V4-08: Preliminary Results of Advanced Image-Guided Renal Biopsy and Thermal Ablation Utilizing Cone-Beam Computerized Tomography: A Surgeons Procedure.
Introduction: The diagnosis of incidental small renal masses (SRM) has increased partly due to the use of cross sectional imaging. Partial nephrectomy is now considered the &[Prime]Gold&[Prime] standard whereas thermal ablation (TA) is an alternative option for sub-optimal surgical candidates. TA in most institutions is performed by Interventional Radiologists with little participation by Urologic Oncologists (UO). In this study patients with SRM were treated by TA using cone-beam computerized tomography (CBCT) [Artis-X, Siemens Healthcare, GmbH] coupled with digital fluoroscopy. Using &[Prime]I-Guide&[Prime] software, needle placement is facilitated and simplified. _x000D_ Objective: To demonstrate the CBCT renal biopsy (RB) and TA technique for select patients with SRM as performed by UO.
20 patients with SRM underwent RB and TA between January and September 2016 (Table 1). Procedures were performed under general anesthesia. 1-3 TA probes were placed (Cool-tip radiofrequency needle, Covidien, Boulder CO, USA). The number of ablation cycles, core biopsies, amount of radiation and contrast used, and intra-operative complications were individualized and recorded. Post-operative complications were evaluated using the Clavien-Dindo classification of surgical complications.
With a median 3 month follow up there were no technical failures and all patients had 6 week contrast enhanced CT demonstrating no enhancement (Table 2). _x000D_
With access to appropriate image guidance tools, Urologists can become more involved in the diagnosis and treatment of SRM. Advanced targeting is now simplified making it possible for oncologic surgeons to perform TA on select patients. Further follow up on this cohort is essential.