Complications after 100 sessions of cone-beam computed tomography-guided lung radiofrequency ablation: a single-center, retrospective experience

Figures & data

Figure 1. CBCT-guided lung RFA with virtual guidance in a 62-year-old woman. (a) CT image shows an 8-mm nodule (arrow) in the left lower lobe. (b) Virtual-guided planning for a safe needle route (green line) to the target lesion was performed. (c) When CBCT moves automatically until the entry-point view (i.e., vertical alignment from the entry site [red circle] to the target lesion [green circle] with virtual color), spots can be seen on the fluoroscopic image. (d) CBCT was performed after electrode placement to confirm the exact location of the needle tip.

Figure 2. Workflow followed in our study from pre-procedural CBCT to management of complication.

Table 1. Characteristics of the 100 RFA sessions in 63 patients with a total of 121 tumors.

	Patients (n = 63)	Tumors (n = 121)	RFA sessions (n = 100)
Age mean (range)	58.0 (31–81)
Gender
Male	31
Female	32
Tumor size mean (range)		12.8 mm (4–50)
Primary lung cancer	20 (31.7%)	26 (21.5%)	24
Recurrence	15	24	22
Inoperative lung cancer	2	2	2
Metastasis	43 (68.3%)	95 (78.5%)	76
Colorectal cancer	19	28	21
Head and neck cancer	14	54	42
Renal cell carcinoma	4	5	5
Hepatocellular carcinoma	2	3	3
Endometrial cancer	2	3	3
Ovarian cancer	2	1	1
Advanced gastric cancer	1	1	1
Patient position
Supine			39
Prone			61
Lesion location
Right upper lobe		19
Right middle lobe		12
Right lower lobe		27
Left upper lobe		33
Left lower lobe		30
Fluoroscopy visible		49
Fluoroscopy invisible		72	69^a
Multiple-electrode ablation^b		21	20
Overlapping ablation		1	1

^aIn these sessions, there was at least one invisible target tumor on fluoroscopy alone.

^bIn one session, multiple-electrode ablation was performed on two target tumors. Two electrodes were used for 20 tumors, and 3 electrodes were used for the remaining 1 tumor.

Table 2. Major Complications in 100 Lung Radiofrequency Ablation (RFA) Sessions.

Major complication	CTCAE grade	No. of RFA Sessions
Immediate complication (<24h after RFA)
Pulmonary hemorrhage^a	Grade 3	1
Periprocedural complication (24h to 30 days after RFA)
Hemothorax requiring PCD	Grade 3	1
Pneumonia treated with antibiotics	Grade 3	2
Delayed complication (>30 days after RFA)
Bronchopleural fistula	Grade 3	1
Total		5

PCD: percutaneous catheter drainage.

^aTechnical failure of RFA was observed. The patient was treated in the intensive care unit.

Figure 3. An 81-year-old man underwent RF ablation of pulmonary metastasis from colorectal carcinoma in the anterior basal segment of the right lower lobe. (a) Chest CT obtained before RFA shows the tumor (arrow), which demonstrates the intimate relation of central pulmonary lesions with the blood vessels, thereby increasing the risk of pulmonary hemorrhage. (b) CBCT image during insertion of RF electrode. Notice traversing the intervening pulmonary vessels by the needle electrode. (c) C-arm fluoroscopy image showed the extent of intra-parenchymal hemorrhage after the insertion of the electrode. Immediate termination of the ablation session was decided because of excessive hemoptysis and deterioration of the clinical condition of the patient. The patient was treated in the intensive care unit. (d) After 3 h, progressive increase in pulmonary hemorrhage was observed in chest plain radiography.

Figure 4. Bronchopleural fistula developed after lung radiofrequency ablation in a 34-year-old woman with an intrapulmonary metastasis from ovarian cancer. (a) Chest CT obtained before RFA demonstrates the tumor (arrow) in the right middle lobe. (b) There is an electrode placement through the tumor under CBCT guidance. (c, d) Computed tomography image obtained 51 days after ablation shows collection of fluid and air (arrowhead) in the right major fissure and adjacent bronchus (arrow), suggesting the possibility of bronchopleural fistula. (e) Plain chest radiograph obtained 82 days after ablation shows large pneumothorax. The bronchopleural fistula was closed after surgical repair.

Table 3. Minor Complications in 100 Lung Radiofrequency Ablation (RFA) Sessions.

Minor complication	CTCAE grade	No. of RFA Sessions
Immediate complication (<24h after RFA)
Pneumothorax not requiring PCD	Grade 1	7
Pneumothorax requiring PCD^a	Grade 2	5
Self-limiting hemoptysis	Grade 1	10
Periprocedural complication (24h to 30 days after RFA)
Pneumothorax not requiring PCD	Grade 1	2
Pneumothorax requiring PCD	Grade 2	1
Subcutaneous emphysema	Grade 1	2
Hemoptysis with re-admission	Grade 2	1
Total		28
Grade 1		21
Grade 2		7

PCD: percutaneous catheter drainage.

^aOf 5 sessions, 2 technical failures were observed.