To identify patient and tumor characteristics predictive of early procedure related complications in patients undergoing thermal ablation of localized renal cell carcinoma.
METHOD AND MATERIALSRetrospective review of 235 consecutive patients who underwent percutaneous thermal ablation for localized RCC from 2001-2015. Patient demographics, comorbidities, pathology, tumor size, RENAL score, procedure and hospital course details, and 30 day complications were recorded. We used an inclusive retrospective assessment to determine which patients benefited from overnight hospitalization. This included patients experiencing a complication, those who stayed >24 hours and those readmitted within 72 hours from discharge. Fischer’s exact, Wilcoxon rank sum, and univariate logistic regression tests were used as appropriate.
RESULTSHigh-grade complications (3.4%) were rare. Six patients (2.5%) had a bleeding complication. These patients had a higher BMI (39.4 vs 31.3, p=0.047), larger tumors (median 4.0 vs 2.6cm, p=0.04), higher RENAL score (9 vs 7, p=0.056) and were more likely to have a hematoma on immediate post-procedure CT (67% vs 12%, p=0.004). Patients with a hematoma were 14.3x more likely to have a bleeding complication (p=0.0028). The use of ≥3 ablation applicators was associated with an 18.9x risk of bleeding (p=0.008). In retrospect, 14 patients (6%) were judged to benefit from hospital admission. Factors associated with this include tumor ≥3cm (OR 4.4, p=0.152), RENAL score >8 (OR 7.2, p=0.0012), post-procedure hematoma (OR 5.6, p=0.0029), and using ≥3 ablation applicators (OR 7.2, p=0.0007).
CONCLUSIONHigh-grade complications, including significant bleeding, are rare following thermal ablation of localized RCC. Larger tumors, higher tumor complexity, post-procedure hematoma, and higher BMI increase the risk for complications. These patients may benefit from overnight hospital admission.
CLINICAL RELEVANCE/APPLICATIONThe majority of patients who undergo percutaneous thermal ablation of renal cell carcinoma can be safely discharged on the day of the procedure and avoid the cost and inconvenience of hospitalization.
Honored Educators Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality educational content in their field of study. Learn how you can become an honored educator by visiting the website at: https://www.rsna.org/Honored-Educator-Award/
Meghan G. Lubner, MD - 2014 Honored Educator
Meghan G. Lubner, MD - 2015 Honored Educator
The purpose of this study was to review our 15 yr institutional experience with renal mass biopsy
METHOD AND MATERIALSUsing our prospectively maintained database we identified patients who underwent renal mass biopsy and reviewed our institutional experience and assessed pathologic and histologic features and concordance rates.
RESULTSA total of 374 renal biopsies were performed from 1999-2015. Core(+/- FNA) was performed in 65.2% of the cases and 41% underwent surgical resection. Core was nondiagnostic in 9% of surgical cases and subsequently diagnosed with RCC. 11% of biopsies were benign and no surgery was performed.Of the benign lesions 69% were oncocytoma and 2.$% angiomyolilpoma. RCC diagnosed on core sampling that underwent resection demonstrated histological/grade concordance of 94.3% /62.5%. All discordant grades were upgraded at surgery. FNA was performed on 22.7% of cases and at final pathology histologic concordance was 72.5% and 5% were upgraded from benign to malignant .
CONCLUSIONRenal lesion biopsy is effective in the evaluation of renal masses and our data is consistent with previously published data.This underscores that although biopsy harbors clinical uncertainaites diagnostic accuracy may assist in clinical managment. Pathways incorporating renal biopsy may decrease over treatment but may also risk under treatment based on poor grade concordance.
CLINICAL RELEVANCE/APPLICATIONRenal mas biopsy is becoing incresingly important in the patient managment and as radiologists we should anticpate that requests for biopsy of renal masses will continue
AwardsStudent Travel Stipend Award
To determine the prevalence and type of complications that occur during ultrasound-guided transplant kidney biopsies in order to discern whether routine pre-procedure intravenous (IV) access is necessary for potential resuscitation efforts.
METHOD AND MATERIALSA retrospective review of medical records was performed in patients who underwent an ultrasound-guided kidney biopsy performed between 7/2/2013 and 6/30/2015. Procedures performed on inpatients, native kidneys, renal lesions, and those performed by services other than Radiology were excluded. Biopsy information was recorded and analyzed, including the following: any intervention or treatment (other than pain control), unexpected complications, and hospital admissions or return visits to the emergency department (ED) within 7 days of the biopsy.
RESULTSAfter exclusion criteria were applied, there were 1318 transplant kidney biopsies in 601 patients. There were five (0.38%) serious complications/unexpected adverse events requiring treatment. These complications included bleeding/hematuria, hypotension, hypertensive urgency, syncope, and pain. Only 1 (0.07%) of the cases was taken to angiography to evaluate for active bleeding, which did not occur until several hours after the biopsy, and no bleeding was found thus no intervention was performed. There were 8 (0.62%) minor complications requiring hospital admission for observation and/or a return visit to the ED for additional evaluation. These included perinephric hematoma (0.38%), hematuria (0.15%), and pain (0.07%).
CONCLUSIONThe prevalence of renal transplant biopsy complications at our institution is low (1.0%), with only 0.38% of biopsies requiring IV access for treatment, which suggests that IV access is not routinely required prior to renal transplant biopsy.
CLINICAL RELEVANCE/APPLICATIONRoutine pre-procedure IV placement may be safely discontinued without negatively affecting patient outcomes, and this should improve both departmental efficiency and patient satisfaction.
To evaluate the effectiveness of MRgFUS as mini-invasive alternative therapy in the treatment of submucosal fibroids and to discuss about its safety and feasibility.
METHOD AND MATERIALSFrom July 2012 to June 2014, 13 patients (mean age 48 years), affected by submucosal uterine fibroids, were treated using MRgFUS. The patients were submitted to preliminary MRI to classify the sub-mucosal fibroids (FIGO classification) and to measure the pre-treatment fibroid volumes. Sub-mucosal fibroids of type 0, 1 and 2 (measuring between 1.5 and 4 cm) were treated using MRgFUS. Five out of 13 patients presented only a single submucosal fibroid (2 of type 1, 2 of type 2 and 1 of type 0). Eight out of 13 patients were simultaneously affected by sub-mucosal fibroids (6 of type 2, 3 of type 1 and 2 of type 0) and other fibroids (type 3-6). The patients were submitted to one treatment alone. Immediately after treatment, the patients were submitted to c.e. MRI to evaluate the Non Perfused Volume (NPV) on the c.e. T1–weighed sequences and measure the radicalization of the treatment in comparison to the pre-treatment volume and after 2-4 years from the treatment.
RESULTSAll treated patients presented a mean extension of the NPV of 90% with a significant radicalization of the treatment without complications or side effects. After 2-4 years from the treatment, 7/13 (54%) showed progressive reduction of the volume with a regularization of the uterine wall. Five out of 13 patients (38%) showed significant reduction of fibroid volume (about 80%.) In one patient (8%), the fibroids of type 0 were partially eliminated from inside the uterine cavity. In this case, the patient was submitted to close MRI follow-up, which showed progressive elimination of the necrotic product. A poor vaginal bleeding lasted 15 days without necessity of hysteroscopy.
CONCLUSIONMRgFUS represent a valid mininvasive and radical approach in the treatment of submucosal fibroids. It allows treatment of the intramural part of the fibroid that cannot be completely treated with hysteroscopy.
CLINICAL RELEVANCE/APPLICATIONMRgFUS is promising technique in submucosal fibroids without significant risks and complications.
To prospectively evaluate clinical outcome of patients affected by uterine leiomyoma and treated using Magnetic Resonance Focused Ultrasound (MRgFUS), Uterine Artery Embolization (UAE) or Surgery.
METHOD AND MATERIALS570 women affected by symptomatic uterine leiomyoma referred our department for treatment of uterine fibroids with MRgFUS. Pre-treatment evaluation assessed fibroids MR characteristics and MRgFUS eligibility. 166 of 182 eligible patients (group A) were treated with MRgFUS, while 388 women resulted ineligible. 33/388 patients underwent UAE (group B), 140/388 myomectomy (group C) and 58/388 hysterectomy (group D). Clinical efficacy for each treatment was determined by Symptoms Severity Score (SSS) pre-treatment and at 3- and 12-month follow-up intervals. Further data concerning number and type of complications, days of hospitalization and days of convalescence were also collected and compared.
RESULTSMRgFUS group showed a mean decrease in SSS of 24,6% at 3 months and 55,8% at 12 months. SSS drop in UAE group was 51,2% and 57,4%, respectively. SSS reduction in myomectomy was 71,5% and 66,0%. After hysterectomy SSS decrease was 96,6% and 94,5%. MRgFUS group demonstrated the least number of adverse events (3 patients, 1,8 %), while the major adverse events rate was experienced in UAE group (37 patients, 26,4 %). MRgFUS patients were treated in outpatient setting, while mean days for hospitalisation and convalescence for other groups were respectively 3,1±2 and 12,4±9 days for group B; 4,5±2 and 17,2±12 days for group C; 4±1 and 26,3±14 days for group D.
CONCLUSIONMRgFUS clinical efficacy for uterine fibroids treatment is comparable to UAE and only slightly lower than myomectomy. However, MRgFUS is feasible in an outpatient setting and complications rate is significantly lower than other therapeutic strategies.
CLINICAL RELEVANCE/APPLICATIONMRgFUS added a new therapeutic strategy for uterine fibroids, being validated as a non-invasive, safe and effective option for selected patients.
AwardsStudent Travel Stipend Award
PATSS is a debilitating condition, an under-recognized complication of combined endometrial ablation and surgical sterilization. The aim is to determine imaging features of PATSS in symptomatic women.
METHOD AND MATERIALSRetrospective chart review revealed 104 women who had endometrial ablation (EA) and surgical sterilization (SS). Inclusion criteria consisted of symptomatic women with imaging studies. 38 patients with total of 55 studies were included.Two radiologists independently reviewed randomized studies in a blinded fashion for presence or absence of: cornual hematometra, central hematometra, hematosalpinx or fluid filled fallopian tube, adhesions, endometriosis, and adenomyosis. Discordances were resolved by a third radiologist. Interobserver agreement was assessed by kappa statistics for the imaging features and diagnosis of PATSS (fluid filled fallopian tube and either central or cornual hematometra).
RESULTS18 CT, 34 ultrasound, and 3 MRI studies were performed. Kappa values for CT and US were: cornual hematometra (0.77 vs 0.59), central hematometra (0.43 vs 0.15), fluid filled fallopian tube (0.63 vs 0.69), PATSS (0.68 vs 0.64), adhesions (0.15 vs 0.42), adenomyosis (0.55 vs 0.39), and endometriosis (1.0 vs 0.65). Interobserver analysis on MRI was excluded due to the small number. PATSS was diagnosed in 6/34 (18%) US, 5/18 (28%) CT, and 3/3 (100%) MRI.Concordance rates for PATSS with final radiology reports were: 4/6 (67%) US, 2/5 (40%) CT, and 3/3 (100%) MRI. 4 out of 11 (36%) women diagnosed with PATSS underwent hysterectomies, often without salpingectomies, with pathology report demonstrating changes consistent with only endometrial ablation.
CONCLUSIONPATSS is under-diagnosed in symptomatic women with history of endometrial ablation and surgical sterilization, with fair to good agreement by US and CT. Limited hysterectomy pathologies are not diagnostic for PATSS. Rather, given the data above, radiologic studies should be considered diagnostic in evaluation of this new entity given management considerations.
CLINICAL RELEVANCE/APPLICATIONRadiologists need to recognize imaging features related to complications of EA and SS procedure with increasing awareness of PATSS.