CT-guided percutaneous cryoablation of renal masses in selected patients.
OBJECTIVE
We analysed our experience with computed tomography (CT)-guided percutaneous cryoablation (PCA) in patients who were not surgical candidates or refused surgery for small to medium-sized renal masses.


METHODS
Two freezing cycles were applied and separated by a passive warming cycle using 1.7- and 2.4-mm cryoprobes under either general anaesthesia or sedation based on patient positioning and respiratory status. Postoperative monitoring included haematological and biochemistry evaluation and CT scan 24 h after PCA. Follow-up consisted of a multislice CT scan at 1 month and every 3 months in the first year then every 6 months thereafter.


RESULTS
Thirty-seven patients (38 lesions) underwent 40 PCA procedures; 5/37 (13.5%) had a solitary kidney. Median mass size was 35 (range 12-70) mm. No complications occurred during the procedure. Clavien grade ≥2 anaemia occurred in two patients (5.4 %): one patient required 1 U of packed red blood cells; the other required an arterial embolisation. Serum creatinine did not increase in any case. Two patients showed persisting or recurrent disease at 1 and 9 months, respectively, and both could be re-treated with PCA. All other patients showed a hypodense mass 3 months after PCA, with no contrast enhancement. Subsequent examinations showed that lesion sizes decreased and CT densitometry remained stable or increased minimally, also with no contrast enhancement.


CONCLUSIONS
PCA proved relatively easy and safe and could be considered an effective alternative for patients who are not surgical candidates or refuse surgery, as well as in patients with medium-sized lesions.
Department of Radiology, National Cancer Institute, Via Venezian 1, 20133, Milan, Italy. carlo.spreafico@istitutotumori.mi.it
C
C
Spreafico
N
N
Nicolai
R
R
Lanocita
C
C
Morosi
M
M
Catanzaro
E
E
Civelli
T
T
Torelli
S
S
Stagni
L
L
Piva
L F
LF
Frigerio
A
A
Marchianò
R
R
Salvioni
D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007479:Iopamidol; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media; D007479:Iopamidol