A prognostic model for thermal ablation of benign thyroid nodules based on interpretable machine learning.

Introduction: The detection rate of benign thyroid nodules is increasing every year, with some affected patients experiencing symptoms. Ultrasound-guided thermal ablation can reduce the volume of nodules to alleviate symptoms. As the degree and speed of lesion absorption vary greatly between individuals, an effective model to predict curative effect after ablation is lacking. This study aims to predict the efficacy of ultrasound-guided thermal ablation for benign thyroid nodules using machine learning and explain the characteristics affecting the nodule volume reduction ratio (VRR). Design: Prospective study. Patients: The clinical and ultrasonic characteristics of patients who underwent ultrasound-guided thermal ablation of benign thyroid nodules at our hospital between January 2020 and January 2023 were recorded. Measurements: Six machine learning models (logistic regression, support vector machine, decision tree, random forest, eXtreme Gradient Boosting [XGBoost], and Light Gradient Boosting Machine [LGBM]) were constructed to predict efficacy; the effectiveness of each model was evaluated, and the optimal model selected. SHapley Additive exPlanations (SHAP) was used to visualize the decision process of the optimal model and analyze the characteristics affecting the VRR. Results: In total, 518 benign thyroid nodules were included: 356 in the satisfactory group (VRR ≥70% 1 year after operation) and 162 in the unsatisfactory group. The optimal XGBoost model predicted satisfactory efficacy with 78.9% accuracy, 88.8% precision, 79.8% recall rate, an F1 value of 0.84 F1, and an area under the curve of 0.86. The top five characteristics that affected VRRs were the proportion of solid components < 20%, initial nodule volume, blood flow score, peripheral blood flow pattern, and proportion of solid components 50-80%. Conclusions: The models, based on interpretable machine learning, predicted the VRR after thermal ablation for benign thyroid nodules, which provided a reference for preoperative treatment decisions.

The Paradox of Modern Technology in Standardizing Thermal Liver Ablation: Fostering Uniformity or Diversity?

PURPOSE: Currently, significant medical practice variation exists in thermal ablation (TA) of malignant liver tumors with associated differences in outcomes. The IMaging and Advanced Guidance for workflow optimization in Interventional Oncology (IMAGIO) consortium aims to integrate interventional oncology into the standard clinical pathway for cancer treatment in Europe by 2030, by development of a standardized low-complex-high-precision workflow for TA of malignant liver tumors. This study was conducted at the start of the IMAGIO project with the aim to explore the current state and future role of modern technology in TA of malignant liver tumors. MATERIALS AND METHODS: A cross-sectional questionnaire was conducted followed by an expert focus group discussion with core members and collaborating partners of the consortium. RESULTS: Of the 13 participants, 10 respondents filled in the questionnaire. During the focus group discussion, there was consensus on the need for international standardization in TA and several aspects of the procedure, such as planning based on cross-sectional images, the adoption of different techniques for needle placement and the importance of needle position- and post-ablative margin confirmation scans. Yet, also considerable heterogeneity was reported in the adoption of modern technology, particularly in navigational systems and computer-assisted margin assessment. CONCLUSION: This study mirrored the current diversity in workflow of thermal liver ablation. To obtain comparable outcomes worldwide, standardization is needed. While advancements in tools and software hold the potential to homogenize outcome measurement and minimize operator-dependent variability, the rapid increase in availability also contributes to enhanced workflow variation.

Meta-analysis of Pulsed Field Ablation Versus Thermal Ablation for Pulmonary Vein Isolation in AF: A Broad Overview Focusing on Efficacy, Safety and Outcomes.

The recently established non-thermal, single-shot pulsed field ablation (PFA) is a potential tool for achieving rapid pulmonary vein isolation (PVI) to cause cell death by electroporation, yet data regarding this state-of-the-art technology remain sparse. In this meta-analysis, we included 3,857 patients from 20 studies. There was no significant difference in AF recurrence between the PFA and control groups. Subgroup analysis showed that additional ablation beyond PVI has a similar rate of AF recurrence to PVI alone (10% versus 13%, respectively). PVI durability was achieved in 83% (mean), 95% CI [65-99%] of the PFA group and in 79% (mean), 95% CI [60-98%] of the control group, with no significant difference in the rate of PVI durability between the two groups. The PFA group had considerably reduced procedure duration, but not fluoroscopy time. No statistically significant differences in periprocedural complications were observed. PFA is associated with shorter procedural time than thermal ablation. Cardiac complications were uncommon and mainly reversible in both the PFA and control groups.

Outcomes of radiofrequency ablation for hepatocellular carcinoma with concurrent steatotic liver disease.

BACKGROUND: Steatotic liver disease (SLD) is an emerging liver disease that has been associated with an increased risk for hepatocellular carcinoma (HCC). The impact of concurrent SLD on the prognosis of HCC remains unknown. This study investigates how concurrent SLD affects the outcomes of patients with HCC undergoing curative radiofrequency ablation (RFA) therapy. METHODS: A retrospective analysis of patients with early-stage HCC receiving curative RFA at a tertiary medical center was conducted. Laboratory data and HCC characteristics were recorded and analyzed by a Cox proportional hazards regression model to predict recurrence and all-cause mortality after RFA. RESULTS: A total of 598 patients with HCC were included between 2005 and 2015, with 139 and 459 classified in SLD and non-SLD groups, respectively. The SLD group exhibited a significantly better liver reserve and a lower cumulative incidence of HCC recurrence and liver-related and all-cause mortality after a median follow-up of 51 months. After adjusting for metabolic dysfunction, liver reserve, and HCC characteristics, the presence of SLD reduced all-cause mortality (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.45-0.996; p = .048), which was supported by inverse probability weighting analysis (aHR, 0.65; 95% CI, 0.42-1.00; p = .049). Poor liver functional reserve (high albumin-bilirubin grades) increased all-cause mortality dose dependently. Barcelona Clinic Liver Cancer staging and a higher Fibrosis-4 index were predictors for HCC recurrence, whereas SLD was not. CONCLUSIONS: Among patients with HCC undergoing curative RFA, those with concurrent SLD had a lower risk of all-cause mortality compared to those with poor liver functional reserve. PLAIN LANGUAGE SUMMARY: The present research demonstrated that patients with both liver cancer and steatotic liver disease who received curative radiofrequency ablation for liver cancer survived longer compared to those without steatotic liver disease. Maintaining good liver function is an important prognostic factor for survival.

Sex-Differences in Post-Procedural Pain Experiences After Thermal Liver Ablations for Liver Tumors: A Retrospective Study.

INTRODUCTION: Literature shows differences in pain experiences between sexes. The exact influence of thermal liver ablation on experienced pain is still not well-known. This study aims to investigate the maximum pain intensity at the recovery between men and women after percutaneous thermal liver ablation. METHODS: Patients treated with percutaneous thermal liver ablation (radiofrequency or microwave ablation) in Maastricht University Medical Center + between 2018 and 2022 for primary or secondary liver tumors were included retrospectively. Outcomes included maximum numerical rating scale (NRS, scale:0-10) score at the recovery room, prevalence of post-procedural pain (defined as NRS score ≥ 4), duration of anesthesia, length of stay at recovery, and complications. Regression analyses were adjusted for age, ASA-score, BMI, tumor type, maximum diameter of lesion, chronic pain in patients' history, and history of psychological disorder. RESULTS: 183 patients were included of which 123 men (67%). Results showed higher average maximum NRS scores in women patients compared to men (mean:3.88 versus 2.73), but not after adjustments (aß:0.75, 95%CI:-0.13-1.64). Women suffered more from acute post-procedural pain (59% versus 35%; aOR:2.50, 95%CI:1.16-5.39), and needed analgesics more often at the recovery room (aOR:2.43, 95%CI:1.07-5.48) compared to men. NRS score at recovery arrival did not significantly differ (aß:0.37, 95%CI:-0.48-1.22). No differences were seen in the length of stay at the recovery, duration of anesthesia, procedure time, and complication rate. Location of the tumor (subcapsular or deep), total tumors per patient, and distinction between primary and secondary tumors had no influence on the NRS. CONCLUSION: This retrospective single-center study shows higher post-procedural pain rates after thermal liver ablation in women, resulting in higher analgesics use at the recovery room. The results suggest considering higher dosage of analgesics during thermal liver ablation in women to reduce post-procedural pain. LEVEL OF EVIDENCE 3: Non-controlled retrospective cohort study.

Complications of ultrasound-guided thermal ablation of thyroid nodules and associated risk factors: an experience from 9667 cases.

OBJECTIVES: To evaluate the safety of ultrasound-guided thermal ablation (UGTA) for thyroid nodules (TNs) by analysing complications and related risks. MATERIALS AND METHODS: This retrospective, single-centre study reviewed patients who underwent UGTA (microwave or radiofrequency ablation) between January 2018 and March 2023. The incidence of complications was recorded and assessed during and immediately after ablation,1-3 h later, and at 1 month, 3 months, and 6 months. Univariate and multivariate analyses were performed to identify risk factors for hoarseness and haemorrhagic complications. RESULTS: We reviewed 9667 cases in this study. Overall, 4494 (46.49%) cases underwent microwave ablation, while 5173 (53.51%) cases underwent radiofrequency ablation. The overall complication rate was 4.43%. The incidence of major complications was 1.94% (haemorrhage, 1.32%; hoarseness, 0.54%; and symptomatic aseptic necrosis, 0.08%). The incidence of minor complications was 2.45%. A large nodule volume, radiofrequency ablation, hyper-enhancing nodules, benign nodules, higher preoperative blood pressure, hyperthyroidism, and higher ablation power were independent risk factors for haemorrhage. Dorsal nodules and a higher ablation power were independent risk factors for hoarseness. All complications were resolved. CONCLUSION: This study suggests that UGTA is a safe treatment for TNs. Several risk factors for haemorrhage and hoarseness should be considered before performing UGTA. Different ablation modalities should be considered for patients with different conditions. CLINICAL RELEVANCE STATEMENT: Thermal ablation may be a safe treatment for eligible patients with TNs. KEY POINTS: We analysed the complications and risk factors associated with UGTA in 9667 cases. The complication rate was 4.43%; 1.94% were major complications. Risk factors of haemorrhage and hoarseness should be considered. UGTA was a safe method for the treatment of TNs.

A Review on the Mechanisms, Applications, and Clinical Trials of Advanced Technologies in the Transdermal Drug Delivery System.

Transdermal Drug Delivery Systems (TDDS) have emerged as a promising method for administering therapeutic agents due to their non-invasive nature and patient-friendly approach. However, the effectiveness of this system is limited to drugs with specific physicochemical properties that allow for transdermal delivery as the skin acts as a barrier. To address this limitation, researchers have been exploring alternative approaches to improve drug delivery through the stratum corneum, ensuring consistent drug distribution at controlled rates. Thirdgeneration delivery systems have been developed to facilitate the delivery of various drugs across the skin barrier by disrupting the stratum corneum while protecting deeper skin tissues from injury. This review has explored various approaches that have gained popularity in enhancing drug delivery through TDDS, including microneedle-mediated, nanoparticle-enabled, thermal ablation-enhanced, and electroporation-driven delivery systems. It has discussed the mechanisms of drug delivery and potential applications for different types of drugs and detailed the clinical studies. This review has also highlighted the significant advancements in TDDS, offering valuable insights into both the pharmaceutical field and biomedical applications. The continued exploration and refinement of these delivery systems, particularly with the incorporation of Internet-of-Things (IoT) technology, Artificial Intelligence (AI), and machine learning, hold promise for expanding the scope of therapeutic interventions.

Five-year follow-up after a single US-guided high intensity focused ultrasound treatment of breast fibroadenoma.

The aim of this study was to evaluate the long-term efficacy of a single ultrasound-guided high-intensity focused ultrasound (US-HIFU) treatment in patients with breast fibroadenoma (FA) in terms of volume and pain reduction as well as palpation findings. From december 2013 until november 2014 27 women with a symptomatic FA were treated in one HIFU-session. Follow-up visits were performed after 7 days, 6 months and 1, 2, 3 and 5 years with clinical examination and ultrasound. One year after the procedure, a core needle biopsy of the residual lesion was offered. There was a significant volume reduction 6 months after HIFU from 1083.10 to 347.13 mm3 (p < 0.0001) with a mean volume reduction ratio (VRR) of 61.63%. Thereafter the FAs showed a further, but no longer significant decrease in size. One patient with an initial incomplete ablation and histologically confirmed persistent vital cells after 1 year showed a strong regrowth after 3 years. Excluding this patient from analysis, the mean VRR at months 12, 24, 36, and 60 was 86.44%, 94.44%, 94.90%, and 97.85%, respectively. Before HIFU, 59.26% of the patients had pain (22.33/100 VAS) which decreased to 6.56/100 after 12 months and remained reduced over the 5 year follow up period. A decrease in palpability from 85.19 to 7.69% was observed within 24 months. A single HIFU intervention let to a substantial reduction in size, pain, and palpability with its most potential effect during the first 12 months. Subsequently, the observed effect remained stable over a 5 year follow up period. Incomplete initial treatment was associated with the risk of regrowth.

Comparative efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma: Systematic review including traditional pooling and Bayesian network meta-analysis.

PURPOSE: To compare the efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma, using a systematic review including traditional pooling and Bayesian network meta-analysis. MATERIALS AND METHODS: A comprehensive literature search in PubMed, EMBASE, and the Cochrane Library databases identified retrospective studies evaluating the tumor volume change after different thermal ablation or conventional surgery. Studies from the date of their inception to January 6, 2024, were included. A review of 4463 potential papers, including a full-text review of 23, identified 10 eligible papers covering a total of 2658 patients for meta-analysis. The tumor volume change over a 12-month follow-up was compared between different thermal ablations. Tumor diameter change, complications, recurrence, operation and hospitalization time were evaluated by network meta-analysis. RESULTS: Based on the traditional frequentist approach, the overall pooled estimates for the standardized mean difference (SMD) in tumor volume change of radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA) were 1.38 (95 % credibility interval (CI), 0.62-2.13), 1.94 (95%CI, 0.78-3.10) and 1.38 (95%CI, 1.01-1.75), respectively. Based on the Bayesian network meta-analysis, in examining the surface under the cumulative ranking area (SUCRA) ranking, RFA (SUCRA, 76.6), MWA (SUCRA, 66.6), and LA (SUCRA, 39.8) were identified as the three interventions that were associated with the greatest reduction in risk for complications compared with conventional surgery (CS), with RFA (SUCRA, 76.6) being ranked as the highest in safety. MWA, SMD 4.43 [95%CI, 2.68-6.17], RFA SMD 4.24 [95 % CI, 1.66-6.82], and LA SMD 4.24 [95 % CI, 1.48-7.00] were associated with the shorter operation time compared with CS. LA SMD 4.61 [95 % CI, 1.79-7.44] and MWA SMD 3.07 [95 % CI, 1.32-4.83] were associated with the shorter hospitalization time compared with CS, with LA (SUCRA, 86.5) yielding the highest ranking. MWA was associated with a reduced risk for tumor recurrence RR 0.02 [95 % CI, -0.44-0.49], compared with CS. CONCLUSION: We conducted a comprehensive review of the published literature on the effectiveness and safety of different thermal ablation techniques and conventional surgery for papillary thyroid microcarcinoma. Important research gaps persist due to a lack of long-term data and high-quality randomized controlled trials (RCTs).

Vocal Fold Paralysis Following Benign Thyroid Nodule Laser Thermal Ablation.

Laser thermal ablation (LTA) is an increasingly common procedure to treat benign and malignant thyroid nodules, allowing patients to avoid thyroidectomy. There are few reported postprocedural complications of LTA among patients with benign thyroid nodules. While vocal fold paralysis is a well-known potential complication after thyroidectomy, we present the first case report of vocal fold paralysis following LTA. A female in her 80s presented to an outside endocrinologist with symptoms of hyperthyroidism and benign thyroid nodules. The patient underwent a fine needle aspiration biopsy, radioiodine uptake scan, radioactive thyroid ablation, and LTA at an outside institution. The patient first noticed hoarseness 2days after LTA, and she presented to our office with a weak, breathy voice more than 4months postprocedure. Videostroboscopic examination revealed immobility of the left vocal fold with incomplete glottic closure. After awake injection laryngoplasty in the office, the patient experienced voice improvement. In conclusion, LTA is a relatively new treatment modality with limited literature on adverse outcomes. As minimally invasive techniques such as LTA are becoming more common, it is essential to remain fully aware of risks to recognize and mitigate complications like vocal fold paralysis.

Mortality and postinterventional complications after ablative treatment of liver malignancies: A cohort study of 4374 patients.

PURPOSE: Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings. Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort. MATERIALS AND METHODS: Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death. RESULTS: Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (p = 0.003; p = 0.0001). Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications. CONCLUSION: Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures. They are a viable alternative or addition to a surgical approach in treating liver lesions.

Clinical value of sequential circulating tumor DNA analysis using next-generation sequencing and epigenetic modifications for guiding thermal ablation for colorectal cancer metastases: a prospective study.

INTRODUCTION: While thermal ablation is now a standard treatment option for oligometastatic colorectal cancer patients, selecting those who will benefit most from locoregional therapies remains challenging. This proof-of-concept study is the first to assess the feasibility of routine testing of ctDNA before and after thermal ablation with curative intent, analyzed by next-generation sequencing (NGS) and methylation specific digital droplet PCR (ddPCR). Our prospective study primary objective was to assess the prognostic value of ctDNA before thermal ablation. METHODS: This single-center prospective study from November 2021 to June 2022 included colorectal cancer patients referred for curative-intent thermal ablation. Cell-free DNA was tested at different time points by next-generation sequencing and detection of WIF1 and NPY genes hypermethylation using ddPCR. The ctDNA was considered positive if either a tumor mutation or hypermethylation was detected; recurrence-free survival was used as the primary endpoint. RESULTS: The study enrolled 15 patients, and a total of 60 samples were analyzed. The median follow-up after ablation was 316 days, and median recurrence-free survival was 250 days. CtDNA was positive for 33% of the samples collected during the first 24 h. The hazard ratio for progression according to the presence of baseline circulating tumor DNA was estimated at 0.14 (CI 95%: 0.03-0.65, p = 0.019). The dynamics are provided, and patients with no recurrence were all negative at H24 for ctDNA. DISCUSSION: This study shows the feasibility of routine testing of ctDNA before and after thermal ablation with curative intent. We report that circulating tumor DNA is detectable in patients with low tumor burden using 2 techniques. This study emphasizes the potential of ctDNA for discerning patients who are likely to benefit from thermal ablation from those who may not, which could shape future referrals. The dynamics of ctDNA before and after ablation shed light on the need for further research and larger studies.

Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

INTRODUCTION: The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12 mm, incompetent great saphenous vein (GSV) in comparison to smaller ones. METHODS: A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12 mm, group B ≥12 mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1 month, 12 months and 24 months postoperatively. RESULTS: 118 patients with GSV diameter <12 mm (group A) and 87 with GSV diameter ≥12 mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1 month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12 months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24 months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12 mm, 1470 nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores. CONCLUSIONS: Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470 nm EVLA and RFA techniques performed similar outcomes.

Salvage stereotactic ablative body radiotherapy after thermal ablation of primary kidney cancer.

OBJECTIVE: To evaluate the effectiveness and safety of salvage stereotactic ablative body radiotherapy (SABR) for recurrent renal cell carcinoma (RCC) after thermal ablation (TA). MATERIALS AND METHODS: This study was a multi-institutional retrospective analysis of patients with recurrent RCC following TA who received SABR between 2016 and 2020. The primary study outcome was freedom from local failure, evaluated radiographically based on Response Evaluation Criteria in Solid Tumours (RECIST) v1.1. Distant failure, cancer-specific survival (CSS), overall survival (OS), treatment-related toxicity and renal function changes following SABR were the secondary outcomes. The Kaplan-Meier method was used to estimate freedom from local and distant failure, CSS and OS. RESULTS: Seventeen patients with 18 biopsy-confirmed RCCs were included, with a median (interquartile range [IQR]) age at time of SABR of 75.2 (72.6-68.7) years, a median (IQR) tumour size of 3.5 (1.9-4.1) cm and follow-up (reverse Kaplan-Meier method) of 3.36 (95% confidence interval [CI] 1.6-4.1) years. Six of the 17 patients had a solitary kidney. Five patients had failed repeat TA prior to SABR. The median (IQR) time from TA procedure to SABR was 3.03 (1.5-5.1) years. No patient experienced local progression, with a local control rate of 100%. Four patients, two with baseline metastatic disease, experienced distant progression. The distant progression-free survival, CSS and OS at 3 years were 72.1% (95% CI 51.9%-100%), 92.3% (95% CI 78.9%-100%) and 82.1% (95% CI 62.1%-100%), respectively. The median (IQR) glomerular filtration rate before SABR was 58 (40-71) mL/min, and at last follow-up, it was 48 (33-57) mL/min. No patient experienced grade 3+ toxicity or went on to develop end-stage renal disease. CONCLUSION: The results showed that SABR appears to be an effective and safe salvage strategy in patients with recurrent RCC following TA.

The influence of peritumoral parenchyma on local tumor progression of hepatocellular carcinoma after thermal ablation: a retrospective multicenter study.

BACKGROUND: With the increasing importance of thermal ablation (TA) in hepatocellular carcinoma (HCC) treatment, local tumor progression (LTP) has become a nonignorable recurrence type after ablation. PURPOSES: To analyze the influence of peritumoral liver parenchyma on LTP and to explore the possible reasons for this influence. METHODS: Ablated HCCs with peritumoral parenchymal biopsy and ablation margins greater than 5 mm were included from two hospitals. The grade of necroinflammatory activity (G) and stage of fibrosis (S) of the parenchyma were evaluated by Scheuer staging system. Univariate/multivariate Cox model was used to analyze the possible factors influencing LTP. Peritumoral satellite focus rate, ablation energy, ablation volume after treatment, ablation volume after one-month, and volume reduction rate were collected and analyzed to explore the possible reasons for influence. Propensity score matching (PSM) was used to balance baselines across different groups. RESULTS: 346 HCCs (64 with LTP, 282 without LTP) were enrolled from January 2013 to June 2022, with a median follow-up of 27 months. Univariate/multivariate analysis showed fibrosis was a protective factor in LTP (OR = 0.70, 95%CI: 0.55-0.89). The low-fibrosis group exhibited higher satellite focus rate (15.6% vs. 8.4%, p = 0.048), lower ablation energy (22637 ± 9424 J vs. 33352 ± 13779 J, p < 0.001) and higher volume reduction rate (0.33 ± 0.06 vs. 0.25 ± 0.06, p < 0.001) than the high-fibrosis group. Therefore, we speculated that the protective effect of fibrosis was due to its blocking of tumor invasion and reduction of sublethal zones. CONCLUSION: Fibrosis of the peritumoral liver parenchyma is a stable protective factor in LTP occurrence.

Imaging in Interventional Radiology: Applications of Contrast-Enhanced Ultrasound.

This review explores the applications of contrast-enhanced ultrasound (CEUS) in interventional radiology, focusing on its role in endoleak detection after endovascular abdominal aortic aneurysm repair (EVAR), periprocedural thermal ablation guidance, and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). CEUS offers a dynamic assessment for the detection of endoleak following EVAR, facilitating accurate diagnosis and classification. In periprocedural thermal ablation, CEUS enhances target lesion delineation with the visualization of real-time perfusion changes, optimizing treatment strategies and reducing residual tumor rates. Finally, CEUS has demonstrated efficacy in intraprocedural evaluation and postprocedural follow-up in TACE for HCC, offering early detection of residual tumor enhancement and providing an alternative for patients with contraindications to contrast-enhanced computed tomography or magnetic resonance imaging. Overall, CEUS is a versatile and valuable tool with many applications to offer interventional radiologists enhanced diagnostic capabilities and improved patient management.

The Landmark Series: Multimodal Management of Oligometastatic Sarcoma.

The concept of "oligometastatic" disease suggests the presence of intermediate states between localized disease and widespread metastases, which may be potentially treatable with curative therapeutic strategies. Metastases local therapy (MLT) can be accomplished through various techniques such as stereotactic ablative radiotherapy (SABR), radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, or surgical metastasectomy. The incorporation of MLT in the multidisciplinary treatment of patients with metastatic sarcoma is complex. Retrospective studies support consideration of MLT for selected patients based on factors such as patient condition, disease biology, histologic type, and disease burden. Decisions regarding type and timing of MLT should be made after multidisciplinary discussion including radiation oncologists, surgical and orthopedic oncologists, medical oncologists, and interventional radiology to explore all options before treatment decsions. All MLT techniques have advantages and disadvantages and should be performed in centers specialized in the care of complex oncology patients where various options can be explored concurrently or sequentially for each patient. Future studies evaluating quality of life and patient-reported outcomes are necessary to adequately align patient goals and optimal outcomes. This article reviews the medical scenarios that may benefit the use of MLT, evaluates the distinct advantages and disadvantages associated with these various techniques, and analyzes the findings from pivotal series to provide a comprehensive understanding of its role in clinical practice.

Integrated omics characterization reveals reduced cancer indicators and elevated inflammatory factors after thermal ablation in non-small cell lung cancer patients.

BACKGROUND: Thermal ablation is a minimally invasive treatment for non-small cell lung cancer (NSCLC). Aside from causing an immediate direct tumour cell injury, the effects of thermal ablation on the internal microenvironment are unknown. This study aimed to investigate the effects of thermal ablation on the plasma internal environment in patients with NSCLC. METHODS: 128 plasma samples were collected from 48 NSCLC (pre [LC] and after thermal ablation [LC-T]) patients and 32 healthy controls (HCs). Olink proteomics and metabolomics were utilized to construct an integrated landscape of the cancer-related immune and inflammatory responses after ablation. RESULTS: Compared with HCs, LC patients exhibited 58 differentially expressed proteins (DEPs) and 479 differentially expressed metabolites (DEMs), which might participate in tumour progression and metastasis. Moreover, 75 DEPs were identified among the HC, LC, and LC-T groups. Forty-eight highly expressed DEPs (eg, programmed death-ligand 1 [PD-L1]) in the LC group were found to be downregulated after thermal ablation. These DEPs had significant impacts on pathways such as angiogenesis, immune checkpoint blockade, and pro-tumour chemotaxis. Metabolites involved in tumour cell survival were associated with these proteins at the expression and functional levels. In contrast, 19 elevated proteins (eg, interleukin [IL]-6) were identified after thermal ablation. These proteins were mainly associated with inflammatory response pathways (NF-κB signalling and tumour necrosis factor signalling) and immune cell activation. CONCLUSIONS: Thermal ablation-induced changes in the host plasma microenvironment contribute to anti-tumour immunity in NSCLC, offering new insights into tumour ablation combined with immunotherapy. Trial registration This study was registered on the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/index.html ). ID: ChiCTR2300076517. Registration Date: 2023-10-11.

Comparison between thermal ablation and surgery in low risk papillary thyroid carcinoma: a prospective study.

Objective: To conduct a comparative analysis of the efficacy, safety, and impact on quality of life outcomes between thermal ablation and surgical interventions in patients diagnosed with papillary thyroid carcinoma (PTC). Methods: A prospective study was undertaken, enrolling patients with PTC ≤5mm who underwent radiofrequency ablation (RFA), laser ablation (LA), or surgery, for analysis of efficacy and safety outcomes. The Thyroid Cancer-Specific Quality of Life questionnaire was administered to all patients before treatment and at 3, 6, and 12 months post-treatment. Results: A total of 162 eligible patients were included in the study. Major complications were not observed in the RFA and LA groups, while five cases were reported in the surgery group, although no statistically significant differences were observed. Minor complications were documented in two, three, and 14 patients in the RFA, LA, and surgery groups, respectively, with no significant variances noted. Surgical duration and hospitalization time were notably shorter in the thermal ablation groups. At the final follow-up, complete disappearance of nodules was seen in 71.4% of cases treated with RFA and 71.0% of cases managed with LA, with no significant disparities between the groups. Both RFA and LA exhibited similar effects on quality of life, with thermal ablation techniques showing better functional outcomes in comparison to surgery. Across all groups, adverse effects were most pronounced at the 3-month post-treatment mark but gradually reverted to baseline levels in the thermal ablation group, contrasting with the surgery group. Conclusions: For PTC ≤5mm, both RFA and LA exhibited similar cancer control outcomes and superior quality of life on par with surgery, while minimizing complications. These findings underscore the promise of RFA and LA as potential standard treatments for small PTCs, subject to further confirmation in future studies.

Study of Biological Effects Induced in Solid Tumors by Shortened-Duration Thermal Ablation Using High-Intensity Focused Ultrasound.

The HIFU ablation technique is limited by the long duration of the procedure, which results from the large difference between the size of the HIFU beam's focus and the tumor size. Ablation of large tumors requires treating them with a sequence of single HIFU beams, with a specific time interval in-between. The aim of this study was to evaluate the biological effects induced in a malignant solid tumor of the rat mammary gland, implanted in adult Wistar rats, during HIFU treatment according to a new ablation plan which allowed researchers to significantly shorten the duration of the procedure. We used a custom, automated, ultrasound imaging-guided HIFU ablation device. Tumors with a 1 mm thickness margin of healthy tissue were subjected to HIFU. Three days later, the animals were sacrificed, and the HIFU-treated tissues were harvested. The biological effects were studied, employing morphological, histological, immunohistochemical, and ultrastructural techniques. Massive cell death, hemorrhages, tissue loss, influx of immune cells, and induction of pro-inflammatory cytokines were observed in the HIFU-treated tumors. No damage to healthy tissues was observed in the area surrounding the safety margin. These results confirmed the efficacy of the proposed shortened duration of the HIFU ablation procedure and its potential for the treatment of solid tumors.