SIR 2024
Interventional Oncology
Fu (Jorden) Lo, MD, BSc
PGY2 in Diagnostic Radiology
London Health Sciences Centre, Canada
Financial relationships: Full list of relationships is listed on the CME information page.
Rahman Ladak, BS
Medical Student
Schulich School of Medicine & Dentistry, Western University, Canada
Disclosure information not submitted.
Lakhdeep Singh Brar, BS, MS
Medical Student Year 4
Schulich School of Medicine and Dentistry, CAN
Disclosure information not submitted.
Joshua Chan, None
Undergraduate Student
Western University, CAN
Disclosure information not submitted.
Amol Mujoomdar, MD FSIR
Professor of Interventional Radiology, Oncology and Medical Biophysics
Western University, Canada
Financial relationships: Full list of relationships is listed on the CME information page.
Leandro Cardarelli Leite, MD
Interventional Radiologist
University of Western Ontario, Canada
Disclosure information not submitted.
David Hocking, MD
Associate Professor
Department of Medical Imaging, Western University, Canada
Disclosure information not submitted.
Derek Cool, MD, PhD
Assistant Professor
Schulich School of Medicine, Canada
Disclosure information not submitted.
To compare and externally validate multiple proposed renal tumor ablation risk-stratification algorithms on prediction of complication and post-ablative residual disease following renal cell carcinoma (RCC) ablation with both heat and cold modalities.
Materials and Methods:
Retrospective study performed on 100 patients (mean age 67.3±10.4 years) and 126 biopsy-confirmed RCC who underwent renal ablation (tumor diameter 2.5±1.0 cm; Left:Right kidney 56:70, T1a:T1b 121:5). Mean follow-up duration was 67.3±37.2 months. Ablative modality included 75 radiofrequency ablations (RFA), 50 cryoablations, and 1 microwave ablation (MWA). Complications were classified using the SIR adverse event classification criteria. RENAL{1}, mRENAL{2}, (MC)2{3}, P-RAC{4}, and P-RENAL{5} were validated with area under the curve (AUC) values of ROC curves against complications and incomplete ablation.
Results:
Out of 126 ablations, 11 mild (8.7%) and 2 moderate (1.6%) complications occurred. 3 of the mild complications occurred with cryoablation and 8 with RFA. Both moderate complications occurred following MWA. No severe complications were observed. T1a tumors included 10 mild complications and 2 moderate complications. T1b tumors included 1 mild complication. The most common complications were bleeding and pain.
97 ablations achieved complete ablation on first follow up, while 29 did not achieve complete ablation.
Mean scores of each of the predictive algorithms are depicted in the table that follows. Within the context of all ablative modalities, none of the algorithms were strong predictors for complications given the AUC values. When isolated to the context of cryoablations only, P-RAC (0.89), mRENAL (0.86), and RENAL (0.81) were strong predictions for complications.
None of the algorithms demonstrated strong prediction for incomplete tumor ablation.
Conclusion: Comparative evaluation suggests that the five proposed risk-scoring systems do not correlate well to either complication risk or incomplete ablation for RCC ablation with all ablative modalities; however, P-RAC, mRENAL, RENAL, and P-RENAL all achieve reasonable AUC values in the context of predicting complications using cryoablation only.