E2939. Percutaneous Ablation of Difficult Renal Cell Carcinoma: Pictorial Review
  1. Aliaksei Salei; University in Alabama at Birmingham Hospital
  2. Matthew Raymond; University in Alabama at Birmingham Hospital
  3. Ricky Pigg; University in Alabama at Birmingham Hospital
  4. Husameddin El Khudari; University in Alabama at Birmingham Hospital
  5. Junaid Raja; University in Alabama at Birmingham Hospital
  6. Andrew Gunn; University in Alabama at Birmingham Hospital
Renal cell carcinoma (RCC) is a seventh most common malignancy by site in the United States with increasing incidence over the past decades. Percutaneous ablation (PA) is an established treatment modality, accepted by major clinical guidelines. It is recognized by interventionalists that PA of RCC may be technically challenging in complex tumors, notably centrally and anteriorly located lesions, as well as with tumors with large size. This exhibit provides pictorial review of strategies aiming to improve technical success rate and safety in PA of difficult RCC.

Educational Goals / Teaching Points
Illustrate imaging findings of potentially difficult for PA of RCCs. Review tumor complexity scoring systems and available evidence of applicability to PA. Review and illustrate PA techniques and ancillary procedures utilized to reduce complications and improve technical success rate.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Review of current clinical guidelines (2022 NCCN guidelines, 2021 AUA guidelines, 2020 SIR Position Statement, 2020 SIR Quality Improvement Standards). Review of available tumor complexity scoring systems (RENAL, mRENAL, PADUA, MC(2), ABLATE) and their ability to predict complications following PA. Review advantages and shortcomings of PA modalities (cryoablation, radiofrequency ablation, microwave ablation, irreversible electroporation) pertinent to management of difficult RCC. Review of ablation strategies (probe placement, transhepatic ablation, staged ablation) and ancillary procedures (neoadjuvant transarterial embolization, displacement techniques, including hydro- and pneumo-dissection, ureteral stenting and pyeloperfusion). Review of complications and their management.

PA of RCC is increasingly utilized due to its minimal invasiveness and favorable oncologic outcomes. Practicing interventional radiologists need to be aware of ablation strategies and ancillary procedures to achieve optimal results in management of difficult RCC.