Background: The aim is to determine the long-term oncologic and survival outcomes of the radiofrequency ablation (RFA) of solitary de novo T1a renal cell carcinoma (RCC). Materials and methods: We retrospectively reviewed our renal ablation registry and included only patients with new solitary, biopsy-proven T1a RCC (<4 cm) who underwent RFA from January 2001 through December 2020. We collected patient and tumor characteristics. Survival rates were estimated using the Kaplan–Meier method. Results: Of the 243 patients who met our inclusion criteria (160 male and 83 female, median age 68 years), 128 (52.6%) had another primary malignancy other than renal malignancy. Two-hundred forty-three RFA procedures were performed for 243 renal tumors of a median tumor size of 2.5 cm. The median follow-up period was 3.7 years. Most tumors (68.6%) were clear cell RCC. Ten patients (4.1%) experienced Clavien–Dindo Grade III complications. Seven patients(3.1%) developed recurrence at the ablation zone, and 11 (4.5%) developed recurrence elsewhere in the kidney. The 15-year local-recurrence- and disease-free survival were 96.5% and 88.6%, respectively. The 15-year metastasis-free survival and cancer-specific survival were 100%. Conclusions: RFA is a highly effective modality for the management of T1a RCC, with low complication and recurrence rates. Long-term data revealed favorable oncologic and survival outcomes.

The purpose of this study was to evaluate the technical success, effectiveness, and safety of transarterial embolization for acute bleeding management with a shear-thinning conformable embolic. This single-center retrospective study evaluated outcomes following embolization using Obsidio(OCE). Technical success was defined as performing transarterial embolization within the target vessel to complete stasis of antegrade flow. Treatment effectiveness was defined as cessation of bleeding for patients. 11 patients underwent 11 embolization procedures. A total of 16 arteries were embolized. Indications for embolization were spontaneous tumor bleeding (6/11), hematuria (2/11), active duodenal bleeding (1/11), portal hypertensive bleeding (1/11), and rectus sheath hematoma (1/11). Technical success was 100%. The median vessel diameter was 2 mm (range 1-3). There were no adverse events as per SIR adverse event criteria or off-target embolization. OCE demonstrated technical success and treatment effectiveness with a short-term safety profile for transarterial embolization interventions.

Background: Our purpose is to evaluate the long-term oncologic efficacy and survival rates of MRI-guided cryoablation for patients with biopsy-proven cT1a renal cell carcinoma (RCC). Materials and Methods: We retrospectively reviewed our renal ablation database between January 2007 and June 2021 and only included patients with solitary-biopsy-proven cT1a RCC (≤4 cm) who underwent MRI-guided cryoablation. We excluded patients with genetic syndromes, bilateral RCC, recurrent RCC or benign lesions, those without pathologically proven RCC lesions and patients who underwent radiofrequency ablation or CT-guided cryoablation. For each patient, we collected the following: age, sex, lesion size, right- or left-sided, pathology, ablation zone tumor recurrence, development of new tumor in the kidney other than ablation zone, development of metastatic disease, patient alive or not, date and cause of death. We used the Kaplan and Meier product limit estimator to estimate the survival outcomes. Results: Twenty-nine patients (median age 70 years) met our inclusion criteria. Twenty-nine MRI-guided cryoablation procedures were performed for twenty-nine tumor lesions with a median size of 2.2 cm. A Clavien–Dindo grade III complication developed in one patient (3.4%). Clear cell RCC was the most reported histology (n = 19). The median follow up was 4.5 years. No tumor recurrence or metastatic disease developed in any of the patients. Two patients developed new renal lesions separate from the ablation zone. The 5- and 10-year OS were 72% and 55.6%, respectively. The 5- and 10-year DFS were 90.5% and the 5-year and 10-year LRFS, MFS and CSS were all 100%. Conclusions: MRI-guided cryoablation is a safe treatment with a low complication rate. Long-term follow-up data revealed long-standing oncologic control.

Cholangiocarcinoma remains a challenge both in terms of diagnosis and treatment. Due to the lack of a useful screening test and often clinically silent early course, disease stage is often advanced at the time of diagnosis. Surgical resection remains the only potentially curative treatment option and recurrence rates are high; however, liver transplantation has recently resulted in promising outcomes in certain groups of patients with intrahepatic and perihilar cholangiocarcinoma. For patients in whom surgery is not an option, chemotherapy with gemcitabine and cisplatin is the first-line treatment. An array of locoregional management options exists, which includes transarterial embolization, hepatic arterial chemotherapy infusion, ablation, and radiation therapy. High-quality data from randomized controlled trials for these treatments remains limited, however, and additional study is needed.

Purpose: To evaluate operational trends in an interventional oncology practice at a tertiary academic center before and after the addition of hybrid angiography–computed tomography (Angio-CT) rooms. Materials and Methods: The procedure volumes and types performed in the hybrid Angio-CT rooms were retrospectively collected from 2016 to 2020. Procedures were divided into categories, including arteriography, endovascular interventional oncology, ablation, venous intervention, non-vascular catheter placement (biliary, nephrostomy, gastrostomy, etc.), and osseous interventions. Procedural trends in the Angio-CT rooms and the frequencies of combination procedures that used both CT and angiography were assessed. Results: A major shift of catheter-based tumor-directed cases to Angio-CT rooms (69% vs 31% in Angio-only rooms) was observed. Amongst liver tumor–directed angiographic procedures, there was an increased rate of spiral CT imaging use (73%) in the Angio-CT rooms compared with cone-beam CT use (27%) prior to hybrid room conversion. Preferential use of Angio-CT was observed in bone augmentation procedures (77% vs 21% in CT-only and 2% in Angio-only with cone-beam CT capabilities) and complex non-oncologic vascular procedures (85% vs 15% in Angio-only with cone-beam CT capabilities). Angio-CT rooms were also commonly used to perform routine procedures such as percutaneous needle biopsies, fluid drainages, and biliary/renal/enteral tube placement and/or exchange cases, thus sharing scheduling load from other rooms. The number of concurrent (ie, liver ablation plus embolization) or consecutive (ie, inferior vena cava filter placement plus CT-guided drainage) procedures that utilized both CT and angiography progressively increased over each of the time periods evaluated. Conclusion: Hybrid Angio-CT procedure rooms with multimodality imaging capabilities serve as preferred rooms for a variety of tumor-directed and other increasingly complex procedures. In addition, these rooms can be used for routine image-guided biopsies and non-vascular procedures, thus providing flexibility and versatility in day-to-day operations in an interventional oncology practice.

Objective: To assess the safety and diagnostic outcomes of image-guided, non-target renal biopsies performed in cancer patients. Materials and Methods: We retrospectively identified patients who underwent percutaneous, image-guided, non-target renal biopsy between January 2017 and December 2020 in our institution. We recorded demographics, clinical, procedural, and pathologic details. Univariate and multivariable logistic regression models were used to assess the association between various variables and diagnostic yield or development of adverse events. Results: A total of 318 biopsies were performed in 318 patients (178 male, 140 female) with a median BMI of 28.4 kg/m². Median systolic and diastolic BP at the time of biopsy were 133 mmHg and 74 mmHg, respectively. Tissue was obtained using 18-gauge needles (99%). Adverse events were documented in 57 cases (18%), with 12 cases (3.8%) classified as grade 2 or higher per SIR classification. Diagnosis was achieved in 310 biopsies (97%). The median number of the glomeruli identified by light microscopy, immunofluorescence, and electron microscopy was 25, 8, and 3, respectively, and a higher number of identified glomeruli was associated with diagnostic yield in univariate analysis, although not in multivariable analysis. Diastolic BP higher than 80 mmHg and CT imaging guidance were associated with the development of adverse events in univariate analysis, and CT use remained so in the final multivariable analysis (p < 0.001). No other variables, including pre-biopsy anticancer or immunotherapy medications, were associated with increased risk of adverse events. Conclusions: Percutaneous, image-guided, non-target renal biopsy in cancer patients using an 18-gauge needle has a high diagnostic yield and safety profile.