SESSION TYPE: Cancer Case Report Posters I
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Microwave ablation is a new development in the field of tumor ablation. This technique allows for flexible approach to treatment in patients with localized lung cancer who are non surgical candidates. .
CASE PRESENTATION: 63 year old male with known history of COPD underwent a CT Chest showing a spiculated nodular opacity in the RUL measuring approx 13 x 8 mm. Subsequent PET Scan showed nodule with increased hypermetabolic activity with SUV of 1.7. He underwent CT guided biopsy of the nodule twice with cytology showing absence of malignant cells.The second biopsy attempt showed atypical cells. He was referred to thoracic oncology with recommendations to undergo thoracoscopic wedge resection of the RUL lung nodule for diagnostic purposes. Histology confirmed Adenocarcinoma. Follow up PET scan in a year showed recurrence of local disease. The area increased in size measuring 11x 9 mm with an SUV of 2.1. He was referred to IR for microwave ablation. He underwent a follow up CT scan showing a well marginated cavitary mass in the right lung area of recent ablation. Patient was seen at urgent care facility twice for shortness of breath and was treated with antimicrobial therapy based on his CXR and CT scan findings. He was seen as a follow up in the pulmonary clinic and had no complains of fevers , chills, or productive cough. Increased airspace density involving the right upper lung at the site of the patient's ablation was thought to be mistaken for an infectious etiology
DISCUSSION: Follow up imaging after and during follow up is necessary to measure the success of thermal ablation. Cavitation can occur in 25% of the lesions. At 1 week to 1 month post ablation the lesion appears as an area of consolidation or nodules. Cavitation at the ablation site can be mistaken for an infectious process. Risk factors include aspiration or steroid treatment. Infection should be considered when follow up imaging shows cavity wall thickening or non focal hypermetabolic activity on the scan.
CONCLUSIONS: Image guided microwave ablation is an exciting science . Presently microwave ablation is best for early stage lung cancers. Cavitation of lung neoplasm following ablation occurs commonly. Awareness along with associated clinical picture can prevent unnecessary usage of antimicrobial therapy
1) Okuma T, Matsuoka T, Yamamoto A, et al. Factors contributing to cavitation after CT-guided percutaneous radiofrequency ablation for lung tumors. J Vasc Interv Radiol 2007; 18:399-404.
DISCLOSURE: The following authors have nothing to disclose: Saad Khan, Harakh Dedhia, Brent Steadman
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