title: Pleural puncture that excludes the ablation zone decreases the risk of pneumothorax after percutaneous microwave ablation in porcine lung.
abstract: OBJECTIVE
  To test the hypothesis that the geometry of probe placement with respect to the pleural puncture site affects the risk of pneumothorax after microwave (MW) ablation in the lung.
  
  
  METHODS
  Computed tomography-guided MW ablation of the lung was performed in 8 swine under general anesthesia and mechanical ventilation. The orientation of the 17-gauge probe was either perpendicular (90°) or parallel (< 30°) with respect to the pleural puncture site, and the ablation power was 30 W or 65 W for 5 minutes. After MW ablation, swine were euthanized, and histopathologic changes were assessed. Frequency and factors affecting pneumothorax were evaluated by multivariate analysis.
  
  
  RESULTS
  Among 62 lung MW ablations, 13 (21%) pneumothoraces occurred. No statistically significant difference was noted in the rate of pneumothorax between the perpendicular and the parallel orientations of the probe (31% vs 14%; odds ratio [OR], 2.8; P = .11). The pneumothorax rate was equal for 65-W and 30-W ablation powers (21% and 21%; OR, 1.0; P = .94). Under multivariate analysis, 2 factors were independent positive predictors of pneumothorax: ablation zone inclusive of pleural insertion point (OR, 7.7; P = .02) and time since intubation (hours) (OR, 2.7; P = .02).
  
  
  CONCLUSIONS
  Geometries where the pleural puncture site excluded the ablation zone decreased pneumothorax in swine undergoing MW ablation in the lung. Treatment planning to ensure that the pleural puncture site excludes the subsequent ablation zone may reduce the rate of pneumothorax in patients undergoing MW ablation in the lung.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Kyungmouk Steve
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Takaki
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Hooman
authors.initials: H
authors.lastname: Yarmohammadi
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Srimathveeravalli
authors.affiliation: Research Animal Resource Center Memorial, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Kerith
authors.initials: K
authors.lastname: Luchins
authors.affiliation: Laboratory of Comparative Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Monette
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Sreejit
authors.initials: S
authors.lastname: Nair
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.
authors.forename: Sirish
authors.initials: S
authors.lastname: Kishore
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065.. Electronic address: erinjerj@mskcc.org.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects* / Q000295:instrumentation; D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D005260:Female; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008872:Microwaves / Q000009:adverse effects*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010994:Pleura; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control*; D011677:Punctures; D012307:Risk Factors; D013552:Swine; D014057:Tomography, X-Ray Computed