title: Simultaneous computed tomography-guided biopsy and radiofrequency ablation of solitary pulmonary malignancy in high-risk patients.
abstract: BACKGROUND
  In recent years experience has been accumulated in percutaneous radiofrequency ablation (RFA) of lung malignancies in nonsurgical patients.
  
  
  OBJECTIVE
  In this study, we retrospectively evaluated a simultaneous diagnostic and therapeutic approach including CT-guided biopsy followed immediately by RFA of solitary malignant pulmonary lesions.
  
  
  METHODS
  CT-guided transthoracic core needle biopsy of solitary pulmonary lesions suspicious for malignancy was performed and histology was proven based on immediate frozen sections. RFA probes were placed into the pulmonary tumors under CT guidance and the ablation was performed subsequently. The procedure-related morbidity was analyzed. Follow-up included a CT scan and pulmonary function parameters.
  
  
  RESULTS
  A total of 33 CT-guided biopsies and subsequent RFA within a single procedure were performed. Morbidity of CT-guided biopsy included pulmonary hemorrhage (24%) and a mild pneumothorax (12%) without need for further interventions. The RFA procedure was not aggravated by the previous biopsy. The rate of pneumothorax requiring chest tube following RFA was 21%. Local tumor control was achieved in 77% with a median follow-up of 12 months. The morbidity of the CT-guided biopsy had no statistical impact on the local recurrence rate.
  
  
  CONCLUSIONS
  The simultaneous diagnostic and therapeutic approach including CT-guided biopsy followed immediately by RFA of solitary malignant pulmonary lesions is a safe procedure. The potential of this combined approach is to avoid unnecessary therapies and to perform adequate therapies based on histology. Taking the local control rate into account, this approach should only be performed in those patients who are unable to undergo or who refuse surgery.
authors.affiliation: Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany. thomas.schneider@thoraxklinik-heidelberg.de
authors.forename: T
authors.initials: T
authors.lastname: Schneider
authors.forename: M
authors.initials: M
authors.lastname: Puderbach
authors.forename: J
authors.initials: J
authors.lastname: Kunz
authors.forename: A
authors.initials: A
authors.lastname: Bischof
authors.forename: F L
authors.initials: FL
authors.lastname: Giesel
authors.forename: H
authors.initials: H
authors.lastname: Dienemann
authors.forename: F J F
authors.initials: FJ
authors.lastname: Herth
authors.forename: P A
authors.initials: PA
authors.lastname: Schnabel
authors.forename: S
authors.initials: S
authors.lastname: Safi
authors.forename: H
authors.initials: H
authors.lastname: Hoffmann
authors.forename: C P
authors.initials: CP
authors.lastname: Heussel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000473:pathology / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods