title: Improved outcome of percutaneous radiofrequency ablation in renal cell carcinoma: a retrospective study of intraoperative contrast-enhanced ultrasonography in 73 patients.
abstract: OBJECTIVE
  To evaluate the impact of contrast-enhanced ultrasonography (CEUS) during percutaneous radiofrequency ablation (PRFA) procedure in renal cell carcinoma (RCC).
  
  
  METHODS
  From January 2008 to July 2010, 73 patients with sporadic unilateral RCC were enrolled to our study (57 men and 16 women, age range: 37-78 years, mean age 57.9 years). The diameter of the tumor was 1.7-5.8, 3.4 cm on average. The patients were divided into two groups depending on the intraoperative ultrasonography type: CEUS group and conventional ultrasound group. Patients in CEUS group received CEUS before insertion of the electrode, and the second CEUS was performed right after the initial ablation to dynamically evaluate the images. If there was highly suspicious residue, additional ablation and repeated CEUS were applied. Patients in the conventional ultrasound group received PRFA guided by gray-scale ultrasound. All of these patients received contrast-enhanced computed tomography (CT) examination 7 days after the procedure (patients in CEUS group received CEUS conducted with each CT scan), with subsequent CT and CEUS assessment at 3, 6, and every 6 months thereafter.
  
  
  RESULTS
  The mean follow-up period was 22 months (range: 12-42 months). All tumors were biopsied before RFA. The local tumor control rate was 94.6% (35/37) in the CEUS group and 86.1% (31/36) in the conventional ultrasound group (P < 0.05); the cancer-specific survival rate and the overall survival rate were 100%. The post-RFA (12 months) mean GFR levels were 84.7 ± 27.5 mL/min/1.73 m(2) (P > 0.05, compared with pre-GFR: 86.4 ± 26.2 mL/min/1.73 m(2)) in the CEUS group and 81.9 ± 22.8 mL/min/1.73 m(2) (P > 0.05, compared with pre-GFR: 83.5 ± 23.7 mL/min/1.73 m(2)) in the conventional ultrasound group.
  
  
  CONCLUSIONS
  Intraoperative CEUS can "real-time" monitor the ablated area during PRFA procedure. This technique can help to achieve a higher success rate compared with conventional ultrasound. No impact of intraoperative CEUS has been found on GFR level.
authors: Urology Department, The Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors: Xiaozhi
authors: X
authors: Zhao
authors: Wei
authors: W
authors: Wang
authors: Shiwei
authors: S
authors: Zhang
authors: Jun
authors: J
authors: Liu
authors: Fan
authors: F
authors: Zhang
authors: Changwei
authors: C
authors: Ji
authors: Xiaogong
authors: X
authors: Li
authors: Weidong
authors: W
authors: Gan
authors: Gutian
authors: G
authors: Zhang
authors: Hongqian
authors: H
authors: Guo
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride