Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk

Purpose: The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding. Material and methods: From 2013 to 2017, nine patients (six males, three females, aged 68.5 \ub1 12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23 mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6 min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded. Results: Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11\u201349 months). Conclusions: LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding

Percutaneous laser ablation for benign and malignant thyroid diseases

Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated

Proceedings of the First Italian Conference on Thyroid Minimally Invasive Treatments and foundation of the Italian Research Group for Thyroid Minimally Invasive Procedures

During the last few decades, a new approach to the nonsurgical management of thyroid nodular disease was proposed and thoroughly assessed. Presently several centres in different parts of the world ..

Transperineal Laser Ablation for Percutaneous Treatment of Benign Prostatic Hyperplasia : A Feasibility Study

Purpose: To assess the feasibility and safety of transperineal laser ablation (TPLA) for treating benign prostatic hyperplasia (BPH). Materials and Methods: Institutional review board approval was obtained for this prospective non-randomized trial. Eightteen patients (age 71.7 \ub1 9.4 years) with urinary symptoms secondary to BPH underwent TPLA under local anesthesia. Under US guidance, up to four 21G applicators were inserted in the prostatic tissue. Each treatment was performed with diode laser operating at 1064 nm changing the illumination time according to prostate size. Primary endpoints were technical success and safety of TPLA. Secondary endpoints included operation time, ablation time, energy deployed, hospitalization time, catheterization time, and change in International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak urinary flow rate (Qmax), post-void residual (PVR), and prostatic volume at 3 months. \u3c72 and Fisher exact tests were used. Results: All procedures were technically successful. No complications occurred. Mean operation time was 43.3 \ub1 8.7 min, mean ablation time 15.9 \ub1 3.9 min, mean energy deployed 10,522 \ub1 3290.5 J, mean hospital stay 1.5 \ub1 0.4 days, and mean catheterization time 17.3 \ub1 10.0 days. At 3 months, IPSS improved from 21.9 to 10.7 (P < 0.001), QoL from 4.7 \ub1 0.6 to 2.1 \ub1 1.2 (P < 0.001), Qmax from 7.6 to 13.3 mL/s (P = 0.001), PVR from 199.9 \ub1 147.3 to 81.5 \ub1 97.8 (P < 0.001), and mean prostate volume from 69.8 to 54.8 mL (P < 0.001). Conclusions: TPLA is feasible and safe in the treatment of BPH, providing significant clinical results at 3 months. Level of Evidence: Case series, Level IV

Image-Guided Thyroid Ablation: Proposal for Standardization of Terminology and Reporting Criteria

Image-guided tumor ablation is commonly performed in clinical practice. Trying to standardize terminology and data collection to enable a more reliable comparison among the different studies, in 2003, a document entitled Image-Guided Tumor Ablation: Proposal for Standardization of Terms and Reporting Criteria was published by the International Working Group on Image-Guided Tumor Ablation. Since then, ablations have evolved significantly, with the development of new technology and techniques and applications. This has included benign thyroid nodules, and their ablation has become increasingly accessible, not only among radiologists but also among other specialists involved in thyroid care, including endocrinologists and surgeons. This has resulted in further inhomogeneity in how data are presented and reported among different studies, resulting in a need for standardization to homogenize language and data reporting on the topic. Summary: In February 2018 in Milano, Italy, a meeting involving specialists concerned with minimally invasive treatments of thyroid lesions was organized, and the Italian Working Group on Minimally Invasive Treatments of the Thyroid was founded with the aim of establishing a collaborative network among all clinicians working in this field. The first work of this group is to present a proposal for standardization of terminology and reporting criteria on image-guided ablations to treat benign thyroid nodules. Conclusion: This proposal was drafted with the goal of providing guidance for standardized reporting of results in studies regarding image-guided thyroid ablations. We encourage adoption of this terminology worldwide, anticipating that this will facilitate improved communication and understanding within the field and stimulate further discussion on the topic over the next years

Treatment of Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma with Percutaneous Laser Ablation

Purpose: To assess the effectiveness of percutaneous laser ablation (PLA) of cervical lymph node metastases from papillary thyroid carcinoma. Materials and Methods: 24 patients (62.3 \ub1 13.2 year; range 32\u201380) previously treated with thyroidectomy, neck dissection, and radioiodine ablation underwent ultrasound-guided PLA of 46 18FDG-PET/CT\u2014positive metachronous nodal metastases. All patients were at high surgical risk or refused surgery and were unsuitable for additional radioiodine ablation. A 300 \ub5m quartz fiber and a continuous-wave Nd-YAG laser operating at 1.064 mm were used. Technical success, rate of complications, rate of serological conversion, and local control at follow-up were derived. Fisher\u2019s exact test and Mann\u2013Whitney U test were used and Kaplan\u2013Meier curve calculated. Results: Technical success was obtained in all 46 lymph nodes (100 %). There were no major complications. Thyroglobulin levels decreased from 8.40 \ub1 9.25 ng/ml before treatment to 2.73 \ub1 4.0 ng/ml after treatment (p = 0.011), with serological conversion in 11/24 (45.8 %) patients. Overall, local control was obtained in 40/46 (86.9 %) lymph nodes over 30 \ub1 11 month follow-up, with no residual disease seen at imaging in 19/24 (79.1 %) patients. Local control was achieved in 40/46 (86.9 %) lymph nodes at 1 year and in all of the 25 nodes (100 %) followed for 3 years. Estimated mean time to progression was 38.6 \ub1 2.7 m. Conclusion: Ultrasound-guided PLA is a feasible, safe, and effective therapy for the treatment of cervical lymph node metastases from papillary thyroid carcinoma

Percutaneous laser ablation of metastatic lymph nodes in the neck from papillary thyroid carcinoma: Preliminary results

Context: Percutaneous laser ablation (PLA) may be useful in treating patients with metachronous metastatic lymph nodes in the neck. Objective: Our objective was to assess PLA as a treatment of difficult-to-treat metachronous cervical lymph node metastases from papillary thyroid carcinoma. Design and Setting: We conducted a retrospective analysis of prospectively collected data at a public hospital. Patients: Fifteen patients with previous resection of papillary thyroid carcinoma with elevated serum levels of thyroglobulin (Tg) or anti-Tg antibodies (TgAbs) and 24 metachronous nodal metastases treated between September 2010 and April 2012 were followed with [18F] fluorodeoxyglucose (18FDG) positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced ultrasound (CEUS). Intervention: Intervention was PLA. Outcome Measures: Technique feasibility and technical success were evaluated. Tg/TgAb serum levels and 18FDG-PET/ CT, and CEUS appearance were assessed at 6 and 12 months and compared with baseline. Complications were recorded. Results: PLA was always feasible, and technical success was achieved in all patients. At 6 months, local control was achieved in 11 of 15 patients (73%), with 6 (40%) having serum Tg/TgAb normalized (P = .017 vs baseline). Whereas 20 of 24 (83%) nodes were negative at 18FDG-PET/CT and CEUS (P < .001 vs baseline), 4 were 18FDG-PET/CT-positive (3 also CEUS-positive). At the 12-month follow-up, local control was achieved in 10 of 14 patients (71.4%). Sixteen of 20 nodes (80%) were negative at 18FDG-PET/CT and CEUS (P < .001 vs baseline), 4 were 18FDG-PET/CT-positive (2 also CEUS-positive). Four of 10 (40%) patients had normalization of serum Tg/TgAb (P = .098 vs baseline). No major complications occurred. Conclusions: PLA is potentially feasible, safe, and effective for the treatment of metachronous cervical nodal metastases from papillary thyroid carcinoma. This procedure may reduce or delay a large number of highly invasive repeat neck dissections