Improved targeting of radio-frequency ablation probes and thermal sensors: a preliminary investigation of flat-panel CT-guided ablation of renal tumors performed in the cardiac catheterization laboratory.

Flat-panel detector CT (FD-CT) provides cross-sectional CT-images while offering an improved workspace using fluoroscopic guidance for thermal probe placement such as for radiofrequency ablation (RFA) needles and thermal sensors. The purpose of this article is to test the feasibility of FD-CT in the application of renal tumor ablation in a "hybrid operating room" environment. Eleven patients with renal masses diagnosed preprocedurally with contrast-enhanced CT scan underwent core biopsy and simultaneous CT-RFA under general anesthesia with FD-CT guidance in the cardiac catheterization laboratory. Scans were taken preablation for tumor targeting, intermittently for probe placement and guidance of temperature sensors, and postablation. Perioperative and postoperative outcomes, pathologic results, and radiographic follow-up were recorded for each patient. Target temperatures >60°C to guide treatment end point were reached for each tumor periphery. Biopsy pathology showed 6/11 (55%) to be renal-cell carcinoma, and 2/11 (18%) to be benign; 3/11 (27%) had an indeterminate biopsy result. Three Clavien grade I complications occurred. One patient showed evidence of recurrent disease on postoperative CT scan. In our experience, we have found FD-CT-guided ablation of small renal tumors to be feasible using this advanced targeting system.