|Year : 2018 | Volume
| Issue : 4 | Page : 764-771
Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity–Lung adenocarcinoma: A pilot study
Xia Yang1, Xin Ye1, Zhengyu Lin2, Yong Jin3, Kaixian Zhang4, Yuting Dong5, Guohua Yu6, Haipeng Ren6, Weijun Fan7, Jin Chen2, Qingfeng Lin2, Guanghui Huang1, Zhigang Wei1, Yang Ni1, Wenhong Li1, Xiaoying Han1, Min Meng1, Jiao Wang1, Yuliang Li8
1 Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
2 Department of Interventional Therapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
3 Department of Interventional Therapy, The Second Affiliated Hospital of Soochow University, Suzhou, China
4 Department of Oncology, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, Tengzhou, China
5 Department of Oncology, Dezhou City People's Hospital, Dezhou, China
6 Department of Oncology, Weifang People's Hospital Affiliated to Weifang Medical College, Weifang, China
7 Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou, China
8 Interventional Treatment Center, The Second Hospital Affiliated to Shandong University, Jinan, China
|Date of Web Publication||27-Jun-2018|
Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250014
Department of Interventional Therapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005
Source of Support: None, Conflict of Interest: None
Purpose: The purpose of the study is to retrospectively evaluate the safety and efficacy of microwave ablation (MWA) for the treatment of ground-glass opacity (GGO)–lung adenocarcinoma.
Materials and Methods: From December 2013 to June 2017, a total of 51 patients (22 males and 29 females, mean age of 69.4 ± 10.1 years) were included in this study, with 51 lung adenocarcinoma lesions showing GGO (mean long-axis diameter of 18.7 ± 6.05 mm). They received a total of 52 sessions of percutaneous computed tomography-guided (CT-guided) MWA. First, lung adenocarcinoma with GGO was histologically defined by needle biopsy under the guidance of CT. Second, the efficacy of CT-guided MWA was analyzed, including the feasibility, safety, 3 years local progression-free survival (LPFS), 3 years disease-specific survival, and 3 years overall survival (OS). Final, complications after MWA were also summarized.
Results: The technical success rate was 100%, without MWA procedure-related death. At the median follow-up period (27.02, range: 7–45 months), the rates of 3 years LPFS, cancer-specific survival, and OS were 98%, 100%, and 96%, respectively. The complications after MWA included pneumothorax (48.1%, 25/52), hemoptysis (28.8%, 14/52), pleural effusion (23.1%, 12/52), and pulmonary infection (7.7%, 4/52).
Conclusions: CT-guided percutaneous MWA was a feasible, safe, and effective therapeutic approach for treating GGO–lung adenocarcinoma.
Keywords: Ground-glass opacity, lung cancer, microwave ablation
|How to cite this article:|
Yang X, Ye X, Lin Z, Jin Y, Zhang K, Dong Y, Yu G, Ren H, Fan W, Chen J, Lin Q, Huang G, Wei Z, Ni Y, Li W, Han X, Meng M, Wang J, Li Y. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity–Lung adenocarcinoma: A pilot study. J Can Res Ther 2018;14:764-71
|How to cite this URL:|
Yang X, Ye X, Lin Z, Jin Y, Zhang K, Dong Y, Yu G, Ren H, Fan W, Chen J, Lin Q, Huang G, Wei Z, Ni Y, Li W, Han X, Meng M, Wang J, Li Y. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity–Lung adenocarcinoma: A pilot study. J Can Res Ther [serial online] 2018 [cited 2019 Nov 20];14:764-71. Available from: http://www.cancerjournal.net/text.asp?2018/14/4/764/235084
| > Introduction|| |
Lung cancer screen through low-dose thoracic computed tomography (CT) has been performed since the 1990s, which has been gradually applied in worldwide., With the increasing CT screen, lung lesions with ground-glass opacity (GGO) have been often detected with the chest CT by accident. Usually, small lung lesions with GGO could be followed up with periodic CT. However, some lung lesions with GGO have been suspected as invasive adenocarcinoma, even if they were still small.,, According to 2018 National Comprehensive Cancer Network Guideline of Lung Cancer Screening  or Fleischner society lung cancer treatment strategy guide, surgical resection would be considered if pure GGO was observed to increase in size, density, or solid components. However, the selection of surgery type has been controversial. In addition, many patients with early-stage lung cancers could not be removed surgically for various reasons (such as multifocal lesions and cardiorespiratory failure). Therefore, many novel and local treatments have been emerging. Recently, local thermal ablation, as a precise and minimally invasive technique, has been increasingly applied to treat early-stage lung cancer.,,,,,,,
Microwave ablation (MWA) is one of the local thermal ablation techniques, which has been applied to treat primary or metastatic lung tumors locally.,,,,,, In this study, the safety, outcomes, and complications of MWA as an alternative approach for treating GGO–lung adenocarcinoma were retrospectively evaluated.
| > Materials and Methods|| |
During December 2013 and June 2017, a retrospective, multicenter study was conducted at either sites including Shandong Provincial Hospital Affiliated to Shandong University, the First Affiliated Hospital of Fujian Medical University, the Second Affiliated Hospital of Soochow University, Teng Zhou Central People's Hospital Affiliated to Jining Medical College, Dezhou City People Hospital, Weifang People's Hospital Affiliated to Weifang Medical University, Sun Yat-sen University Cancer Center, and the Second Hospital affiliated to Shandong University. This study enrolled 51 patients (22 males and 29 females; mean age of 69.4 years, range: 42–83 years) with 51 lung adenocarcinoma lesions showing GGO (mean long-axis diameter of 18.7 mm). A total of 52 percutaneous CT-guided MWA sessions were conducted including one repeated session due to the local progression. The patient and GGO characteristics were listed [Table 1].
GGO was defined with a thin-section CT (TSCT) scan, as increased hazy opacities in the lung parenchyma with preservation of the bronchial structures and vascular margins., The diameter of the tumor (T) was defined as the largest axial diameter of the lesion on the lung window setting. The axial diameter of consolidation (C) on the lung window setting was also measured. The consolidation was defined as an area with increased opacification that completely obscured the underlying bronchial structures and vascular markings., All the preselected lung–GGO lesions were histologically adenocarcinoma, which was confirmed by needle biopsy under CT guidance before MWA. Positron emission tomography/CT scanning was performed in 18 patients before MWA, without any abnormal accumulation of 18 F-fluorodeoxyglucose. Typical classification of GGO is based on the findings of TSCT was as follows: pure GGO, part-solid GGO, and solid GGO. In all involved lesions, thirty-four (34/51) were pure GGO, and seventeen (17/51) were part-solid GGO (C/T ≤50%). All patients were evaluated and consulted by an interdisciplinary group, consisting of a thoracic surgeon, radiation oncologist, radiologist, and medical oncologist.
The patients met the following criteria were enrolled in this study. Inclusion criteria: (1) a pulmonary lesion with a GGO (C/T ≤ 50%) on TSCT images (slice with the thickness of 1 mm or sub mm) before MWA, which could not be detected on CT scans in the mediastinal window setting; (2) GGO lesion size of ≤30 mm, single lesion; (3) medically intolerable to surgery due to poor lung functions (forced expiratory volume 1 [FEV1] <1 L, FEV1 z% <50%, maximum voluntary ventilation 50%), renal or heart dysfunction and other comorbid medical conditions (such as severe diabetes); (4) refused surgery; (5) no abnormal coagulability, platelet count ≥100 × 109, and (6) Eastern Cooperative Oncology Group performance status of ≤2. Exclusion criteria: the patients received previous therapy to the target lesion, or with regional lymph node metastasis or distant metastasis. Anticoagulant therapy and/or antiplatelet agents should be withdrawn for at least 5–7 days before the ablation procedure. The patients were informed in detail about the risks and benefits associated with MWA treatment. The written informed consent for the ablation procedure was obtained from all the patients. Ethics approval to conduct this study was obtained by the Institutional Review Board of all the sites.
MWA was conducted at the GGO sites under the guidance of percutaneous CT. A lightspeed 64 V spiral CT machine (GE) or a Siemens SOMATOM Sensation 64 CT scanner (Siemens) or a NeuViz 16 Platinum (Neusoft) was applied for scanning. MTC-3C MWA system (Vison-China Medical Devices R & D Center, CFDA Certificated No.: 20153251978), or KY-2450B MWA system (CANYOU Medical Inc., CFDA Certificated No.: 20153251727), or ECO-100A1 MWA system (ECO Medical Instrument Co., Ltd. CFDA Certificated No.: 20173251268) was applied for performing MWA. The microwave emission frequency was 2.450 ± 50 MHz. The adjustable output level of the continuous wave was ranged from 0 to 100 W. There was with a long-tapered end on the microwave antenna, with the effective length of 100–180 mm and an outer diameter of 14–19 G. A water circulation cooling system was applied to reduce the surface temperature of the antennae. The ablative zone was nearly 3.5 cm × 3 cm for MWA, with an output of 60–80 Watt/6–8 min.,
Local anesthesia (lidocaine) and preemptive analgesia (morphine) were administrated. Preoperative localization was confirmed with CT images, and the patient was placed in appropriate positions. Once satisfactory anesthesia was achieved, the skin at the puncture point was cut, the ablation microwave antennae were inserted through the deeper layers of tissue to the GGO lesion. This procedure was performed per the preoperative-planned route, and the puncture depth was the preoperative-planned “target skin distance.” MWA was started followed by the connection of cold circulating pipes and pumps to the MWA antennae and machine. The technical success was that the “postablation GGO” was generally 0.5–1.0 cm larger than the tumor sites. After the procedure, the MWA antennae were withdrawn, local disinfection was performed, and a bandage was applied to protect the wound.
Follow-up imaging and outcome assessment
A non-contrast chest CT scan was conducted on all the patients, 24–48 h after MWA, for detecting the potential complications and the technique effectiveness. Then, a serial of repeated contrast-enhanced CT (CECT) scans was conducted on the patients at 1-, 3-, 6-, 9-, and 12-month intervals. Thereafter, follow-up visits were conducted every 6 months.
Evaluation of local response and survival
The response was determined 4–6 weeks after ablation of the lesion and then compared with the baseline: (1) complete ablation, with any one of the following patterns: (a) lesion disappeared; (b) cavity completely formed; (c) fibrosis or scar; (d) solid nodule involution or no change, without contrast enhanced signs on the CT; (e) atelectasis, lesion in atelectasis without contrast enhanced signs on the CT; (2) local progression, with any one of the following patterns: (a) cavity partially formed, with some remaining solid parts or liquid components, and with irregular peripheral or internal enhancement signs on the CT; (b) partial fibrosis, with solid residues in the fibrotic lesion, presented as irregular peripheral or internal enhancement signs on CT; (c) solid nodules with increased size, which also presented as irregular peripheral or internal enhancement signs on CT; (d) atelectasis, lesion in atelectasis with contrast enhanced signs on the CT; (e) enlarging or new GGO or nodule on CT images around the ablated lesion.
When the inclusion criteria for MWA were met, the local tumor progression was treated again by MWA. Tumor recurrence other than local tumor progression was defined as distant metastasis. With the results of follow-up, 3 years local progression-free survival (LPFS), 3 years cancer-specific survival (CSS), and 3 years overall survival (OS) were assessed. LPFS was defined as the time between the initial ablation and the first radiologic evidence of local progression. CSS was defined as the time between the initial ablation and 3 years cancer-related death. The 3 years OS was defined as the time between the initial ablation and death from any cause.
The complications were assessed according to the classifications of the American Society of Interventional Radiology (SIR) criteria. The definition of major complication was an event that leads to substantial morbidity and disability (e.g., unexpected loss of an organ) increasing the level of care, hospital admission, or substantially lengthened hospital stay (SIR classifications C-E). This also included any case in which the blood transfusion or interventional drainage procedure was required. Any patient death within 30 days after image-guided tumor ablation should be addressed (SIR classification F). All other events were considered as minor complications. According to the time of occurrence, the complications were classified into: immediate complications (<24 h after ablation), perioperative complications (24 h–30 d after ablation), and delayed complications (>30 d after ablation).
Data analysis was performed with SPSS for Windows Version 13.0 (IBM, Chicago, IL). OS curves were constructed with the Kaplan–Meier method and compared with the log-rank test. Comparison between groups was performed with Chi-square test. Statistical significance was set at P < 0.05.
| > Results|| |
Ablation procedure was completed based on the planned protocol and well-tolerated in all sessions. The technical success rate was 100% in 51 sessions. A total of 51 lesion sites were entirely covered by the ablative zones 24–48 h after initial MWA. The technique effectiveness rate was 100%.
By the time of 31 March 2018, no patients were lost to follow-up, and the median follow-up period after ablation was (27.02, range: 7–45 months) with CECT [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]. One patient (2%, 1/51) showed local tumor progression 14 months after MWA. Therefore, a second MWA was performed on this patient. This tumor presented complete ablation after the second MWA. The patient died due to liver cirrhosis 15 months after the second MWA. At the 1-year follow-up, 51 ablated tumors (51 MWA sessions) were controlled in all 51 patients. At the 2-year follow-up, 50 ablated tumors (51 MWA sessions) were controlled in 50 patients, and one patient died. At the 3-year follow-up, 49 ablated tumors (49 MWA sessions) were controlled in 49 patients. The 1-year, 2-year, and 3-year local control rates were 100%, 98%, and 100%, respectively.
|Figure 1: Female: 78-year-old patient with 28 mm × 22 mm right lung part-solid ground-glass opacity (invasive adenocarcinoma) complete ablation. (a) Ground-glass opacity lesion (1 mm, arrow) seen on computed tomography before microwave ablation. (b) The microwave antenna was punctured into lesion (arrow). (c) Ablated lesion computed tomography scan immediately postmicrowave ablation. (d) Follow-up computed tomography scan at 6 months shows a fibrous scar at the site of the ablated lesion (arrow). (e) 12 months after ablation, ablated lesion (arrow) significantly involution. (f) 42 months after ablation, lesion become fiber cord (arrow)|
Click here to view
|Figure 2: Female: 68-year-old patient with 12 mm × 10 mm right lung pure ground-glass opacity (minimally invasive adenocarcinoma) complete ablation. (a) Ground-glass opacity lesion (1 mm, arrow) seen on computed tomography before microwave ablation. (b) The microwave antenna was punctured into lesion (arrow). (c) Ablated lesion computed tomography scan immediately postmicrowave ablation. (d) 3 months after ablation, the ablated lesion shows a fibrous hyperplasia (arrow). (e) 12 months after ablation, fibrous hyperplasia of ablated lesion (arrow) involution. (f) 36 months after ablation, lesion become fiber scar (arrow)|
Click here to view
|Figure 3: Male: 62-year-old patient with 29 mm × 20 mm right lung pure ground-glass opacity (invasive adenocarcinoma) complete ablation. (a) Ground-glass opacity lesion (1 mm, arrow) seen on computed tomography before microwave ablation. (b) The microwave antenna was punctured into lesion (arrow). (c) Ablated lesion computed tomography scan immediately postmicrowave ablation. (d) 6 months after ablation, the ablated lesion shows a fibrous hyperplasia (arrow). (e) 12 months after ablation, fibrous hyperplasia of ablated lesion (arrow) involution. (f) 40 months after ablation, lesion become fiber cord (arrow)|
Click here to view
|Figure 4: Female: 52-year-old patient with 23 mm × 22 mm right lung pure ground-glass opacity (invasive adenocarcinoma) complete ablation. (a) Ground-glass opacity lesion (1 mm, arrow) seen on computed tomography before microwave ablation. (b) The microwave antenna was punctured into lesion (arrow). (c) Ablated lesion computed tomography scan immediately postmicrowave ablation. (d) 6 months after ablation, the ablated lesion shows a fibrous hyperplasia (arrow). (e) 36 months after ablation, lesion become fiber cord (arrow)|
Click here to view
|Figure 5: Local progression-free survival, cancer-specific OS and OS of all patients|
Click here to view
During the follow-up, two patients died. One died of cerebral infarction 13 months after MWA, and the other patient died of liver cirrhosis 29 months after lung MWA. The recurrence of lung cancer was not observed in neither of the two patients. The 1-year and 3-year LPFS rates were 100% and 98% (50/51) (95% confidence interval [CI], 77.5%–99.5%), respectively. The 1-year and 3-year CSS rates were 100% and 100%, respectively. The 1-year and 3-year OS rates were 100% and 96% (49/51) (95% CI, 77.5%–99.5%), respectively [Figure 5]. No mediastinal lymph node and distant metastasis were observed in all 51 patients.
Side effects and complications
No death-related to the MWA procedure was observed during the procedure or within 30 days after MWA.
Side effects were summarized as follows: (1) Pain – during the procedure, pain was the common side effect under the local anesthesia conditions during the procedure. In 52 sessions of MWA, the patients in eight sessions reported moderate-to-severe pain, of which two sessions were severe. The procedure was stopped when there was severe pain, and it was followed by subcutaneous injection of morphine. At the same time, an adequate amount of sedatives such as midazolam were intravenously administrated. After the procedure of MWA, nine patients suffered from moderate pain, without severe postablation pain. (2) Cough – in 52 sessions of MWA, the patients in seven sessions suffered from moderate-to-severe cough, of which two sessions were severe. The procedure was stopped with severe cough, and it was followed by subcutaneous injection of midazolam, or the procedure would be intermitted. (3) Postablation syndrome – the main symptoms were fever (lower than 38.5°C), fatigue, general malaise, nausea and vomiting, etc., A total of 13 patients showed above postablation syndrome.
Complications were also summarized. Pneumothorax was the most common complication. There was a total of 25 (48.1%, 25/52) cases of pneumothorax, of which five sessions (9.8%) required a chest tube drainage. Hemoptysis was observed in 14 sessions (28.8%, 14/52) and could be effectively relieved with the conventional application of hemostatic agents. In all 14 sessions with hemoptysis, four sessions occurred during the procedure of ablation. The reason was that ablation itself could result in blood coagulation, thus hemoptysis during ablation would be gradually stopped without the need of special treatment). There were 12 sessions (23.1%, 12/52) of pleural effusion, of which three sessions (5.7%) underwent chest tube insertion. About four sessions (7.7%, 4/52) suffered from pneumonia after the procedure, which could be effectively controlled by antibiotics based on the results of the sputum or blood culture. The grade of complications was illustrated [Table 2].
|Table 2: Grade of Complications during and postmicrowave ablation (42 sessions)|
Click here to view
| > Discussion|| |
Recently, there were a few clinical studies on the outcome and safety of radiofrequency ablation (RFA) in the treatment of GGO–lung cancer., Kodama. et al. reported that lung RFA was performed on 33 patients with 42 lung tumors with ≥50% GGO components. All patients were alive and only one died of brain hemorrhage. OS and CSS rates were 100% and 100% at 1-year, 96.4% and 100% at 3-years, and 96.4% and 100% at 5-years, respectively. Iguchi et al. reported that 16 patients with 17 lung cancer lesions showing GGO received a total of 20 percutaneous CT-guided RFA sessions. The median follow-up period of all the patients was 65.6 months. About 15 patients were alive, while only one patient died of recurrence of other cancer 11.7 months after RFA. OS and disease-specific survival rates were 93.3% and 100% at 1-year, 93.3% and 100% at 5-years, respectively. These results suggested that lung RFA was safe and effective for treating lung cancer with GGO, bringing about promising survival rates. However, there was very few clinical study on the effect and safety of MWA for treating lung cancer with GGO.
MWA has several advantages over RFA, including faster ablations (shorter procedure time), higher temperatures without the limitations related to electric impedance, less sensitivity to tissue type, more consistent results, and less “heat sink” effect for better treating perivascular tissues. In addition, the size of ablation zone could be maximized by simultaneously positioning multiple MWA antennae into the larger lesion.,,,,,,, To the best of our knowledge, this study was the first retrospective, multicenter study that aimed to assess the safety, outcomes, and complications of MWA as an alternative approach for treating GGO–lung adenocarcinoma.
In this study, local tumor progression after MWA procedure was 2% (1/51) for the treatment of GGO–lung adenocarcinoma. The incidence of local tumor progression was significantly lower than that of reported in our previous study (23.1%) for treating inoperable stage I solid lung tumors., No mediastinal lymph node and distant metastasis were found in all the 51 patients. The slow-growing nature of GGO–lung adenocarcinoma seemed to contribute to this difference. In addition, GGO-dominant lung adenocarcinoma rarely showed pathologic invasiveness, including lymphatic, vascular, pleural invasion, or lymph node metastasis. The local tumor progression rate may be underestimated; however, it was difficult to differentiate the ablation zone with the tumor margin. Long-term follow-up of the ablated tumors was necessary.
From the follow-up results of this study, the 1-year and 3-year LPFS rates were 100% and 98% (50/51) (95% CI, 77.5%–99.5%), respectively. The 1-year and 3-year CSS rates were 100% and 100%, respectively. The 1-year and 3-year OS rates were 100% and 96% (49/51) (95% CI, 77.5%–99.5%), respectively. These results suggested that MWA was effective in improving the survival of patients with GGO–lung adenocarcinoma.
Pneumothorax was one of the most common complications for MWA. The incidence of pneumothorax in this study was 45.2% (19/42). The incidence of pneumothorax was similar to that of in our previous report.,, Although the occurrence rate of pneumothorax was high, chest tube insertion was required in only five cases. Other complications consisted of hemoptysis 26.2% (11/42), pleural effusion 33.3% (14/42), pulmonary infection (9.5%, 4/42), severe pain (4.8%, 2/42), severe cough (4.8%, 2/42), and postablation syndromes (31%, 17/42). All these side effects and complications mentioned above could be well controlled through observation or proper treatments. There was no death within 30-day postprocedure in our patient series. Furthermore, ablation procedure was completed per planned protocol and well tolerated in all sessions. The technical success rate was 100% in 52 sessions. This study suggested that MWA was feasible and safe for treating a patient with GGO–lung adenocarcinoma. Since 42 medically inoperable patients were included due to elderly, severe cardiopulmonary dysfunction and other concomitant diseases in this study, we suggested that the application of MWA was for more suitable for medically inoperable patients with GGO–lung adenocarcinoma.
Certainly, there were some limitations in this study. The main limitations were its retrospective nature, relatively short follow-up duration after addressing GGO lesions, as well as the small sample size. Furthermore, this study was not designed to compare the MWA with other treatments such as surgery, stereotactic body radiotherapy, or other local ablation technologies. Prospective multicenter study of MWA with larger sample size would be necessary to better clarify the effectiveness and safety of this treatment strategy.
| > Conclusions|| |
CT-guided percutaneous MWA was a feasible, safe, and useful therapeutic approach for GGO–lung adenocarcinoma. It would become an alternative approach for treating medically inoperable patients with peripheral GGO–lung adenocarcinoma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| > References|| |
Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suemasu K, et al.
Peripheral lung cancer: Screening and detection with low-dose spiral CT versus radiography. Radiology 1996;201:798-802.
International Early Lung Cancer Action Program Investigators, Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, et al.
Survival of patients with stage I lung cancer detected on CT screening. N
Engl J Med 2006;355:1763-71.
Noguchi M, Morikawa A, Kawasaki M, Matsuno Y, Yamada T, Hirohashi S, et al.
Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer 1995;75:2844-52.
Nakamura S, Fukui T, Taniguchi T, Usami N, Kawaguchi K, Ishiguro F, et al.
Prognostic impact of tumor size eliminating the ground glass opacity component: Modified clinical T descriptors of the tumor, node, metastasis classification of lung cancer. J Thorac Oncol 2013;8:1551-7.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y, et al.
International association for the study of lung cancer/American Thoracic Society/European Respiratory Society: International multidisciplinary classification of lung adenocarcinoma: Executive summary. Proc Am Thorac Soc 2011;8:381-5.
Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, et al
. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16:412-41.
MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al.
Guidelines for management of incidental pulmonary nodules detected on CT images: From the fleischner society 2017. Radiology 2017;284:228-43.
Vogl TJ, Naguib NN, Lehnert T, Nour-Eldin NE. Radiofrequency, microwave and laser ablation of pulmonary neoplasms: Clinical studies and technical considerations – Review article. Eur J Radiol 2011;77:346-57.
de Baère T. Lung tumor radiofrequency ablation: Where do we stand? Cardiovasc Intervent Radiol 2011;34:241-51.
Bi N, Shedden K, Zheng X, Kong FS. Comparison of the effectiveness of radiofrequency ablation with stereotactic body radiation therapy in inoperable stage I non-small cell lung cancer: A systemic review and pooled analysis. Int J Radiat Oncol Biol Phys 2016;95:1378-90.
Dupuy DE, Fernando HC, Hillman S, Ng T, Tan AD, Sharma A, et al.
Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: Results from the American college of surgeons oncology group Z4033 (Alliance) trial. Cancer 2015;121:3491-8.
Nakamura T, Matsumine A, Yamakado K, Takao M, Uchida A, Sudo A, et al.
Clinical significance of radiofrequency ablation and metastasectomy in elderly patients with lung metastases from musculoskeletal sarcomas. J Cancer Res Ther 2013;9:219-23.
Safi S, Rauch G, op den Winkel J, Kunz J, Schneider T, Bischof M, et al.
Sublobar resection, radiofrequency ablation or radiotherapy in stage I non-small cell lung cancer. Respiration 2015;89:550-7.
Dupuy DE. Image-guided thermal ablation of lung malignancies. Radiology 2011;260:633-55.
Chen J, Lin ZY, Wu ZB, Chen ZW, Chen YP. Magnetic resonance imaging evaluation after radiofrequency ablation for malignant lung tumors. J Cancer Res Ther 2017;13:669-75.
Healey TT, March BT, Baird G, Dupuy DE. Microwave ablation for lung neoplasms: A Retrospective analysis of long-term results. J Vasc Interv Radiol 2017;28:206-11.
Xiong L, Dupuy DE. Lung ablation: Whats new? J Thorac Imaging 2016;31:228-37.
Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J, et al.
Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: Clinical evaluation of 47 cases. J Surg Oncol 2014;110:758-63.
Yang X, Ye X, Huang G, Han X, Wang J, Li W, et al.
Repeated percutaneous microwave ablation for local recurrence of inoperable stage I nonsmall cell lung cancer. J Cancer Res Ther 2017;13:683-8.
Vogl TJ, Eckert R, Naguib NN, Beeres M, Gruber-Rouh T, Nour-Eldin NA, et al.
Thermal ablation of colorectal lung metastases: Retrospective comparison among laser-induced thermotherapy, radiofrequency ablation, and microwave ablation. AJR Am J Roentgenol 2016;207:1340-9.
Nour-Eldin NA, Exner S, Al-Subhi M, Naguib NN, Kaltenbach B, Roman A, et al.
Ablation therapy of non-colorectal cancer lung metastases: Retrospective analysis of tumour response post-laser-induced interstitial thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA). Int J Hyperthermia 2017;33:820-9.
Wei Z, Wang J, Ye X, Yang X, Huang G. Computed tomography-guided percutaneous microwave ablation of early stage non-small cell lung cancer in a pneumonectomy patient. Thorac Cancer 2016;7:151-3.
Austin JH, Müller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, et al.
Glossary of terms for CT of the lungs: Recommendations of the nomenclature committee of the fleischner society. Radiology 1996;200:327-31.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J, et al.
Fleischner society: Glossary of terms for thoracic imaging. Radiology 2008;246:697-722.
Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al.
The IASLC lung cancer staging project: Proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol 2016;11:1204-23.
Moon Y, Lee KY, Park JK. The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection. J Thorac Dis 2017;9:3782-92.
Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al.
Image-guided tumor ablation: Standardization of terminology and reporting criteria – A 10-year update. Radiology 2014;273:241-60.
Kodama H, Yamakado K, Hasegawa T, Takao M, Taguchi O, Fukai I, et al.
Radiofrequency ablation for ground-glass opacity-dominant lung adenocarcinoma. J Vasc Interv Radiol 2014;25:333-9.
Iguchi T, Hiraki T, Gobara H, Fujiwara H, Matsui Y, Soh J, et al.
Percutaneous radiofrequency ablation of lung cancer presenting as ground-glass opacity. Cardiovasc Intervent Radiol 2015;38:409-15.
Brace CL. Radiofrequency and microwave ablation of the liver, lung, kidney, and bone: What are the differences? Curr Probl Diagn Radiol 2009;38:135-43.
Abbas G, Schuchert MJ, Pennathur A, Gilbert S, Luketich JD. Ablative treatments for lung tumors: Radiofrequency ablation, stereotactic radiosurgery, and microwave ablation. Thorac Surg Clin 2007;17:261-71.
Lee KS, Erinjeri JP. Decision making in interventional oncology: Ablative options in the lung. Semin Intervent Radiol 2017;34:176-81.
Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr., Brace CL. Percutaneous tumor ablation tools: Microwave, radiofrequency, or cryoablation – What should you use and why? Radiographics 2014;34:1344-62.
Sidoff L, Dupuy DE. Clinical experiences with microwave thermal ablation of lung malignancies. Int J Hyperthermia 2017;33:25-33.
Abbas G, Danish A, Krasna MJ. Stereotactic body radiotherapy and ablative therapies for lung cancer. Surg Oncol Clin N
Fan W, Li X, Zhang L, Jiang H, Zhang J. Comparison of microwave ablation and multipolar radiofrequency ablation in vivo
using two internally cooled probes. AJR Am J Roentgenol 2012;198:W46-50.
Song Z, Qi H, Zhang H, Xie L, Cao F, Fan W, et al.
Microwave ablation: Results with three different diameters of antennas in ex vivo
bovine and in vivo
porcine liver. J Cancer Res Ther 2017;13:737-41.
Kakinuma R, Noguchi M, Ashizawa K, Kuriyama K, Maeshima AM, Koizumi N, et al.
Natural history of pulmonary subsolid nodules: A prospective multicenter study. J Thorac Oncol 2016;11:1012-28.
Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al.
Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: Wedge resection or segmentectomy. Chest 2014;145:66-71.
Zheng A, Wang X, Yang X, Wang W, Huang G, Gai Y, et al.
Major complications after lung microwave ablation: A single-center experience on 204 sessions. Ann Thorac Surg 2014;98:243-8.
Yu J, Zhu S, Ge Z, Shen B, Shen Y, Wang C, et al.
Multislice spiral computed tomography in the differential diagnosis of ground-glass opacity. J Cancer Res Ther 2018;14:128-32.
Wang D, Yan N, Yang X, Ge Y, Xu D, Shao G, et al.
Correlation between epidermal growth factor receptor mutation and histologic subtypes or characteristics of computed tomography findings in patients with resected pulmonary adenocarcinoma. J Cancer Res Ther 2018;14:240-4.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]