Comparison of Double-Freeze versus Modified Triple-Freeze Pulmonary Cryoablation and Hemorrhage Volume Using Different Probe Sizes in an In Vivo Porcine Lung.

Purpose: To determine size of ablation zone and pulmonary hemorrhage in double-freeze (DF) vs modified triple-freeze (mTF) cryoablation protocols with different probe sizes in porcine lung.

Materials And Methods: In 10 healthy adult pigs, 20 pulmonary cryoablations were performed using either a 2.4-mm or a 1.7-mm probe. Either conventional DF or mTF protocol was used. Serial noncontrast CT scans were performed during ablations. Ablation iceball and hemorrhage volumes were measured and compared between protocols and probe sizes.

Results: With 1.7-mm probe, greater peak iceball volume was observed with DF compared with mTF, although difference was not statistically significant (16.1 mL ± 1.9 vs 8.8 mL ± 3.6, P = .07). With 2.4-mm probe, DF and mTF produced similar peak iceball volumes (14.0 mL ± 2.8 vs 14.6 mL ± 2.7, P = .88). Midcycle hemorrhage was significantly larger with DF with the 1.7-mm probe (94.3 mL ± 22.2 vs 19.6 mL ± 2.1, P = .02) and with both sizes combined (93.2 mL ± 17.5 vs. 50.9 mL ± 12.6, P = .048). Rate of hemorrhage increase was significantly higher in DF (10.4 mL/min vs 5.1 mL/min, P = .003). End-cycle hemorrhage was visibly larger in DF compared with mTF across probe sizes, although differences were not statistically significant (P = .14 for 1.7 mm probe, P = .18 for 2.4 mm probe, and P = .07 for both probes combined). Rate of increase in hemorrhage during the last thaw period was not statistically different between DF and mTF (3.0 mL/min vs 2.8 mL/min, P = .992).

Conclusions: mTF reduced rate of midcycle hemorrhage compared with DF. With mTF, midcycle hemorrhage was significantly smaller with 1.7-mm probe; although noticeably smaller with 2.4-mm probe, statistical significance was not achieved. Iceball size was not significantly different across both protocols and probe types.