Radiofrequency ablation of renal tumours with clinical, radiographical and pathological results
A partir de données médicales portant sur 150 patients présentant une tumeur rénale bénigne ou maligne (108 cas) traitée entre 2002 et 2008 (âge : 24 à 85 ans ; durée moyenne de suivi : 40 mois), cette étude évalue, du point de vue de la survie spécifique à court terme et de la récidive, l'efficacité d'une ablation tumorale par radiofréquence
What's known on the subject? and What does the study add? * Radiological imaging is heavily relied on for follow up after renal ablative therapy. We show that while this is largely reliable, there are quantifiable false negative and false positive findings. A non-involuting zone of ablation should be considered for multisite-directed core biopsies even in the absence of detectable enhancement. Objective * To evaluate our experience with radiofrequency ablation (RFA) for renal masses and to report on clinical, radiological and post-RFA biopsy results. Patients and Methods * The study collected clinical, radiological and pathological data from 150 consecutive patients who were treated with RFA of a renal mass between 2002 and 2008 at a tertiary referral centre. * Post-ablation biopsies were performed in patients with non-involuting lesions or suspicion of recurrence on imaging. * Comparisons were performed using the Mann–Whitney U-test. * Survival was estimated using the Kaplan–Meier method. Results * Renal malignancy was found in 72.1% of patients based on the initial diagnostic biopsy. Median tumour size was 2.6 cm, 22.7% of patients had a solitary kidney, and most were central tumours. * The mean follow-up period was 40.1 month. There was no recurrence in 96.7% of the entire cohort. Cancer-specific survival for 106 patients with sporadic, localized, biopsy proven renal malignancy was 100% at 38.5 months. * Biopsies were obtained in 43 patients for a median of 21 months after RFA. * Among 38 patients who had biopsy for non-involuting, non-enhancing zones of ablation, three (7.9%) were positive. Conclusions * Short-term cancer-specific survival after RFA remains excellent and most cases are successful based on a combination of imaging and post-ablation biopsies performed almost 2 years after treatment. * There were four out of 150 (2.7%) patients who had recurrences with tissue confirmation; one of these patients was detected on imaging and three (2%) were radiologically occult. * The absence of enhancement in the setting of non-involuting lesions is not always a guarantee of a successful ablation.