CT volumetric assessment of pulmonary neoplasms after radiofrequency ablation: when to consider a second intervention?

Purpose: To determine the minimal follow-up time point to predict therapeutic response to radiofrequency (RF) ablation of lung tumors.

Materials And Methods: A retrospective study design was approved by the institutional review board. From January 2008 to January 2010, 78 patients (46 men and 32 women; mean age, 58.9 y) underwent computed tomography (CT)-guided percutaneous RF ablation of pulmonary malignancies. A single RF multitined electrode was used to treat 100 index tumors, 6 primary lesions, and 94 metastatic lesions. CT volumetric measurements of ablated tumors were made before ablation and 24 hours, 3-6 weeks, 3 months, 6 months, 9 months, and 12 months after ablation. An unpaired t test and Spearman rank correlation coefficient were used to analyze the volumetric changes.

Results: Complete successful ablation was achieved in 80% of index tumors. The mean time to detection of tumor residue or recurrence tumor residue or recurrence was 6.7 months after ablation. In successfully ablated lesions, the mean volume before ablation was 1.81 cm(3) (standard deviation [SD], 1.71); in failed ablation lesions, the mean volume before ablation was 2.58 cm(3) (SD, 2.8) (P = .42). The earliest statistically significant follow-up time point that showed a difference in the volumetric measurements of failed and successful ablations as well as the earliest significant correlation with the 12-month point was 3 months (P = .025, Spearman R = 0.72). Secondary tumor control after repeat ablation was statistically significant for lesions ablated at a 3-month interval (four out of five lesions) (P = .04).

Conclusions: CT volumetric assessment of ablated tumors revealed that 3 months was the earliest time point that may determine the response of a pulmonary ablation or repeat intervention.