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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 11/2016

01-11-2016 | Technical Note

Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes

Authors: Julien Garnon, Guillaume Koch, Jean Caudrelier, Nitin Ramamurthy, Pramod Rao, Georgia Tsoumakidou, Roberto Luigi Cazzato, Afshin Gangi

Published in: CardioVascular and Interventional Radiology | Issue 11/2016

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Abstract

Objective

This study was designed to describe the technique of percutaneous image-guided cryoablation with large-volume hydrodissection for the treatment of challenging mediastinal lesions.

Methods

Between March 2014 and June 2015, three patients (mean age 62.7 years) with four neoplastic anterior mediastinal lesions underwent five cryoablation procedures using large-volume hydrodissection. Procedures were performed under general anaesthesia using CT guidance. Lesion characteristics, hydrodissection and cryoablation data, technical success, complications, and clinical outcomes were assessed using retrospective chart review.

Results

Lesions (mean size 2.7 cm; range 2–4.3 cm) were in contact with great vessels (n = 13), trachea (n = 3), and mediastinal nerves (n = 6). Hydrodissection was performed intercostally (n = 4), suprasternally (n = 2), transsternally (n = 1), or via the sternoclavicular joint (n = 1) using 1–3 spinal needles over 13.4 (range 7–26) minutes; 450 ml of dilute contrast was injected (range 300–600 ml) and increased mean lesion-collateral structure distance from 1.9 to 7.7 mm. Vulnerable mediastinal nerves were identified in four of five procedures. Technical success was 100 %, with one immediate complication (recurrent laryngeal nerve injury). Mean follow-up period was 15 months. One lesion demonstrated residual disease on restaging PET-CT and was retreated to achieve complete ablation. At last follow-up, two patients remained disease-free, and one patient developed distant disease after 1 year without local recurrence.

Conclusions

Cryoablation using large-volume hydrodissection is a feasible technique, enabling safe and effective treatment of challenging mediastinal lesions.
Literature
1.
Matsuda Y, Yano M, Miyoshi N, Noura S, Ohue M, Sugimura K, Motoori M, Kishi K, Fujiwara Y, Gotoh K, Marubashi S, Akita H, Takahashi H, Sakon M. Solitary mediastinal lymph node recurrence after curative resection of colon cancer. World J Gastrointest Surg. 2014;6(8):164–8.CrossRefPubMedPubMedCentral
2.
Kanzaki R, Higashiyama M, Okami J, Kodama K. Surgical treatment for patients with solitary metastasis in the mediastinal lymph node from renal cell carcinoma. Interact CardioVasc Thorac Surg. 2009;8(4):485–7.CrossRefPubMed
3.
Manabe Y, Shibamoto Y, Baba F, Murata R, Yanagi T, Hashizume C, Iwata H, Kosaki K, Miyakawa A, Murai T, Yano M. Radiotherapy for hilar or mediastinal lymph node metastases after definitive treatment with stereotactic body radiotherapy or surgery for stage I non-small cell lung cancer. Pract Radiat Oncol. 2012;2(4):e137–43.CrossRefPubMed
4.
De Leyn P, Dooms C, Kuzdzal J, Lardinois D, Passlick B, Rami-Porta R, Turna A, Van Schil P, Venuta F, Waller D, Weder W, Zielinski M. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014;45(5):787–98.CrossRefPubMed
5.
6.
Pereira PL, Masala S. Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Standards of practice: guidelines for thermal ablation of primary and secondary lung tumors. Cardiovasc Intervent Radiol. 2012;35(2):247–54.CrossRefPubMed
7.
McCarley JR, Soulen MC. Percutaneous ablation of hepatic tumors. Sem Intervent Radiol. 2010;27(3):255–60.CrossRef
8.
Pusceddu C, Melis L, Meloni GB. Feasibility and safety of CT-guided percutaneous radiofrequency, microwave or cryoablation of the pulmonary and mediastinal unresectable tumours adjacent to the heart and large vessels. Paper presented at European Congress of Radiology, March 7–11 2013, Vienna, Austria.
9.
Thanos L, Mylona S, Giannoulakos N, Ptohis N, Galani P, Pomoni M. Percutaneous radiofrequency ablation of lung tumors in contact with the aorta: dangerous and difficult but efficient: a report of two cases. Cardiovasc Intervent Radiol. 2008;31(6):1205–9.CrossRefPubMed
10.
Iguchi T, Hiraki T, Gobara H, Mimura H, Fujiwara H, Tajiri N, Sakurai J, Yasui K, Date H, Kanazawa S. Percutaneous radiofrequency ablation of lung tumors close to the heart or aorta: evaluation of safety and effectiveness. J Vasc Interv Radiol. 2007;18(6):733–40.CrossRefPubMed
11.
Colak E, Tatlı S, Shyn PB, Tuncalı K, Silverman SG. CT-guided percutaneous cryoablation of central lung tumors. Diagn Interv Radiol. 2014;20(4):316–22.CrossRefPubMedPubMedCentral
12.
Abtin F, Suh RD, Nasehi L, Han SX, Hsu W, Quirk M, Genshaft S, Gutierrez AJ, Cameron RB. Percutaneous cryoablation for the treatment of recurrent thymoma: preliminary safety and efficacy. J Vasc Interv Radiol. 2015;26(5):709–14.CrossRefPubMed
13.
Hiraki T, Yasui K, Mimura H, Gobara H, Mukai T, Hase S, Fujiwara H, Tajiri N, Naomoto Y, Yamatsuji T, Shirakawa Y, Asami S, Nakatsuka H, Hanazaki M, Morita K, Tanaka N, Kanazawa S. Radiofrequency ablation of metastatic mediastinal lymph nodes during cooling and temperature monitoring of the tracheal mucosa to prevent thermal tracheal damage: initial experience. Radiology. 2005;237(3):1068–74.CrossRefPubMed
14.
15.
Patel IJ, Davidson JC. Standards of Practice Committee, with Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36.CrossRefPubMed
16.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
17.
Paliogiannis P, Pala C, Versace R, Pusceddu C. Radiofrequency ablation in the management of advanced stage thymomas: a case report on a novel multidisciplinary therapeutic approach. Case Rep Radiol. 2014;2014:697480.PubMedPubMedCentral
18.
19.
Yamauchi Y, Izumi Y, Hashimoto K, Yashiro H, Inoue M, Nakatsuka S, Kawamura M, Nomori H. Palliative percutaneous cryoablation in a patient with locally advanced invasive thymoma. Eur Respir J. 2012;39(2):505–7.CrossRefPubMed
20.
Langen HJ, Klose KC, Keulers P, Adam G, Jochims M, Günther RW. Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results. Radiology. 1995;196(3):703–6.CrossRefPubMed
21.
Hiraki T, Gobara H, Iguchi T, Fujiwara H, Matsui Y, Kanazawa S. Creation of an artificial hydromediastinum for radiofrequency ablation of lung tumor: a report of two cases. J Vasc Interv Radiol. 2014;25(11):1834–7.CrossRefPubMed
22.
Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol. 2009;19(11):2630–40.CrossRefPubMed
23.
Farrell MA, Charboneau JW, Callstrom MR, Reading CC, Engen DE, Blute ML. Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol. 2003;181(5):1315–7.CrossRefPubMed
24.
DeBenedectis CM, Beland MD, Dupuy DE, Mayo-Smith WW. Utility of iodinated contrast medium in hydrodissection fluid when performing renal tumor ablation. J Vasc Interv Radiol. 2010;21(5):745–7.CrossRefPubMed
25.
26.
Ishii H, Hiraki T, Gobara H, Fujiwara H, Mimura H, Yasui K, Doke T, Mukai T, Kurokawa H, Ando Y, Hase S, Iguchi T, Yabuki T, Omae K, Tajiri N, Mitsuhashi T, Kanazawa S. Risk factors for systemic air embolism as a complication of percutaneous CT-guided lung biopsy: multicenter case-control study. Cardiovasc Intervent Radiol. 2014;37(5):1312–20.CrossRefPubMed
27.
Campbell C, Lubner MG, Hinshaw JL, Muñoz del Rio A, Brace CL. Contrast media-doped hydrodissection during thermal ablation: optimizing contrast media concentration for improved visibility on CT images. AJR Am J Roentgenol. 2012;199(3):677–82.CrossRefPubMedPubMedCentral
Metadata
Title
Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes
Authors
Julien Garnon
Guillaume Koch
Jean Caudrelier
Nitin Ramamurthy
Pramod Rao
Georgia Tsoumakidou
Roberto Luigi Cazzato
Afshin Gangi
Publication date
01-11-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 11/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1396-0

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