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Risk of persistent air leaks following percutaneous cryoablation and microwave ablation of peripheral lung tumors

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Abstract

Objectives

To compare the incidence of persistent air leak (PAL) following cryoablation vs MWA of lung tumors when the ablation zone includes the pleura.

Methods

This bi-institutional retrospective cohort study evaluated consecutive peripheral lung tumors treated with cryoablation or MWA from 2006 to 2021. PAL was defined as an air leak for more than 24 h after chest tube placement or an enlarging postprocedural pneumothorax requiring chest tube placement. The pleural area included by the ablation zone was quantified on CT using semi-automated segmentation. PAL incidence was compared between ablation modalities and a parsimonious multivariable model was developed to assess the odds of PAL using generalized estimating equations and purposeful selection of predefined covariates. Time-to-local tumor progression (LTP) was compared between ablation modalities using Fine-Gray models, with death as a competing risk.

Results

In total, 260 tumors (mean diameter, 13.1 mm ± 7.4; mean distance to pleura, 3.6 mm ± 5.2) in 116 patients (mean age, 61.1 years ± 15.3; 60 women) and 173 sessions (112 cryoablations, 61 MWA) were included. PAL occurred after 25/173 (15%) sessions. The incidence was significantly lower following cryoablation compared to MWA (10 [9%] vs 15 [25%]; p = .006). The odds of PAL adjusted for the number of treated tumors per session were 67% lower following cryoablation (odds ratio = 0.33 [95% CI, 0.14–0.82]; p = .02) vs MWA. There was no significant difference in time-to-LTP between ablation modalities (p = .36).

Conclusions

Cryoablation of peripheral lung tumors bears a lower risk of PAL compared to MWA when the ablation zone includes the pleura, without adversely affecting time-to-LTP.

Key Points

• The incidence of persistent air leaks after percutaneous ablation of peripheral lung tumors was lower following cryoablation compared to microwave ablation (9% vs 25%; p = .006).

• The mean chest tube dwell time was 54% shorter following cryoablation compared to MWA (p = .04).

• Local tumor progression did not differ between lung tumors treated with percutaneous cryoablation compared to microwave ablation (p = .36).

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Abbreviations

CI:

Confidence interval

HU:

Hounsfield units

IGTA:

Image-guided thermal ablation

LTP:

Local tumor progression

MWA:

Microwave ablation

OR:

Odds ratio

PAL:

Persistent air leak

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Acknowledgements

M.A.K. is grateful for support from the Rolf W. Günther Stiftung für Radiologische Wissenschaften.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Maya Abrishami Kashani, Mark C. Murphy, Jonathan A. Saenger, Maria M. Wrobel, Ismail Tahir, Sofiane Mrah, Stefan Ringer & Florian J. Fintelmann

  2. University of Heidelberg, Heidelberg, Germany

    Maya Abrishami Kashani

  3. Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany

    Maya Abrishami Kashani & Alexander C. Bunck

  4. Faculty of Medicine, Sigmund Freud University, Vienna, Austria

    Jonathan A. Saenger

  5. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Stuart G. Silverman & Paul B. Shyn

  6. Division of Mathematics and Science, Babson College, Wellesley, MA, USA

    Dessislava A. Pachamanova

  7. Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA

    Dessislava A. Pachamanova

Authors
  1. Maya Abrishami Kashani
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  9. Stuart G. Silverman
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Corresponding author

Correspondence to Florian J. Fintelmann.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Florian J. Fintelmann.

Conflict of interest

Florian J. Fintelmann received salary support from the William M. Wood Foundation for related research during the study period and is a consultant for Pfizer. The other authors have no relevant conflicts of interest to report.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap:

The cohort (but not the analysis) of the current study overlaps with two previously published reports in that 125 tumors in 37 patients were part of prior investigations.

a) Reference #16

Comparison of Percutaneous Image-Guided Microwave Ablation and Cryoablation for Sarcoma Lung Metastases: A 10-Year Experience. AJR Am J Roentgenol. 2022 Mar;218(3):494–504. https://doi.org/10.2214/AJR.21.26551. Epub 2021 Oct 6. Bourgouin PP, Wrobel MM, Mercaldo ND, Murphy MC, Leppelmann KS, Levesque VM, Muniappan A, Silverman SG, Shepard JO, Shyn PB, Fintelmann FJ.

Here we assessed overall survival and local tumor progression of pulmonary sarcoma metastases treated with percutaneous microwave and cryoablation.

b) Reference #17

Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study. Ann Surg Oncol. 2021 Oct;28(11):5829–5839. https://doi.org/10.1245/s10434-021-09714-4. Epub 2021 Feb 23. Leppelmann KS, Levesque VM, Bunck AC, Cahalane AM, Lanuti M, Silverman SG, Shyn PB, Fintelmann FJ.

Here we assessed overall survival and local tumor progression of Adenoid Cystic Carcinoma of the Head and Neck metastases treated with percutaneous microwave and cryoablation.

The current study differs in that the focus is persistent air leaks following percutaneous lung ablation of peripheral lung tumors, regardless of histology.

Methodology

• retrospective

• observational

• multicenter study

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Abrishami Kashani, M., Murphy, M.C., Saenger, J.A. et al. Risk of persistent air leaks following percutaneous cryoablation and microwave ablation of peripheral lung tumors. Eur Radiol 33, 5740–5751 (2023). https://doi.org/10.1007/s00330-023-09499-y

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