Advertisement

CardioVascular and Interventional Radiology

, Volume 41, Issue 7, pp 1089–1094 | Cite as

Single 15-Min Protocol Yields the Same Cryoablation Size and Margin as the Conventional 10–8–10-Min Protocol: Results of Kidney and Liver Swine Experiment

  • John D. Werner
  • Aline C. Tregnago
  • George J. Netto
  • Constantine Frangakis
  • Christos S. Georgiades
Laboratory Investigation

Abstract

Introduction

The objective was to determine the ablation size of a single 15-min freeze and compare it with the conventional 10-min freeze–8-min thaw–10-min freeze protocol. Secondary objectives were to determine the ablation margin and to ascertain whether islands of viable tissue remain within the ablation zone.

Materials and Methods

Five adult swine under general anesthesia were used. After surgical abdominal exposure, two ablations were performed in liver and two in kidney. One ablation utilized the 15-min and the second the 10–8–10-min protocol. At maximum ice-ball, tissue ink was infused via an angiographic catheter in hepatic or renal artery to stain the non-frozen tissue. Animals were euthanized and organs examined macro- and microscopically.

Results

Three histological regions were observed: (A) a viable/stained region representing the tissue outside the ice-ball, (B) a central necrotic area representing the ablated region within the ice-ball and (C) an unstained but viable margin representing the non-lethal margin within ice-ball. Ablation size did not vary with protocol but did for tissue type. Renal ablation was approximately 5 × 4 cm with both protocols, whereas liver ablation was approximately 6.7 × 4.4 cm. Ablation margin was measured at 1 mm irrespective of ablation protocol or tissue. No islands of viable tissue were identified within the ablation zone.

Discussion

Fifteen-minute cryoablation yielded an ablation size and margin identical to that of the conventional 10–8–10-min protocol. Within the ablated region, cell death was uniform. The only difference was a larger cryoablation zone in hepatic tissue compared to renal tissue, likely attributable to differences in blood perfusion.

Keywords

Cryoablation Margin Ablation size 

Notes

Funding

The study was supported by Galil Medical.

Compliance with Ethical Standards

Conflict of interest

Senior author is a consultant for Galil Medical. On behalf of the other authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

The study was approved by the Johns Hopkins University Animal Care & Use Committee.

References

  1. 1.
    Georgiades CS, Rodriguez R. Efficacy and safety of percutaneous cryoablation for stage 1A/B renal cell carcinoma: results of a prospective, single-arm, 5-years study. Cardiovasc Intervent Radiol. 2014;37:1494–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Horn CJ, Fischman AM, Fung JW, et al. Percutaneous microwave ablation of renal parenchymal tumors using a 2.4 GHz gas-cooled probe: initial results and technique. J Vasc Interv Radiol. 2013;24:S20–1.CrossRefGoogle Scholar
  3. 3.
    Niemeyer DJ, Simo KA, McMillan MT, et al. Optimal ablation volumes are achieved at submaximal power settings in a 245-GHz microwave ablation system. Surgical Innovation. 2015;22:41–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Chan JY, Ooi EH. Sensitivity of thermophysiological models of cryoablation to the thermal and biophysical properties of tissues. Cryobiology. 2016;73:304–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Erinjeri JP, Clark TWI. Cryoablation: mechanism of action and devices. J Vasc Interv Radiol. 2010;21:S187–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171–86.CrossRefPubMedGoogle Scholar
  7. 7.
    Nakayama A, Kuwahara Y, Iwata K, Kawamura M. The limiting radius for freezing a tumor during percutaneous cryoablation. J Heat Transf. 2008;130:111101–1111016.CrossRefGoogle Scholar
  8. 8.
    Williams LR, Leggett RW. Reference values for resting blood flow to organs of man. Clin Phys Physiol Meas. 1989;10:187–217.CrossRefPubMedGoogle Scholar
  9. 9.
    Ge BH, Guzzo TJ, Nadolski GJ, et al. Percutaneous renal cryoablation: short-axis ice-ball margin as a predictor of outcome. J Vasc Interv Radiol JVIR. 2016;27:403–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Georgiades C, Rodriguez R, Azene E, et al. Determination of the nonlethal margin inside the visible “ice-ball” during percutaneous cryoablation of renal tissue. Cardiovasc Intervent Radiol. 2013;36:783–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Overduin CG, Jenniskens SF, Sedelaar JP, Bomers JG, Futterer JJ. Percutaneous MR-guided focal cryoablation for recurrent prostate cancer following radiation therapy: retrospective analysis of iceball margins and outcomes. Eur Radiol. 2017;27(11):4828–36.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tani S, Tatli S, Hata N, et al. Three-dimensional quantitative assessment of ablation margins based on registration of pre- and post-procedural MRI and distance map. Int J Comput Assist Radiol Surg. 2016;11:1133–42.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    van Oostenbrugge TJ, Langenhuijsen JF, Overduin CG, Jenniskens SF, Mulders PFA, Futterer JJ. Percutaneous MR Imaging-guided cryoablation of small renal masses in a 3-T closed-bore MR imaging environment: initial experience. J Vasc Interv Radiol JVIR. 2017;28(1098–107):e1.Google Scholar
  14. 14.
    Martin JW, Patel RM, Okhunov Z, Vyas A, Vajgrt D, Clayman RV. Multipoint thermal sensors associated with improved oncologic outcomes following cryoablation. J Endourol. 2017;31:355–60.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Cahan WG. Cryosurgery of malignant and benign tumors. Fed. Proc. 1965;24:241–8.Google Scholar
  16. 16.
    Sutherland SE, Resnick MI, Maclennan GT, Goldman HB. Does the size of the surgical margin in partial nephrectomy for renal cell cancer really matter? J Urol. 2002;167(1):61–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Sofocleous CT, Garg SK, Cohen P, et al. Ki 67 is an independent predictive biomarker of cancer specific and local recurrence-free survival after lung tumor ablation. Ann Surg Oncol. 2013;20(Suppl 3):S676–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Sotirchos VS, Petrovic LM, Gonen M, et al. Colorectal cancer liver metastases: biopsy of the ablation zone and margins can be used to predict oncologic outcome. Radiology. 2016;280:949–59.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Korpan NN, Hochwarter G, Sellner F. Cryoscience and cryomedicine: new mechanisms of biological tissue injury following low temperature exposure. Experimental study. Klin Khir. 2009;7–8:80–5.Google Scholar
  20. 20.
    Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol. 1984;247:C125–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Snoeren N, Jansen MC, Rijken AM, et al. Assessment of viable tumour tissue attached to needle applicators after local ablation of liver tumours. Dig Surg. 2009;26:56–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Division of Vascular and Interventional Radiology, Department of RadiologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of PathologyThe Johns Hopkins UniversityBaltimoreUSA
  3. 3.Department of PathologyUniversity of AlabamaBirminghamUSA
  4. 4.Bloomberg School of Public HealthThe Johns Hopkins UniversityBaltimoreUSA

Personalised recommendations