SIR 2024
Interventional Oncology
Garrett Fisher, BS (he/him/his)
Medical Student
Wright State University BSOM
Financial relationships: Full list of relationships is listed on the CME information page.
Hannah Kaufman, BS
Medical Student
Wright State University Boonshoft School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Amanda Burke, BS
Medical Student
Wright State University Boonshoft School of Medicine
Disclosure information not submitted.
Ericson John V. Torralba, BSc
Medical Student
Wright State University Boonshoft School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Heather Payne, RN
Interventional Radiology Nurse
Dayton VA Medical Center
Disclosure information not submitted.
Emily Boldman, PA
Interventional Radiology Physician Assistant
Dayton VA Medical Center
Disclosure information not submitted.
Brendan Boyer, PA
Interventional Radiology Physician Assistant
Dayton VA Medical Center
Disclosure information not submitted.
Robert Short, MD, PhD
Section Chief, Interventional Radiology, Associate Professor, Surgery and Biomedical Engineering
Dayton VA Medical Center, Wright State University
Financial relationships: Full list of relationships is listed on the CME information page.
To assess the ability of RENAL, PADUA, and P-RAC nephrometry scoring systems to predict outcomes, sedation requirements, and procedural complexity in patients undergoing microwave ablation (MWA) of solid renal masses.
Materials and Methods:
IRB approved, retrospective review of a prospectively maintained database of yielded 78 solid renal masses in 72 patients from 2016 to 2023 treated with MWA under moderate sedation. MWA was performed by a single operator using a 2.45 GHz, gas-cooled system (NeuWave/Ethicon, Madison, WI) with moderate (“conscious”) sedation administered by certified radiology nurses. RENAL, PADUA, and P-RAC nephrometry scores were calculated for each mass from CT or MRI. Spearman’s rank correlations were examined for each scoring system and procedure length, sedation dose, ablation energy, adverse events (AE), and local tumor recurrence (LTR). ANOVA was performed to determine differences in procedure time and sedation by scoring system risk groups (low, moderate, and high). Kruskal Wallis or Mann-Whitney U test was used to determine what variables could predict procedure time, energy delivered, and sedation doses.
Results:
74 T1a and 4 T1b lesions were included, (avg 2.3 cm, range, 1-4.5cm). Median procedure time was 46.5 minutes; median sedation doses were 2.5 mg midazolam, 150 mcg fentanyl. RENAL score risk showed weak correlation between with sedation dose: fentanyl (r=0.306, p=0.006) and midazolam (r=0.358, p=0.001). PADUA score had weak correlation with length of procedure (r=0.266, p=0.019) and sedation: fentanyl (r=0.274, p=0.015) and midazolam (r=0.279, p=0.013). P-RAC risk correlated with procedure length (r=0.427, p< 0.001) and sedation: midazolam (r=0.433, p< 0.001), fentanyl (r=0.386, p< 0.001). No scoring system correlated with ablation energy, adverse events (n=2), or local recurrence (n=2). The variables best predicting procedure length and sedation dose are: exophytic/endophytic (p=0.029-0.042), nearness to collecting system (p < 0.001-0.002), collecting system involvement (p=0.029-0.042), and distance to nearest structure (p < 0.003-0.043). None correlated with energy, AE, or LTR.
Conclusion:
Of the scoring systems examined, P-RAC best predicted procedural complexity and sedation requirements but only with moderate correlations to procedure length and drug doses. Further study may be needed to evaluate the utility of nephrometry scoring to predict recurrence or adverse events.