Percutaneous image-guided cryoablation of painful metastases involving bone: multicenter trial.

BACKGROUND: This study sought to describe the results of a single-arm multicenter clinical trial using image-guided percutaneous cryoablation for the palliation of painful metastatic tumors involving bone. METHODS: Over a 44-month period, 61 adult patients with 1 or 2 painful bone metastases with a score of 4 or more on a scale of 0 to 10 (≥4/10) worst pain in a 24-hour period who had failed or refused conventional treatment were treated with percutaneous image-guided cryoablation. Patient pain and quality of life was measured using the Brief Pain Inventory prior to treatment, 1 and 4 days after the procedure, weekly for 4 weeks, and every 2 weeks thereafter for a total of 6 months. Patient analgesic use was also recorded at these same follow-up intervals. Complications were monitored. Analysis of the primary endpoint was undertaken via paired comparison procedures. RESULTS: A total of 69 treated tumors ranged in size from 1 to 11 cm. Prior to cryoablation, the mean score for worst pain in a 24-hour period was 7.1/10 with a range of 4/10 to 10/10. At 1, 4, 8, and 24 weeks after treatment, the mean score for worst pain in a 24-hour period decreased to 5.1/10 (P < .0001), 4.0/10 (P < .0001), 3.6/10 (P < .0001), and 1.4/10 (P < .0001), respectively. One of 61 (2%) patients had a major complication with osteomyelitis at the site of ablation. CONCLUSIONS: Percutaneous cryoablation is a safe, effective, and durable method for palliation of pain due to metastatic disease involving bone.

Blood patch rates after lumbar puncture with Whitacre versus Quincke 22- and 20-gauge spinal needles.

OBJECTIVE: The objective of our study was to compare the incidence of blood patch as the best objective indicator of postdural puncture headache after elective fluoroscopic lumbar puncture with the use of a 22-gauge Whitacre (pencil point) needle versus standard 22- and 20-gauge Quincke (bevel-tip) needles and to determine the best level of puncture. MATERIALS AND METHODS: The records of 724 consecutive patients who were referred to St. Mary's Medical Center department of radiology for fluoroscopic lumbar puncture from January 2003 through April 2007 were retrospectively reviewed. Emergency requests (191) were discarded along with those for patients with clinical signs of pseudotumor cerebri (21), normal pressure hydrocephalus (3), and failed attempts (4). The collective total was 505 elective lumbar punctures. RESULTS: The blood patch rate for the 22-gauge Whitacre needle was 4.2%. The result for the 22-gauge Quincke point needle was 15.1% whereas that for the 20-gauge Quincke point needle was 29.6%. In addition, the level of puncture showed a blood patch rate that increased as the level of lumbar puncture lowered. The highest level of lumbar puncture was L1-L2 with the lowest recorded level being L5-S1. CONCLUSION: The Whitacre needle is associated with a significantly lower incidence of blood patch rate after lumbar puncture. The highest level of puncture (L1-L2) also provides the lowest level of blood patch rate.

Percutaneous imaging-guided solid organ core needle biopsy: coaxial versus noncoaxial method.

OBJECTIVE: The purpose of our study was to compare the diagnostic yield and complication rate of coaxial technique with those of noncoaxial technique in percutaneous imaging-guided renal and hepatic core biopsies. We also compared bleeding complication rates with and without absorbable gelatin sponge occlusion of the biopsy track. MATERIALS AND METHODS: The records of 1,060 consecutively registered patients who underwent percutaneous imaging-guided hepatic or renal biopsy at two hospitals were retrospectively reviewed. Core specimens were obtained in all biopsies. Indications for biopsy included acquisition of general tissue specimens to evaluate for hepatic (n = 495) or renal disease (n = 243) and acquisition of specimens of specific hepatic (n = 289) and renal (n = 33) lesions. Samples were acquired with a coaxial set of needles (n = 764) or with a noncoaxial needle (n = 296 patients). Absorbable gelatin sponge was injected before removal of the outer needle in 269 of the 764 coaxial biopsies. Gelatin sponge was not injected in the other 495 coaxial biopsies. Complication rates were evaluated in a comparison of the two methods and of the coaxial biopsies with and without postprocedural injection of gelatin sponge. Complications were considered minor if follow-up imaging in the 7 days after the procedure showed a complication that did not necessitate treatment other than conservative pain management. Complications were considered major if treatment such as blood product transfusion or surgery was needed or if the patient died. RESULTS: Specimens were immediately given to a pathologist, who typically was present during the procedure. Specimens were evaluated and judged adequate for a specific diagnosis by the histopathology staff. The rates of minor complications were 3.4% (10/296) for the noncoaxial method and 2.6% (20/764) for the coaxial method. The rates of major complications were 1.0% (3/296) for the noncoaxial method and 0.9% (7/764) for the coaxial method. Six cases of major complications necessitating blood product transfusion were documented for the coaxial method and one case for the noncoaxial method. One (0.1%) of the patients undergoing coaxial biopsy died. One patient undergoing noncoaxial biopsy needed surgical repair of an arterial injury that was refractory to blood transfusion, and another developed pancreatitis and needed a blood transfusion. The percentage of minor complications of the coaxial method with absorbable gelatin sponge injection was 3.7% (10/269), and that of major complications was 0.7% (2/269). There was no statistical difference in complication rates between the various methods of percutaneous hepatic and renal biopsy. CONCLUSION: In regard to complications, there are no differences between coaxial and noncoaxial biopsy methods or between the coaxial method with or without injection of absorbable gelatin sponge.

Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study.

PURPOSE: Few options are available for pain relief in patients with bone metastases who fail standard treatments. We sought to determine the benefit of radiofrequency ablation (RFA) in providing pain relief for patients with refractory pain secondary to metastases involving bone. PATIENTS AND METHODS: Thirty-one US and 12 European patients with painful osteolytic metastases involving bone were treated with image-guided RFA using a multitip needle. Treated patients had > or = 4/10 pain and had either failed or were poor candidates for standard treatments such as radiation or opioid analgesics. Using the Brief Pain Inventory-Short Form, worst pain intensity was the primary end point, with a 2-unit drop considered clinically significant. RESULTS: Forty-three patients were treated (median follow-up, 16 weeks). Before RFA, the mean score for worst pain was 7.9 (range, 4/10 to 10/10). Four, 12, and 24 weeks following treatment, worst pain decreased to 4.5 (P <.0001), 3.0 (P <.0001), and 1.4 (P =.0005), respectively. Ninety-five percent (41 of 43 patients) experienced a decrease in pain that was considered clinically significant. Opioid usage significantly decreased at weeks 8 and 12. Adverse events were seen in 3 patients and included (1) a second-degree skin burn at the grounding pad site, (2) transient bowel and bladder incontinence following treatment of a metastasis involving the sacrum, and (3) a fracture of the acetabulum following RFA of an acetabular lesion. CONCLUSION: RFA of painful osteolytic metastases provides significant pain relief for cancer patients who have failed standard treatments.