Microwave ablation: How we do it?

Abstract

Minimally invasive techniques such as Image guided thermal ablation are now widely used in the treatment of tumors. Microwave ablation (MWA) is one of the newer modality of thermal ablation and has proven its safety and efficacy in the management of the tumors amenable for ablation for primary and metastatic diseases. It is used in the treatment of primary and secondary liver malignancies, primary and secondary lung malignancies, renal and adrenal tumors and bone metastases. We wanted to share our initial experience with this newer modality. In this article we will describe the mechanism and technique of MWA, comparison done with RFA, advantages and disadvantages of MWA along with pre procedure workup, post procedure follow-up and review of literature.

Keywords

Microwave ablation - Radiofrequency ablation - Technique

Publication History

Received: 01 June 2019

Accepted: 20 February 2020

Article published online:
19 July 2021

• References

• 1 Halsted WS. The results of operations for the cure of cancer of the breast performed at the Johns Hopkins hospital from June, 1889, to January, 1894. Ann Surg 1894; 20: 497-555
• 2 Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: Principle and applications. Radiographics 2005; 25 Suppl (01) S69-83
• 3 Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: A unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174: 323-31
• 4 Dupuy DE, Goldberg SN. Image-guided radiofrequency tumor ablation: Challenges and opportunities—part II. J Vasc Interv Radiol 2001; 12: 1135-48
• 5 Shibata T, Iimuro Y, Yamamoto Y, Maetani Y, Ametani F, Itoh K. et al. Small hepatocellular carcinoma: Comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 2002; 223: 331-7
• 6 Seki T, Tamai T, Nakagawa T, Imamura M, Nishimura A, Yamashiki N. et al. Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma. Cancer 2000; 89: 1245-51
• 7 Lu MD, Chen JW, Xie XY, Liu L, Huang XQ, Liang LJ. et al. Hepatocellular carcinoma: US-guided percutaneous microwave coagulation therapy. Radiology 2001; 221: 167-72
• 8 Sun Y, Wang Y, Ni X, Gao Y, Shao Q, Liu L. et al. Comparison of ablation zone between 915- and 2,450-MHz cooled-shaft microwave antenna: Results in in vivo porcine livers. AJR Am J Roentgenol 2009; 192: 511-4
• 9 Tanaka M, Sato M. Microwave heating of water, ice, and saline solution: Molecular dynamic study. J Chem Phys 2007; 126: 034509
• 10 Skinner MG, Iizuka MN, Kolios MC, Sherar MD. A theoretical comparison of energy sources—microwave, ultrasound and laser—for interstitial thermal therapy. Phys Med Biol 1998; 43: 3535-3547
• 11 Lubner MG, Brace CL, Ziemlewicz TJ, Hinshaw JL, Lee Jr FT. Microwave ablation of hepatic malignancy. Semin Intervent Radiol 2013; 30: 56-66
• 12 Kotewall CN, Cheung TT. Microwave ablation for liver malignancy: A literature review. Clin Surg 2016; 1: 1130
• 13 Lu DS, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R. et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14: 1267-74
• 14 Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: Multivariate meta-analysis and review of contributing factors. Ann Surg 2005; 242: 158-71
• 15 Bhardwaj N, Strickland AD, Ahmad F, Atanesyan L, West K, Lloyd DM. A comparative histological evaluation of the ablations produced by microwave, cryotherapy and radiofrequency in the liver. Pathology 2009; 41: 168-72
• 16 Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG. et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. for the Standards of practice committee, with Cardiovascular and interventional radiological society of europe (CIRSE) endorsement. J Vasc Interv Radiol 2012; 23: 727-36
• 17 Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: Principles and applications. Radiographics 2005; 25 Suppl (01) S69-83
• 18 Stauffer PR, Rossetto F, Prakash M, Neuman DG, Lee T. Phantom and animal tissues for modeling the electrical properties of human liver. Int J Hyperthermia 2003; 19: 89-101
• 19 Wright AS, Lee Jr FT, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol 2003; 10: 275-83
• 20 Shock SA, Meredith Warner TF, Sampson LA, Winter TC, Mahvi DM, Fine JP. et al. Microwave ablation with loop antenna: In vivo porcine liver model. Radiology 2004; 231: 143-9
• 21 Livraghi T, Meloni F, Solbiati L, Zanus G. Collaborative Italian Group using AMICA system. Complications of microwave ablation for liver tumors: Results of a multicenter study. Cardiovasc Intervent Radiol 2012; 35: 868-74
• 22 Brace CL, Laeseke PF, Sampson LA, Frey TM, van derWeide DW, Lee Jr FT. Microwave ablation with a single small-gauge triaxial antenna: In vivo porcine liver model. Radiology 2007; 242: 435-40
• 23 Yang D, Converse MC, Mahvi DM, Webster JG. Measurement and analysis of tissue temperature during microwave liver ablation. IEEE Trans Biomed Eng 2007; 54: 150-5
• 24 Yu NC, Raman SS, Kim YJ, Lassman C, Chang X, Lu DS. Microwave liver ablation: Influence of hepatic vein size on heat-sink effect in a porcine model. J Vasc Interv Radiol 2008; 19: 1087-92
• 25 Awad MM, Devgan L, Kamel IR, Torbensen M, Choti MA. Microwave ablation in a hepatic porcine model: Correlation of CT and histopathologic findings. HPB (Oxford) 2007; 9: 357-62
• 26 Dong B, Liang P, Yu X, Su L, Yu D, Cheng Z. et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: Results in 234 patients. AJR Am J Roentgenol 2003; 180: 1547-55
• 27 Lu MD, Xu HX, Xie XY, Yin XY, Cheng JW, Kuang M. et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: A retrospective comparative study. J Gastroenterol 2005; 40: 1054-60
• 28 Shibata T, Iimuro Y, Yamamoto Y, Maetani Y, Ametani F, Itoh K. et al. Small hepatocellular carcinoma: Comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 2002; 223: 331-7
• 29 Ohmoto K, Yoshioka N, Tomiyama Y, Shibata N, Kawase T, Yoshida K. et al. Comparison of therapeutic effects between radiofrequency ablation and percutaneous microwave coagulation therapy for small hepatocellular carcinomas. J Gastroenterol Hepatol 2009; 24: 223-7
• 30 Ding J, Jing X, Liu J, Wang Y, Wang F, Wang Y. et al. Comparison of two different thermal techniques for the treatment of hepatocellular carcinoma. Eur J Radiol 2013; 82: 1379-84
• 31 Lu MD, Xu HX, Xie XY, Yin XY, Chen JW, Kuang M. et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: A retrospective comparative study. J Gastroenterol 2005; 40: 1054-60
• 32 Williams LR, Leggett RW. Reference values for resting blood flow to organs of man. Clin Phys Physiol Meas 1989; 10: 187-217
• 33 Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH. et al. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182: 1271-9
• 34 Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: Part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005; 185: 64-71
• 35 Liang P, Wang Y, Zhang D, Yu X, Gao Y, Ni X. Ultrasound guided percutaneous microwave ablation for small renal cancer: Initial experience. J Urol 2008; 180: 844-8
• 36 Clark PE, Woodruff RD, Zagoria RJ, Hall MC. Microwave ablation of renal parenchymal tumors before nephrectomy: Phase I study. AJR Am J Roentgenol 2007; 188: 1212-4
• 37 Yu J, Liang P, Yu XL, Cheng ZG, Han ZY, Zhang X. et al. US-guided percutaneous microwave ablation versus open radical nephrectomy for small renal cell carcinoma: Intermediate-term results. Radiology 2014; 270: 880-7
• 38 Morrison PR, van Sonnenberg E, Shankar S, Godleski J, Silverman SG, Tuncali K. et al. Radiofrequency ablation of thoracic lesions: Part 1, experiments in the normal porcine thorax. AJR Am J Roentgenol 2005; 184: 375-80
• 39 Van Sonnenberg E, Shankar S, Morrison PR, Nair RT, Silverman SG, Jaklitsch MT. et al. Radiofrequency ablation of thoracic lesions: Part 2, initial clinical experience—technical and multidisciplinary considerations in 30 patients. AJR Am J Roentgenol 2005; 184: 381-90
• 40 Wolf FJ, Grand DJ, Machan JT, Dipetrillo TA, Mayo-Smith WW, Dupuy DE. Microwave ablation of lung malignancies: Effectiveness, CT findings, and safety in 50 patients. Radiology 2008; 247: 871-9
• 41 Shi F, Li G, Zhou Z, Xu R, Li W, Zhuang W. et al. Microwave ablation versus radiofrequency ablation for the treatment of pulmonary tumors. Oncotarget 2017; 8: 109791-8
• 42 Jiang B, Mcclure MA, Chen T, Chen S. Efficacy and safety of thermal ablation of lung malignancies. A Network meta-analysis. Ann Thorac Med 2018; 13: 243-50
• 43 Schmitz JJ, Schmit GD, Atwell TD, Callstrom MR, Kurup AN, Weisbrod AJ. et al. Percutaneous cryoablation of extraabdominal desmoid tumors: A 10 year experience. Am J Roentgenol 2016; 207: 190-5
• 44 Ilaslan H, Schils J, Joyce M, Marks K, Sundaram M. Radiofrequency ablation: Another treatment option for local control of desmoid tumors. Skeletal Radiol 2010; 39: 169-73
• 45 Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal Liver tumors with percutaneous radiofrequency ablation: Complicaions encountered in a multicenter study. Radiology 2003; 226: 441-51
• 46 Liang P, Wang Y, Yu X, Dong B. Malignant liver tumors: Treatment with percutaneous microwave ablation—complications among cohort of 1136 patients. Radiology 2009; 251: 933-40
• 47 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