E2958. Cryoablation of T1b and T2 Renal Cell Carcinoma: Strategies and Techniques
  1. Aliaksei Salei; University in Alabama at Birmingham Hospital
  2. Ricky Pigg; University in Alabama at Birmingham Hospital
  3. Matthew Raymond; University in Alabama at Birmingham Hospital
  4. William Parkhurst; University in Alabama at Birmingham Hospital
  5. Theresa Caridi; University in Alabama at Birmingham Hospital
  6. Andrew Gunn; University in Alabama at Birmingham Hospital
Renal cell carcinoma (RCC) makes up 4.0% of the total number of cancer diagnoses in the United States with an estimated 76,080 new diagnoses in 2021. The widespread use of abdominal imaging has contributed to markedly increased incidence since 1970s. With rising incidence and significant proportion of patients who are poor surgical candidates, current clinical guidelines recognize the use of percutaneous cryoablation (CA) for T1a RCC. Recently, multiple reports noted that CA can be a safe and effective treatment for tumors staged as T1b (4.1cm - 7cm) and T2a (7.1 - 10cm). Increased tumor size, however, poses higher risk of procedural complications and may result in less favorable oncologic outcomes. This exhibit provides pictorial review of strategies and techniques utilized in CA of T1b and T2a RCC.

Educational Goals / Teaching Points
Review current literature on percutaneous ablation of RCC beyond T1a stage. Illustrate approaches to CA in the treatment of patients with T1b and T2 RCC. Discuss applicable quality and safety standards.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Introduction and review of current clinical guidelines and applicable quality improvement standards. Review of available literature on percutaneous ablation of T1b and T2a RCC and comparison to surgical outcomes. Pictorial review of CA strategies, including approaches to probe placement, displacement techniques and considerations of staged CA. Review of available evidence for transarterial embolization prior to CA and pictorial review of cases. Review of strategies to avoid and manage post-procedural complications.

Percutaneous ablation of T1b and T2 RCC can be performed safely with good oncologic outcomes. Strategies such as orderly probe placement, displacement techniques, pre-ablation embolization, and focusing on tumor margins can optimize results.