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458
The patient is
complaining
of worsening
chest pain post-
biopsy:
1. Monitor vitals, increase supplemental
oxygenation, and draw labs for potential blood
loss (Hb, Hct).
2. Oral analgesics for moderate pain (most
situations).
3. PCA pumps or oral narcotics if severe/
increasing pain.
4. NSAIDs for 3–5days following discharge
to limit pleural inflammation, thereby limiting
pain and risk of pleural effusion.
Complications
What can go
wrong?
Complications in lung ablation include
post-ablation syndrome, mild pyrexia,
pneumothorax, hemorrhage, hemoptysis,
bronchopleural fistulas, ARDS, and damage
to the surrounding skin (cellulitis) or abscess
formation.
What if the
patient has pain
at the puncture
site?
Look at incision sites to ensure absence
of bleeding, or cellulitis (erythema (red),
hyperemia (warm to touch), purulence, dolor
(pain), and tumor (swelling)):
If there is no evidence of cellulitis– treat
with analgesics.
If there is concern for cellulitis– consider
adding antibiotics (cefazolin).
(continued)
J. Smirniotopoulos and M. Mitry
https://t.me/med1917
459
What do I need
to know about
pneumothoraces
and lung biopsies/
ablations?
This may occur in up to 25% of patients,
though not all pneumothoraces are treated
the same way.
If the pneumothorax is small, repeat a chest
X-ray to ensure stability. If the patient is
asymptomatic, they can likely be discharged
without additional intervention.
4–12% of pneumothoraces will require a
chest tube, which also includes Heimlich valve
chest tubes (patients can be discharged home
with this type of tube).
20% of pneumothoraces after ablation
resolve following evacuation of air with a
small needle or catheter.
What is the
risk of pleural
effusion?
Pleural effusion after ablation may
occur in 6–19% of patients. Most resolve
spontaneously and rarely require
thoracentesis or chest tube.
What is the risk
of hemoptysis?
Hemoptysis may occur in up to 15% of
patients, though it is often self-limited and
does not require admission to the hospital.
What factors
influence severe
pulmonary
hemorrhage or
hemothorax?
Incidence is correlated with biopsy or
ablation in close proximity to the hilum.
What should I do
if there is concern
for severe
hemorrhage?
Obtain a stat CTA and prepare for
endovascular or surgical intervention.
What is post-
ablation
syndrome (within
24–48hours)?
Flu-like symptoms that develop within the
first 24–48hours of the procedure. Explain
to the patient that they may experience
fever, malaise, chills, myalgia, and nausea.
Productive cough with rust-colored sputum
may also occur.
(continued)
34 Pulmonary Oncology
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460
Does post-
ablation
syndrome require
treatment?
This is typically self-limited, and may last up
to 7–14days.
Are there other
less common
complications to
be aware of?
Infection, bronchopleural fistula, tumor
seeding, and air embolism
Landmark Research
Lorenz JM.Updates in percutaneous lung biopsy: new indi-
cations, techniques and controversies. Semin Intervent Radiol.,
U.S.National Library of Medicine. 2012;29(4):319–24. www.
ncbi.nlm.nih.gov/pubmed/?term=24293806%5Bpmid%5D.
Winokur RS, et al. Percutaneous lung biopsy: technique,
efficacy, and complications. Semin Intervent Radiol.,
U.S.National Library of Medicine. 2013;30(2):121–7.
Ahmed M, Brace CL, Lee FT Jr, Goldberg SN.Principles
of and advances in percutaneous ablation. Radiology.
2011;258(2):351–69.
Dupuy DE.Microwave ablation compared with radiofre-
quency ablation in lung tissue—is microwave not just for
popcorn anymore? Radiology. 2009;251(3):617–8.
Brace CL.Radiofrequency and microwave ablation of the
liver, lung, kidney, and bone: what are the differences? Curr
Probl Diagn Radiol. 2009;38(3):135–43.
Hinshaw JL, Lee FT Jr, Laeseke PF, Sampson LA, Brace
C. Temperature isotherms during pulmonary cryoablation
and their correlation with the zone of ablation. J Vasc Interv
Radiol. 2010;21(9):1424–8.
Kawamura M, Izumi Y, Tsukada N, et al. Percutaneous
cryoablation of small pulmonary malignant tumors under
computed tomographic guidance with local anesthesia for
nonsurgical candidates. J Thorac Cardiovasc Surg.
2006;131(5):1007–13.
J. Smirniotopoulos and M. Mitry
https://t.me/med1917
461
Wang H, Littrup PJ, Duan Y, Zhang Y, Feng H, Nie
Z. Thoracic masses treated with percutaneous cryotherapy:
initial experience with more than 200 procedures. Radiology.
2005;235(1):289–98.
Common Questions
What follow-up do
post-lung ablation
patients require?
Non-contrast/contrast chest CT at
1month
Chest CT at 4months
FDG-PET/CT at 6 and 12months
Followed by PET/CT or contrast CT at
6-month intervals
Further Reading
Aberle DR, Adams AM, Berg CD, et al. Reduced lung-can-
cer mortality with low-dose computed tomographic screening.
N Engl J Med. 2011;365(5):395–409. https://doi.org/10.1056/
NEJMoa1102873
.
Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of
and advances in percutaneous ablation. Radiology.
2011;258(2):351–69.
American Cancer Society. Key statistics for lung cancer. 2019.
https://www.cancer.org/content/cancer/en/cancer/lung- cancer/
about/key- statistics.html.
Blackmon JM, Franco A. Normal variants of the accessory hemi-
azygos vein. Br J Radiol. 2011;84(1003):659–60. https://doi.
org/10.1259/bjr/13695502.
Boaz NT, Bernor RL, Meshida K, etal. Anatomy, thoracotomy and
the collateral intercostal neurovascular bundle. [Updated 2019
Jul 14]. In: StatPearls [Internet]. Treasure Island: StatPearls
Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/
books/NBK544368/.
Brace CL. Radiofrequency and microwave ablation of the liver,
lung, kidney, and bone: what are the differences? Curr Probl
Diagn Radiol. 2009;38(3):135–43.
34 Pulmonary Oncology
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462
Buy X, Tok C-H, Szwarc D, et al. Thermal protection during per-
cutaneous thermal ablation procedures: interest of carbon
dioxide dissection and temperature monitoring. Cardiovasc
Intervent Radiol. 2009;32:529–34.
https://doi.org/10.1007/
s00270-
009- 9524- 8.
Centers for Disease Control and Prevention. National Center for
Health Statistics. CDC WONDER on-line database, compiled
from compressed mortality file 1999–2016, series 20, no. 2V, 2017.
Chassagnon G, Morel B, Carpentier E, Ducou Le Pointe H, Sirinelli
D.Tracheobronchial branching abnormalities: lobe-based clas-
sification scheme. Radiographics. 2016;36(2):358–73. https://doi.
org/10.1148/rg.2016150115
.
Chen E, Itkin M. Thoracic duct embolization for chylous
leaks. Semin Intervent Radiol. 2011;28(1):63–74. https://doi.
org/10.1055/s-
0031- 1273941.
de Koning HJ, Meza R, Plevritis SK, ten Haaf K, Munshi VN,
Jeon J. Benefits and harms of computed tomography lung
cancer screening strategies: a comparative modeling study
for the U.S. Preventive Services Task Force. Ann Intern Med.
2014;160(5):311–20.
https://doi.org/10.7326/M13- 2316.
Domadia S, Kumar SR, Votava-Smith JK, Pruetz JD. Neonatal
outcomes in total anomalous pulmonary venous return: the
role of prenatal diagnosis and pulmonary venous obstruc-
tion. Pediatr Cardiol. 2018;39(7):1346–54. https://doi.org/10.1007/
s00246-
018- 1901- 0.
Dupuy DE. Microwave ablation compared with radiofrequency
ablation in lung tissue—is microwave not just for popcorn any-
more? Radiology. 2009;251(3):617–8.
Fassina A, et al. Role and accuracy of rapid on-site evaluation of
CT-guided fine needle aspiration cytology of lung nodules.
Semin Intervent Radiol., U.S. National Library of Medicine.
2011;22(5):306–12. www.ncbi.nlm.nih.gov/pubmed/?term=20738
359%5Bpmid%5D
Gervais D, Sabharwal T. Interventional radiology procedures in
biopsy and drainage. Springer; 2011.
Gupta S, et al. Quality improvement guidelines for percutaneous
needle biopsy. J Vasc Interv Radiol. 2010;21(7):969–75. https://
doi.org/10.1016/j.jvir.2010.01.011.
Hikari T, Gobara H, Fujiwara H, Ishii H, Tomita K, Uka M,
Makimoto S, Kanazawa S.Lung cancer ablation: complications.
Semin Intervent Radiol. 2013 Jun;30(2):169–75.
J. Smirniotopoulos and M. Mitry
https://t.me/med1917
463
Hinshaw JL, Lee FT Jr, Laeseke PF, Sampson LA, Brace
C.Temperature isotherms during pulmonary cryoablation and
their correlation with the zone of ablation. J Vasc Interv Radiol.
2010;21(9):1424–8.
Hollings N, Shaw P.Diagnostic imaging of lung cancer. Eur Respir
J. 2002;19:722–42.
https://doi.org/10.1183/09031936.02.00280002.
Kanaji N, Watanabe N, Kita N, etal. Paraneoplastic syndromes asso-
ciated with lung cancer. World J Clin Oncol. 2014;5(3):197–223.
https://doi.org/10.5306/wjco.v5.i3.197.
Kaufman JA, Lee MJ. Vascular and interventional radiology.
Elsevier/Saunders; 2014.
Kawamura M, Izumi Y, Tsukada N, etal. Percutaneous cryoablation
of small pulmonary malignant tumors under computed tomo-
graphic guidance with local anesthesia for nonsurgical candi-
dates. J Thorac Cardiovasc Surg. 2006;131(5):1007–13.
Kinoshita F, et al. CT-guided transthoracic needle biopsy using
a puncture site-down positioning technique. AJR Am J
Roentgenol. 2006;187(4):926–32. www.ajronline.org/doi/
abs/10.2214/AJR.05.0226
Klein JS, Zarka MA.Transthoracic needle biopsy. Radiol Clin North
Am., U.S.National Library of Medicine. 2000;38(2):235–66, vii.
www.ncbi.nlm.nih.gov/pubmed/?term=10765388%5Bpmid%5D
Kumaresh A, Kumar M, Dev B, Gorantla R, Sai PV, Thanasekaraan
V. Back to basics – “must know” classical signs in tho-
racic radiology. J Clin Imaging Sci. 2015;5:43. https://doi.
org/10.4103/2156- 7514.161977.
Lorenz JM. Updates in percutaneous lung biopsy: new indica-
tions, techniques and controversies. Semin Intervent Radiol.,
U.S.National Library of Medicine. 2012;29(4):319–24. www.ncbi.
nlm.nih.gov/pubmed/?term=24293806%5Bpmid%5D
Loverdos K, Fotiadis A, Kontogianni C, Iliopoulou M, Gaga
M.Lung nodules: a comprehensive review on current approach
and management. Ann Thorac Med. 2019;14(4):226–38. https://
doi.org/10.4103/atm.ATM_110_19.
Manhire A, Charig M, Clelland C, et al. Guidelines for radiologi-
cally guided lung biopsy. Thorax, BMJ Publishing Group Ltd.
2003;58(11):920–36. thorax.bmj.com/content/58/11/920
National Comprehensive Cancer Network. NCCN Guidelines
Version 6.2020. Non-small cell lung cancer. Available at: www.
nccn.org. Accessed 11 Aug 2020.
34 Pulmonary Oncology
https://t.me/med1917
464
National Comprehensive Cancer Network. NCCN Guidelines
Version 1.2021. Small cell lung cancer. Available at:
www.nccn.
org
. Accessed 11 Aug 2020.
Panagopoulos N, Leivaditis V, Koletsis E, et al. Pancoast tumors:
characteristics and preoperative assessment. J Thorac
Dis. 2014;6(Suppl 1):S108–15.
https://doi.org/10.3978/j.
issn.2072-
1439.2013.12.29.
Parker MS, Chasen MH, Paul N. Radiologic signs in thoracic
imaging: case-based review and self-assessment module [pub-
lished correction appears in AJR Am J Roentgenol. 2009;193(3
Suppl):S58]. AJR Am J Roentgenol. 2009;192(3 Suppl):S34–48.
https://doi.org/10.2214/AJR.07.7081.
Piciucchi S, Barone D, Sanna S, etal. The azygos vein pathway: an
overview from anatomical variations to pathological changes.
Insights Imaging. 2014;5(5):619–28.
https://doi.org/10.1007/
s13244-
014- 0351- 3.
Smirniotopoulos J, et al. Interventional oncology: keeping out
of trouble in ablation techniques. Tech Vasc Interv Radiol.
2018;21(4):223–7.
Stoddard N, Lowery D.Anatomy, thorax, mediastinum. StatPearls
Publishing; 2019.
Tyrak KW, Holda J, Holda MK, Koziej M, Piatek K, Klimek-
Piotrowska W.Persistent left superior vena cava. Cardiovasc J
Afr. 2017;28(3):e1–4. https://doi.org/10.5830/CVJA- 2016- 084.
U.S.Department of Health and Human Services. The health conse-
quences of involuntary exposure to tobacco smoke. A report of
the surgeon general. Atlanta: Centers for Disease Control and
Prevention (US); 2006.
Varona Porres D, Persiva Morenza O, Pallisa E, Roque A, Andreu J,
Martínez M.Learning from the pulmonary veins. Radiographics.
2013;33(4):999–1022. https://doi.org/10.1148/rg.334125043.
Wang H, Littrup PJ, Duan Y, Zhang Y, Feng H, Nie Z. Thoracic
masses treated with percutaneous cryotherapy: initial experience
with more than 200 procedures. Radiology. 2005;235(1):289–98.
Winokur RS, etal. Percutaneous lung biopsy: technique, efficacy, and
complications. Semin Intervent Radiol., U.S.National Library of
Medicine. 2013;30(2):121–7.
World Health Organization. Cancer fact sheet, 2018.
J. Smirniotopoulos and M. Mitry
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465© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_35
Evaluating Patient
What are the most
common types of
renal malignancies?
RCC, lymphoma, urothelial cell carcinoma,
and metastasis. Of these, RCC is the most
common.
Why has the
incidence of RCC
increased over the
past decade?
Detection rates of RCCs have increased
with increasing use of radiologic imaging,
as well as prevalence of smoking and
obesity.
What are some
symptoms of RCC?
Symptoms of RCC are nonspecific and may
include abdominal or flank pain, anemia,
fever, hematuria, a palpable lump, and
weight loss.
Chapter 35
Renal Oncology
ShajiKhan andMonicaJ.Uceda
S. Khan (*) · M. J. Uceda
Department of Radiology, Presence Health St. Francis Hospital,
Evanston, IL, USA
e-mail: shaji.khan@presencehealth.org;
monica.uceda-arriola@presencehealth.org
(continued)
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466
What is the
differential
diagnosis for an
RCC on imaging?
A renal mass should be suspicious for
malignancy until proven otherwise.
Differential diagnoses include
angiomyolipoma (AML) or oncocytoma,
renal abscess, hematoma, lymphoma,
metastasis, and a complex cyst.
What are some
subtypes of RCC?
Clear cell (most common, 70%), papillary
(10–15%), chromophobe (< 5%), and
medullary (rare)
What are imaging
features of the
different RCC
subtypes?
Clear cell: High T2 with microscopic
fat (loses signal on out of phase);
heterogenous and avidly enhancing
Papillary: Low T2 and may contain
hemosiderin (loses signal on in-phase);
slow homogenous enhancement
(hypovascular)
Chromophobe: Typically low T2, commonly
with calcifications; intermediate vascularity;
may have stellate scar/spoke-wheel
enhancement similar to oncocytoma
High Yield History
What is the average
age of diagnosis of
RCC?
Typical age at diagnosis of RCC is between
50 and 70years old.
Does RCC
have a gender
predilection?
Yes, males are more commonly affected at a
ratio of approximately 2:1.
What are the risk
factors for RCC?
Smoking, obesity, dialysis, and
cyclophosphamide use. Sickle cell disease
or sickle cell trait is specifically a risk factor
for medullary type RCC.
S. Khan and M. J. Uceda
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467
Is RCC associated
with any
syndromes?
von Hippel-Lindau (VHL)
Autosomal dominant; VHL gene on
chromosome 3
Clear cell RCC, often multiple
Tuberous sclerosis
Sporadic more often than inherited (AD);
TSC1 gene on chromosome 9 or TSC2 on
chromosome 16
Multiple angiomyolipomas (rarely clear
cell RCC)
Hereditary papillary renal cell cancer
syndrome
Autosomal dominant; c-MET gene on
chromosome 7
Multiple papillary RCCs
Sickle cell trait
Renal medullary RCC with very poor
prognosis
What is the 5-year
survival of RCC?
In the absence of metastasis, the 5-year
survival is 65–90%. With metastasis,
however, the 5-year survival is considerably
lower.
Indications/Contraindications
What are some treatment
options interventional
radiology can offer
for treatment of renal
malignancies?
Thermal ablation techniques and
renal artery embolization with a wide
variety of embolic agents
(continued)
35
Renal Oncology
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