were achieved in the liver; conversely, the lung exhibited the smallest ablation zone and the lowest maximum temperatures. The study found that using two electrodes for 9 min produced larger, more rounded ablation areas compared to a single electrode for 12 min. Our findings support the efficacy of the RFA system and highlight the need for tailored RFA parameters based on organ type and tumor properties. This research provides insights into the characterization of RFA systems for optimizing RFA techniques and underscores the importance of accurate thermometry and precise procedural planning to enhance clinical outcomes.
Background/Objectives: The aim of our study is to evaluate the feasibility and efficacy of the rendezvous technique for the treatment of iatrogenic ureteral injuries. Methods: From 2014 to 2019, 29 patients treated with the rendezvous technique for mono- or bilateral iatrogenic ureteral injuries were enrolled in this retrospective study. All the leaks were previously assessed by CT-urography and antegrade pyelography. Ureteral continuity was restored by performing the rendezvous technique, combining antegrade trans-nephrostomic access and a retrograde trans-cystostomic approach. A double J stent was antegradely inserted, and a nephrostomy tube was kept in place at the end of the procedure. A post-procedure CT-urography and a 30-day nephrostogram follow-up were performed. In the absence of a contrast leak, the nephrostomy tube was removed. Patient follow-up was set with CT-urography at 3, 6, and 12 months and stent substitution every 4 months. The CT-urography was performed to confirm the restored integrity of the ureter before stent removal. Results: The rendezvous technique was successful in all cases with the resolution of the ureteral leak. No major complications were observed. In all the patients, the nephrostomy tube was removed after 30 days. After performing CT-urography, the stent was removed permanently after 12 months. Only three cases showed local post-treatment stenosis treated with surgical ureteral reimplantation. Conclusions: The rendezvous technique is a safe and effective minimally invasive procedure that can be used to restore the continuity of the ureter, avoiding open surgery and providing valuable support for the management of complications after gynecological surgery.
Isolated post-traumatic rupture of renal pelvis (IPTRRP) is an extremely rare condition and only a few cases following blunt abdominal trauma have been reported in the literature. To our knowledge, no cases of IPTRRP following blunt chest trauma have been reported. We present the case of an 84-year-old woman who was admitted to our Emergency Department due to persistent left flank pain that started after she had fallen to the ground 4 days before, with blunt trauma on her chest. CT showed a rupture of the left renal pelvis with contrast extravasation, associated with multiple rib fractures. No renal and other parenchymal injuries were detected. The patient was managed conservatively with the implantation of a ureteral stent and discharged in good clinical conditions. Our case shows the first description that IPTRRP might be an uncommon but possible complication of blunt chest trauma and must be included in the differential diagnosis.
