Abstract
Purpose of Review
Technological advancements in transbronchial tumor ablation are poised to revolutionize bronchoscopic interventions by enabling diagnosis and treatment in one session. However, a deep understanding of ablation technologies and the factors determining their success is vital for effective implementation, which this review aims to address.
Recent Findings
While percutaneous ablation has been part of lung cancer care for over two decades, transbronchial ablation is in its infancy. Recent reports of transbronchial ablation bring excitement and the need for further developments.
Summary
Transbronchial ablative technologies could soon be a key part of the toolset for interventional pulmonologists. Thorough knowledge about ablation technologies, their determining factors and conditions for safe and effective application are crucial for effective utilization.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Doppman JL, Krudy AG, Marx SJ, et al. Aspiration of enlarged parathyroid glands for parathyroid hormone assay. Radiology. 1983;148(1):31–5.
Solbiati L, Giangrande A, De Pra L, Bellotti E, Cantù P, Ravetto C. Percutaneous ethanol injection of parathyroid tumors under US guidance: Treatment for secondary hyperparathyroidism. Radiology. 1985;155(3):607–10.
Livraghi T, Festi D, Monti F, Salmi A, Vettori C. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology. 1986;161(2):309–12.
Livraghi T, Vettori C, Lazzaroni S. Liver metastases: Results of percutaneous ethanol injection in 14 patients. Radiology. 1991;179(3):709–12.
Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: Long-term results of percutaneous ethanol injection. Radiology. 1995;197(1):101–8.
Glazer ES, Curley SA. The ongoing history of thermal therapy for cancer. Surg. Oncol. Clin. N. 2011.
Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: A unified approach to underlying principles, techniques, and diagnostic imaging guidance. Am J Roentgenol. 2000;174(2):323–31.
Chu KF, Dupuy DE. Thermal ablation of tumours: Biological mechanisms and advances in therapy. Nat Rev Cancer. 2014;14(3):199–208.
Strasberg S, Linehan D. Radiofrequency ablation of liver tumors. Curr Probl Surg. 2003;40(8):459–98.
Goldberg SN, Gazelle GS, Halpern EF, Rittman WJ, Mueller PR, Rosenthal DI. Radiofrequency tissue ablation: Importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol. 1996;3(3):212–8.
Ahmed M, Brace CL, Lee FC, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology. 2011.
Cooper IS. Cryogenic surgery: A new method of destruction or extirpation of benign or malignant tissues. N Engl J Med. 1963;268(14):743–9.
Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37(3):171–86.
Organ LW. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol. 1976;39(2):69–76.
McGahan JP, Browning PD, Brock JM, Tesluk H. Hepatic ablation using radiofrequency electrocautery. Invest Radiol. 1990;25(3):267–70.
Livraghi T, Goldberg SN, Monti F, et al. Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases. Radiology. 1997;202(1):205–10.
Ni Y, Miao Y, Mulier S, Yu J, Baert AL, Marchal G. A novel “cooled-wet” electrode for radiofrequency ablation. Eur. Radiol. 2000.
Pereira PL, Trübenbach J, Schenk M, et al. Radiofrequency ablation: In vivo comparison of four commercially available devices in pig livers. Radiology. 2004;232(2):482–90.
Rossi S, Buscarini E, Garbagnati F, et al. Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. Am J Roentgenol. 1998;170(4):1015–22.
Laeseke PF, Frey TM, Brace CL, et al. Multiple-electrode radiofrequency ablation of hepatic malignancies: Initial clinical experience. Am J Roentgenol. 2007;188(6):1485–94.
Lu DS, Raman SS, Vodopich DJ, Wang M, Sayre J, Lassman C. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: Assessment of the “heat sink” effect. Am J Roentgenol. 2002;178(1):47–51.
Osepchuk JM. The history of the microwave oven: A critical review. Paper presented at: 2009 IEEE MTT-S International Microwave Symposium Digest. 2009.
Sun Y, Wang Y, Ni X, et al. Comparison of ablation zone between 915- and 2,450-MHz cooled-shaft microwave antenna: Results in in vivo porcine livers. AJR Am. J. Roentgenol. 2009.
Brace CL. Microwave ablation technology: What every user should know. Curr Probl Diagn Radiol. 2009;38(2):61–7.
Carrafiello G, Laganà D, Mangini M, et al. Microwave tumors ablation: Principles, clinical applications and review of preliminary experiences. Int J Surg. 2008;6(Suppl 1):S65-69.
Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J. Hepatol. 2015.
Fallahi H, Prakash P. Antenna designs for microwave tissue ablation. Crit Rev Biomed Eng. 2018.
Lubner MG, Brace CL, Hinshaw JL, Lee FT. Microwave tumor ablation: Mechanism of action, clinical results, and devices. JVIR 2010;21(8, Supplement):S192-S203.
Gage AA. History of cryosurgery. Semin Surg Oncol. 1998;14(2):99–109.
Erinjeri JP, Clark T. Cryoablation: Mechanism of action and devices. JVIR. 2010.
Lyons GR, Winokur RS, Pua BB. Pulmonary cryoablation zones: More aggressive ablation is warranted in vivo. AJR Am. J. Roentgenol. 2019.
Gage AA, Guest K, Montes M, Caruana JA, Whalen DA. Effect of varying freezing and thawing rates in experimental cryosurgery. Cryobiology. 1985;22(2):175–82.
Olive G, Yung R, Marshall H, Fong KM. Alternative methods for local ablation-interventional pulmonology: A narrative review. Transl Lung Cancer Res. 2021;10(7):3432–45.
Steinfort DP, Rangamuwa K. A glimpse of the future?-Bronchoscopic ablation of peripheral early stage lung cancer. Transl Lung Cancer Res. 2021;10(10):3861–4.
Harris K, Puchalski J, Sterman D. Recent advances in bronchoscopic treatment of peripheral lung cancers. Chest. 2017;151(3):674–85.
de Baere T, Tselikas L, Catena V, Buy X, Deschamps F, Palussiere J. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging. 2016;97(10):1019–24.
Genshaft SJ, Suh RD, Abtin F, et al. Society of interventional radiology multidisciplinary position statement on percutaneous ablation of non-small cell lung cancer and metastatic disease to the lungs: Endorsed by the Canadian Association for Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology. J Vasc Interv Radiol. 2021;32(8):1241 e1241–1241 e1212.
Murphy MC, Wrobel MM, Fisher DA, Cahalane AM, Fintelmann FJ. Update on image-guided thermal lung ablation: Society guidelines, therapeutic alternatives, and postablation imaging findings. AJR Am J Roentgenol. 2022;219(3):471–85.
• Bartlett EC, Rahman S, Ridge CA. Percutaneous image-guided thermal ablation of lung cancer: What is the evidence? Lung Cancer. 2023;176:14–23. This is the most recent review on the evidence to date for percutaneous IGTA.
Siu ICH, Chan JWY, Manuel II TB, Ngai JCL, Lau RWH, Ng CSH. Bronchoscopic ablation of lung tumours: Patient selection and technique. JOVS. 2021;8.
Tsushima K, Koizumi T, Tanabe T, et al. Bronchoscopy-guided radiofrequency ablation as a potential novel therapeutic tool. Eur Respir J. 2007;29(6):1193–200.
Tanabe T, Koizumi T, Tsushima K, et al. Comparative study of three different catheters for CT imaging-bronchoscopy-guided radiofrequency ablation as a potential and novel interventional therapy for lung cancer. Chest. 2010;137(4):890–7.
Koizumi T, Tsushima K, Tanabe T, et al. Bronchoscopy-guided cooled radiofrequency ablation as a novel intervention therapy for peripheral lung cancer. Respiration. 2015;90(1):47–55.
Steinfort DP, Antippa P, Rangamuwa K, et al. Safety and feasibility of a novel externally cooled bronchoscopic radiofrequency ablation catheter for ablation of peripheral lung tumours: A first-in-human dose escalation study. Respiration. 2023;102(3):211–9.
**e F, Zheng X, **ao B, Han B, Herth FJF, Sun J. Navigation bronchoscopy-guided radiofrequency ablation for nonsurgical peripheral pulmonary tumors. Respiration. 2017;94(3):293–8.
Chan JWY, Lau RWH, Ngai JCL, et al. Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance-A novel technique and initial experience with 30 cases. Transl Lung Cancer Res. 2021;10(4):1608–22.
• Chan JWY, Siu ICH, Chang ATC, et al. Transbronchial techniques for lung cancer treatment: Where are we now? Cancers (Basel). 2023;15(4).This is the most recent review on transbronchial techniques for lung cancer.
**e F, Chen J, Jiang Y, Sun J, Hogarth DK, Herth FJF. Microwave ablation via a flexible catheter for the treatment of nonsurgical peripheral lung cancer: A pilot study. Thorac Cancer. 2022;13(7):1014–20.
Pritchett MA, Reisenauer JS, Kern R, et al. Novel image-guided flexible-probe transbronchial microwave ablation for stage 1 lung cancer. Respiration. 2023;102(3):182–93.
Bao F, Yu F, Wang R, et al. Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule. Transl Lung Cancer Res. 2021;10(9):3759–70.
Fan Y, Zhang AM, Wu XL, et al. Transbronchial needle aspiration combined with cryobiopsy in the diagnosis of mediastinal diseases: A multicentre, open-label, randomised trial. Lancet Respir Med. 2023;11(3):256–64.
Kim SH, Mok J, Jo EJ, et al. The additive impact of transbronchial cryobiopsy using a 11-mm diameter cryoprobe on conventional biopsy for peripheral lung nodules. Cancer Res Treat. 2023;55(2):506–12.
Hammer D, Budi L, Nagy A, Varga R, Horvath P. Evaluation of a transbronchial cryoprobe for the ablation of pulmonary nodules: An in vitro pilot study. BMC Pulm Med. 2023;23(1):71.
Zheng X, Yuan H, Gu C, et al. Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model. Diagn Interv Imaging. 2022;103(1):49–57.
Moore W, Talati R, Bhattacharji P, Bilfinger T. Five-year survival after cryoablation of stage I non-small cell lung cancer in medically inoperable patients. J Vasc Interv Radiol. 2015;26(3):312–9.
McDevitt JL, Mouli SK, Nemcek AA, Lewandowski RJ, Salem R, Sato KT. Percutaneous cryoablation for the treatment of primary and metastatic lung tumors: Identification of risk factors for recurrence and major complications. J Vasc Interv Radiol. 2016;27(9):1371–9.
de Baere T, Tselikas L, Woodrum D, et al. Evaluating cryoablation of metastatic lung tumors in patients–Safety and efficacy: The ECLIPSE trial–Interim analysis at 1 year. J Thorac Oncol. 2015;10(10):1468–74.
Callstrom MR, Woodrum DA, Nichols FC, et al. Multicenter study of metastatic lung tumors targeted by interventional cryoablation evaluation (SOLSTICE). J Thorac Oncol. 2020;15(7):1200–9.
• Paez-Carpio A, Gomez FM, Isus Olive G, et al. Image-guided percutaneous ablation for the treatment of lung malignancies: Current state of the art. Insights Imaging. 2021;12(1):57. This is a detailed review of technical aspects percutaneous IGTA.
Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e278S-e313S.
NCCN. NCCN guidelines® insights - Non–small cell lung cancer, version 3.2023. https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published 2023. Accessed 06/01/2023, 2023.
Venturini M, Cariati M, Marra P, Masala S, Pereira PL, Carrafiello G. CIRSE standards of practice on thermal ablation of primary and secondary lung tumours. Cardiovasc Intervent Radiol. 2020;43(5):667–83.
Eberhardt WE, De Ruysscher D, Weder W, et al. 2nd ESMO consensus conference in lung cancer: Locally advanced stage III non-small-cell lung cancer. Ann Oncol. 2015;26(8):1573–88.
Nelson DB, Tam AL, Mitchell KG, et al. Local recurrence after microwave ablation of lung malignancies: A systematic review. Ann Thorac Surg. 2019;107(6):1876–83.
Sebek J, Taeprasartsit P, Wibowo H, Beard WL, Bortel R, Prakash P. Microwave ablation of lung tumors: A probabilistic approach for simulation‐based treatment planning. Med Phys. 2021.
Ponder E. The coefficient of thermal conductivity of blood and of various tissues. J Gen Physiol. 1962;45(3):545–51.
Sonntag PD, Hinshaw JL, Lubner MG, CL Brace, Lee FT Jr. Thermal ablation of lung tumors. Surg Oncol Clin N Am. 2011;20(0):369–87.
Blackmon SH, Sterner R, Eiken PW, et al. Technical and safety performance of CT-guided percutaneous microwave ablation for lung tumors: An ablate and resect study. JTD. 2021.
Frandon J, Akessoul P, Kammoun T, et al. Microwave ablation of liver, kidney and lung lesions: One-month response and manufacturer’s charts’ reliability in clinical practice. Sensors (Basel). 2022;22(11).
U.S. Food and Drug Administration. (2020, October 13). Letter to NeuWave Medical, Inc. regarding the NEUWAVE Microwave Ablation System and Accessories (K200081). https://www.accessdata.fda.gov/cdrh_docs/pdf20/K200081.pdf.
Hu H, Nan Q, Tian Z, Gao X. Study on the microwave ablation effect of inflated porcine lung. Appl. Sci. 2022.
Vespro V, Bonanno MC, Andrisani MC, et al. CT after lung microwave ablation: Normal findings and evolution patterns of treated lesions. Tomography. 2022;8(2):617–26.
Chheang S, Abtin F, Guteirrez A, Genshaft S, Suh RD. Imaging features following thermal ablation of lung malignancies. Semin. Interv. Radiol. 2013.
Li H, Long Y, Yan G-W, et al. Microwave ablation vs. cryoablation for treatment of primary and metastatic pulmonary malignant tumors. Mol Chin Oncol. 2022.
Colak E, Tatli S, Shyn PB, Tuncali K, Silverman SG. CT-guided percutaneous cryoablation of central lung tumors. Diagn Interv Radiol. 2014.
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Russell J. Miller, MD, CDR, MC, USN is a military service member or federal/contracted employee of the United States government. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. The views expressed in this article reflect the results of research conducted by the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.
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Miller, R., Cheng, G. Transbronchial Tumor Ablation. Curr Pulmonol Rep 13, 103–115 (2024). https://doi.org/10.1007/s13665-023-00329-6
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DOI: https://doi.org/10.1007/s13665-023-00329-6