Absence of Viable Renal Carcinoma in Biopsies Performed More Than 1 Year Following Radio Frequency Ablation Confirms Reliability of Axial Imaging

Jay D. Raman, Joshua M. Stern, Ilia Zeltser, Wareef Kabbani, Jeffrey A Cadeddu

Research output: Contribution to journalArticle

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Abstract

Purpose: Radio frequency ablation is an emerging nephron sparing treatment option in select patients with small renal tumors. Some have questioned the completeness of cell death and the reliability of axial imaging for radio frequency ablation followup. We present results in patients with no evidence of radiographic active disease who underwent biopsy more than 1 year following ablation. Materials and Methods: Patients who had no clinical evidence of disease, defined as absent lesion growth and contrast enhancement on computerized tomography, 1 year or more following radio frequency ablation underwent percutaneous renal biopsy to evaluate cell viability in the ablative zone. A total of 19 patients (20 lesions) were included in the study. Histological comparison of pre-ablation and post-ablation specimens was performed using hematoxylin and eosin staining. Results: Pre-ablation biopsies confirmed that 17 of 20 tumors were renal cell carcinoma, while the remaining 3 were oncocytoma. Following ablation at a mean followup of 26.9 months (range 13.1 to 58.0) all 20 lesions were stable in size without evidence of contrast enhancement on computerized tomography. At repeat biopsy all histology specimens showed unequivocal tumor eradication with no evidence of cellular viability. Histological changes beyond 1 year demonstrated coagulative necrosis, hyalinization, inflammatory cell infiltration and residual ghost cells. Conclusions: Pathological examination of radiographically negative lesions biopsied more than 1 year following radio frequency ablation confirmed no evidence of disease in all specimens. Therefore, axial imaging can reliably monitor treatment efficacy in the long term. Chronic changes after radio frequency ablation demonstrate coagulative necrosis and nonviable cells. This suggests an evolution of pathological changes that renders early post-ablative biopsy unreliable.

Original languageEnglish (US)
Pages (from-to)2142-2145
Number of pages4
JournalJournal of Urology
Volume179
Issue number6
DOIs
StatePublished - Jun 2008

Fingerprint

Radio
Carcinoma
Kidney
Biopsy
Necrosis
Tomography
Oxyphilic Adenoma
Neoplasms
Nephrons
Hematoxylin
Eosine Yellowish-(YS)
Renal Cell Carcinoma
Cell Survival
Histology
Cell Death
Staining and Labeling
Growth
Therapeutics

Keywords

  • biopsy
  • carcinoma
  • catheter ablation
  • cell survival
  • kidney
  • renal cell

ASJC Scopus subject areas

  • Urology

Cite this

Absence of Viable Renal Carcinoma in Biopsies Performed More Than 1 Year Following Radio Frequency Ablation Confirms Reliability of Axial Imaging. / Raman, Jay D.; Stern, Joshua M.; Zeltser, Ilia; Kabbani, Wareef; Cadeddu, Jeffrey A.

In: Journal of Urology, Vol. 179, No. 6, 06.2008, p. 2142-2145.

Research output: Contribution to journalArticle

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abstract = "Purpose: Radio frequency ablation is an emerging nephron sparing treatment option in select patients with small renal tumors. Some have questioned the completeness of cell death and the reliability of axial imaging for radio frequency ablation followup. We present results in patients with no evidence of radiographic active disease who underwent biopsy more than 1 year following ablation. Materials and Methods: Patients who had no clinical evidence of disease, defined as absent lesion growth and contrast enhancement on computerized tomography, 1 year or more following radio frequency ablation underwent percutaneous renal biopsy to evaluate cell viability in the ablative zone. A total of 19 patients (20 lesions) were included in the study. Histological comparison of pre-ablation and post-ablation specimens was performed using hematoxylin and eosin staining. Results: Pre-ablation biopsies confirmed that 17 of 20 tumors were renal cell carcinoma, while the remaining 3 were oncocytoma. Following ablation at a mean followup of 26.9 months (range 13.1 to 58.0) all 20 lesions were stable in size without evidence of contrast enhancement on computerized tomography. At repeat biopsy all histology specimens showed unequivocal tumor eradication with no evidence of cellular viability. Histological changes beyond 1 year demonstrated coagulative necrosis, hyalinization, inflammatory cell infiltration and residual ghost cells. Conclusions: Pathological examination of radiographically negative lesions biopsied more than 1 year following radio frequency ablation confirmed no evidence of disease in all specimens. Therefore, axial imaging can reliably monitor treatment efficacy in the long term. Chronic changes after radio frequency ablation demonstrate coagulative necrosis and nonviable cells. This suggests an evolution of pathological changes that renders early post-ablative biopsy unreliable.",
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