PURPOSETo review the recurrence patterns in patients with primary non-small cell lung cancer (NSCLC) treated with percutaneous image-guided radiofrequency (RF) ablation.MATERIALS AND METHODSThis ...retrospective review was institutional review board approved and HIPAA compliant. Informed consent was waived. Data from all patients with primary NSCLC who underwent lung RF ablation from January 1998 to January 2008 were reviewed. Ninety-one patients were identified. Ten patients with no posttreatment imaging results and two patients with multiple treated lung cancers were excluded. There were 79 tumors in 79 patients (mean age, 75 years). Mean tumor size was 2.5 cm (range, 1-5.5 cm). Fifteen (19%) tumors were central, and 64 (81%) tumors were peripheral. Nineteen (24%) patients underwent adjuvant external beam radiation, and nine (11%) patients underwent concomitant brachytherapy. Correlation of computed tomography and positron emission tomography imaging studies with biopsy results, tumor size, location, and stage was performed. Patterns of recurrence were classified as local, intrapulmonary, nodal, mixed (local and nodal), and distant.RESULTSForty-five (57%) patients demonstrated no evidence of recurrence at follow-up imaging (range, 1-72 months; mean, 17 months). Recurrence was seen in 34 (43%) patients (range, 2-48 months; mean, 14 months). Recurrence after RF ablation was local in 13 (38%), intrapulmonary in six (18%), nodal in six (18%), mixed in two (6%), and distant metastases in seven (21%) cases. Median disease-free survival was 23 months. Sex, tumor location, and radiation therapy were not associated with risk of recurrence. Increasing tumor size (P = .02) and stage (P = .007) were related to risk of recurrence.CONCLUSIONThe most common pattern of recurrence was local, which suggests that more aggressive initial RF ablation and adjuvant radiation may offer improvement in outcomes. Continued follow-up imaging is needed because new recurrences were seen throughout the 2 years following treatment.
To retrospectively evaluate long-term survival, local tumor progression, and complication rates for all percutaneous computed tomographic (CT)-guided lung tumor radiofrequency (RF) ablations ...performed at a tertiary care cancer hospital in patients who refused or who were not candidates for surgery.
This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Between 1998 and 2005, 153 consecutive patients (mean age, 68.5 years; range, 17-94 years) with 189 primary or metastatic medically inoperable lung cancers underwent percutaneous fluoroscopic CT-guided RF ablation. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease (when available). Kaplan-Meier method was used to estimate overall survival and disease-free survival (progression) as a function of time since RF ablation. Comparisons between survival functions were performed by using the log-rank statistic; P < .05 was considered to indicate a significant difference.
The overall 1-, 2-, 3-, 4-, and 5-year survival rates, respectively, for stage I non-small cell lung cancer were 78%, 57%, 36%, 27%, and 27%; rates for colorectal pulmonary metastasis were 87%, 78%, 57%, 57%, and 57%. The 1-, 2-, 3-, 4-, and 5-year local tumor progression-free rates, respectively, were 83%, 64%, 57%, 47%, and 47% for tumors 3 cm or smaller and 45%, 25%, 25%, 25%, and 25% for tumors larger than 3 cm. The difference between the survival curves associated with large (>3 cm) and small (< or =3 cm) tumors was significant (P < .002). The overall pneumothorax rate was 28.4% (52 of 183 ablation sessions), with a 9.8% (18 of 183 ablation sessions) chest tube insertion rate. The overall 30-day mortality rate was 3.9% (six of 153 patients), with a 2.6% (four of 153 patients) procedure-specific 30-day mortality rate.
Lung RF ablation appears to be safe and linked with promising long-term survival and local tumor progression outcomes, especially given the patient population treated.
Minimally invasive alternatives to surgery for the treatment of malignancy are becoming more attractive owing to improvements in technology, reduced morbidity and mortality, and the ability to ...provide treatment in an outpatient setting. Radio-frequency (RF) ablation has become the imaging-guided ablative method of choice because of its relatively low cost, its capability of creating large regions of coagulative necrosis in a controlled fashion, and its relatively low toxicity. RF ablation in the thorax involves the use of computed tomography (CT) to localize the tumor and determine the optimal approach. The size of the tumor determines whether a cluster of electrodes or a single electrode of a particular length will be used to perform the ablation. CT fluoroscopy aids in guiding placement of the electrode. In patients with non-small cell lung malignancy who are not candidates for surgery owing to poor cardiorespiratory reserve, RF ablation alone or followed by conventional radiation therapy with or without chemotherapy may prove to be a treatment option. In patients with metastatic disease, RF ablation may be suitable for treatment of a small tumor burden or for palliation of larger tumors that cause symptoms such as cough, hemoptysis, or pain. Patients with chest wall or osseous metastatic tumors in whom other therapies have failed may benefit from RF ablation as an alternative to radiation therapy.
The aim of the study is to determine whether computed tomography (CT) urography (CTU) can characterize incidental adrenal nodules.
This retrospective cohort study was performed at an academic medical ...center. Patients were identified by free text search of CTU reports that contained the terms "adrenal mass" "adrenal nodule" and "adrenal lesion." Computed tomography urography technique consisted of unenhanced images and postcontrast images obtained at 100 seconds and 15 minutes. The final cohort included 145 patients with 151 adrenal nodules. Nodules were considered lipid-rich adenomas or myelolipomas based on unenhanced imaging characteristics. Absolute and relative washout values were calculated for the remaining nodules, using a cutoff of 60% and 40%, respectively, to diagnose adenomas. Reference standard for lipid-poor adenomas and malignant nodules was histopathology or imaging/clinical follow-up. Mann-Whitney U test was used for comparison of continuous variables, and Fisher exact test was used for categorical variables.
One hundred nodules were lipid-rich adenomas and 3 were myelolipomas. Forty-eight nodules were indeterminate at unenhanced CT, corresponding to 39 lipid-poor adenomas and 9 malignant nodules based on reference standards. Both absolute and relative washout correctly characterized 71% of nodules (34/48), with a sensitivity of 67% and specificity of 89%. Overall, 91% of all adrenal nodules (137/151) were correctly characterized by CTU alone. Lipid-poor adenomas were smaller than malignant nodules (P < 0.01) and were lower in attenuation on unenhanced and delayed images (P < 0.01).
Adrenal nodules detected at 3-phase CTU can be accurately characterized, potentially eliminating the need for subsequent adrenal protocol CT or magnetic resonance imaging.
In 21 patients undergoing percutaneous renal tumor ablation, hydrodissection with use of a mixture of 5% dextrose in water and iodinated contrast medium was performed to prevent thermal injury to ...adjacent structures. This technique allows for the movement of adjacent organs as well as improved differentiation among the hydrodissection fluid, renal tumor, and adjacent tissues.
Incidentally discovered adrenal mass Song, Julie H; Mayo-Smith, William W
The Radiologic clinics of North America,
03/2011, Letnik:
49, Številka:
2
Journal Article
Recenzirano
Adrenal masses are common incidental findings on cross-sectional imaging. Most of these masses are benign, and adenomas are the most common entity. Several imaging studies allow accurate diagnosis of ...these masses, separating inconsequential benign masses from the lesions that require treatment. This article discusses contemporary adrenal imaging and the optimal algorithm for the workup of incidentally detected adrenal masses.
The purpose of our study was to investigate whether D-dimer screening is being used effectively to determine the need for MDCT in diagnosing acute pulmonary embolism (PE) in emergency department ...patients.
We performed a retrospective review of all patients who underwent D-dimer testing or MDCT in the emergency department from January 1, 2003, through October 31, 2005. A D-dimer value of > 0.43 microg/mL was considered positive. Diagnosis of PE was made on the basis of the MDCT. Clinical algorithms for diagnosing PE mandate that patients with a low clinical suspicion for PE undergo D-dimer testing, then MDCT if positive. For patients with a high clinical suspicion for PE, MDCT should be performed without D-dimer testing.
Of 3,716 D-dimer tests, 1,431 (39%) were positive and 2,285 (61%) were negative. MDCT was performed in 166 (7%) patients with negative D-dimer results and in 826 (58%) patients with positive D-dimer results. The prevalence of PE in patients with a high clinical suspicion and no D-dimer testing was 9% (139/1,628), which was higher than the rate of PE in the positive D-dimer group at 2% (19/826) (p < 0.0001). There was no significant difference in the prevalence of PE in the positive and negative D-dimer groups (2% vs 0.6%, respectively) (p = 0.23). The sensitivity and negative predictive value of D-dimer for PE were 95% (95% CI, 73.1-99.7%) and 99% (95% CI, 96.2-99.9%), respectively.
D-dimer screening is not used according to established diagnostic algorithms to determine the need for MDCT in diagnosing acute pulmonary embolism in our emergency department.
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