Synchronous percutaneous core-needle biopsy and microwave ablation for stage I non-small cell lung cancer in patients with Idiopathic pulmonary fibrosis: initial experience

Figures & data

Figure 1. Axial CT images of a 64-year-old man with stage IA NSCLC (adenocarcinoma) with IPF who underwent CT-guided synchronous percutaneous CNB and MWA. (a) CT prior to MWA treatment shows a 1.9 × 1.2 cm lesion in the right lower lobe (arrow); (b), (c) CT findings during MWA treatment, a 15 G coaxial introducer needle (arrow) was advanced to the proximal edge of the lesion, and the antenna was positioned centrally through the cannula into the lesion (arrow); (d) CT image immediately post-procedure showed ground-glass opacity around the tumor (arrow); (e) CT image 24 h post-procedure showed the expected thermal damage around the target lesion, without pneumothorax. (f) CT image 6 months after MWA treatment showed a reduced ablation area (arrow), cavitation changes in the primary focus, and surrounding fibrotic scarring with signs of inflammation. CT: computed tomography; NSCLC: non-small cell lung cancer; IPF: idiopathic pulmonary fibrosis; CNB: core-needle biopsy; MWA: microwave ablation.

Figure 2. Axial CT images of a 76-year-old man with stage IA NSCLC (squamous carcinoma) with IPF who underwent CT-guided synchronous percutaneous CNB and MWA. (a) CT prior to MWA treatment showed a 1.4 × 0.9 cm subpleural lesion in the left upper lobe (arrow); (b) CT findings during MWA treatment, the antenna punctured the Central position of the lesion through honeycomb lesions (arrow); (c) CT image 24 h post-procedure showed ground-glass opacity around the tumor (arrow); (d) the 12-month CT image after MWA treatment revealed gradual shrinkage of the ablated lesion, and it became a fiber scar (arrow). CT: computed tomography; NSCLC: non-small cell lung cancer; CNB: core-needle biopsy; MWA: microwave ablation; IPF: idiopathic pulmonary fibrosis.

Table 1. Patients and tumor characteristics.

No	Age/Gender	Smoking (years)	IPF (year)	Stage	Pathology	Location	Size (cm)	Comorbidity	Pulmonary function	Hospital stays (days)	LTP (months)	Follow-up (months/status)
1	61/M	30	6	Ia	Adenocarcinoma	LLL	1.6	Emphysema, COPD	FVC 2.12 L, FEV1 1.21 L, FEV1/FVC 57.1%	4	None	31/died
2	70/M	50	10	Ia	Large cell carcinoma	LUL	1.8	Hypertension, COPD	FVC 1.85 L, FEV1 0.92 L, FEV1/FVC 49.73%	4	None	36/died
3	71/M	51	11	Ia	Squamous carcinoma	RLL	2.0	Diabetes (type II), COPD	FVC 2.15 L, FEV1 1.31 L, FEV1/FVC 60.93%	3	20	25/died
4	63/M	40	8	Ia	Adenocarcinoma	LUL	1.4	COPD	FVC 2.57 L, FEV1 2.21 L, FEV1/FVC 86.03%	3	13	14/died
5	77/F	None	20	Ia	Squamous carcinoma	RLL	2.5	Hypertension, Emphysema, COPD, RA,	FVC 2.02 L, FEV1 0.98 L, FEV1/FVC 48.50%	5	None	33/died
6	83/M	40	15	Ia	Squamous carcinoma	LUL	2.0	Emphysema, Diabetes (type II), CHD	FVC 1.26 L, FEV1 0.86 L, FEV1/FVC 68.25%	4	None	5/died
7	79/M	30	2	Ia	Squamous carcinoma	LUL	2.0	Sjogren syndrome, CHD	FVC 1.78, FEV1 1.51, FEV1/FVC 84.47%	4	None	28/died
8	61/M	35	30	Ia	Squamous carcinoma	LUL	1.7	RA, COPD	FVC 2.02, FEV1 1.56, FEV1/FVC 77.17%	10	None	25/died
9	76/M	36	35	Ia	Squamous carcinoma	LUL	1.4	Emphysema, COPD, Hypertension, CI	FVC 3.02 L, FEV1 1.88 L, FEV1/FVC 62.25%	4	None	23/died
10	64/M	47	32	Ia	Adenocarcinoma	RML	1.9	COPD, TB	FVC 2.06 L, FEV1 0.88 L, FEV1/FVC 42.72%	6	None	13/survived
11	61/M	20	3	Ib	Squamous carcinoma	RUL	4.0	AA	FVC 2.6, FEV1 1.26, FEV1/FVC 61.16%	4	8	10/died
12	69/M	32	2	Ib	Adenocarcinoma	LUL	3.8	COPD	FVC 2.82, FEV1 1.9, FEV1/FVC 67.38%	4	10	16/died
13	72/M	60	10	Ia	Adenocarcinoma	LUL	2.0	CI, CRF, Emphysema	FVC 2.89, FEV1 2.21, FEV1/FVC 76.52%	3	None	15/survived
14	86/M	70	13	Ia	Squamous carcinoma	RUL	1.6	COPD, Emphysema, CHD, CHB	FVC 3.15, FEV1 1.9, FEV1/FVC 60.32%	3	None	18/survived
15	72/M	50	5	Ia	Squamous carcinoma	LUL	1.3	Emphysema	FVC 1.95, FEV1 0.87, FEV1/FVC 44.62%	2	None	25/died
16	68/F	None	1	Ia	Squamous carcinoma	LLL	2.0	COPD, CHD	FVC 3.78, FEV1 3.05, FEV1/FVC 80.65%	3	17	21/died
17	58/F	None	2	Ia	Adenocarcinoma	RUL	1.4	Hypertension	FVC 4.06, FEV1 3.27, FEV1/FVC 80.67%	2	None	17/survived
18	88/M	45	11	Ia	Squamous carcinoma	RLL	2.6	Hypertension, COPD, Diabetes (type II),	FVC 2.19, FEV1 1.47, FEV1/FVC 67.0%	2	12	13/survived
19	79/F	60	9	Ia	Squamous carcinoma	RUL	2.1	Emphysema, COPD	FVC 1.18, FEV1 0.8, FEV1/FVC 68.13%	2	15	19/died

COPD: chronic obstructive pulmonary; RA: Rheumatoid arthritis; CHD: Coronary heart disease; TB: tuberculosis; AA: allergic asthma; CI: cerebral infarction; CRF: chronic renal failure; CHB: chronic hepatitis B; LLL: left lower lobe; LUL: left upper lobe; RLL: right lower lobe; RML: right middle lobe; RUL: right upper lobe; IPF: idiopathic pulmonary fibrosis; FEV1: forced expiration volume in the first second; FVC: forced vital capacity; LTP: local tumor progression.

Table 2. Grade of complications during and following MWA.

Grade	Complications	Number (%)
Major complications	Pneumothorax (lung compression > 20%)	3 (15.79%)
	Bronchopleural fistula	1 (5.26%)
	Pneumonia	1 (5.26%)
Minor complications	Pneumothorax (lung compression < 20%)	2 (10.53%)
	Subcutaneous emphysema	1 (5.26%)
	Pleural effusion	2 (10.53%)
	Transient hemoptysis	3 (15.79%)
Side effects	Local pain	10 (52.63%)
	Fever	3 (17.79%)

MWA: microwave ablation.

Figure 3. Kaplan-Meier survival curve for nineteen stage I non-small cell lung cancer (NSCLC) patients with idiopathic pulmonary fibrosis (IPF) that received microwave ablation (MWA) treatment.

Data availability statement

In addition to the raw data in the manuscript, the datasets used are available from the corresponding author on reasonable request.