Progress in ablation therapy of pulmonary nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHEN Xu ^1,2 , SHEN Cheng ² , XIAO Congjia ² , LIN Haonan ² ,  ZHU Yunke ² ,  LIN Feng ² ,  LIAO Hu ²

1. Department of Thoracic Surgery, Shangjin Hospital West China Hospital/Chengdu Shangjin Nanfu Hospital, Chengdu, 611743, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

ZHU Yunke, Email: yunke_zhu@qq.com; LIN Feng, Email: linfeng0220@aliyun.com; LIAO Hu, Email: drliaohu@scu.edu.cn

Keywords：

Multiple pulmonary nodule; lung cancer; radiofrequency ablation; microwave ablation; cryoablation; review

DOI：

10.7507/1007-4848.202306025

Video：

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In recent years, with the improvement of people's awareness of physical examination and the more accurate detection equipment, the detection rate of pulmonary nodules is getting higher and higher. Surgical resection is the first choice for the treatment of malignant pulmonary nodules, but multiple pulmonary nodules, nodules in complex areas and those with surgical contraindications are not suitable for surgery. As an effective, less invasive and low-cost treatment, ablation has developed rapidly in the treatment of multiple pulmonary nodules. This article introduces the progress of several common ablation techniques (radiofrequency ablation, microwave ablation, cryoablation) in the treatment of multiple pulmonary nodules, the indications and contraindications of ablation techniques, the efficacy evaluation and complications after ablation therapy, and the prospects of ablation techniques in the treatment of multiple pulmonary nodules.

Citation： SHEN Xu, SHEN Cheng, XIAO Congjia, LIN Haonan, ZHU Yunke, LIN Feng, LIAO Hu. Progress in ablation therapy of pulmonary nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(3): 401-405. doi: 10.7507/1007-4848.202306025 Copy

1.	Dube PN, Sakle NS, Dhawale SA, et al. Synthesis, biological investigation and docking study of novel chromen derivatives as anti-cancer agents. Anticancer Agents Med Chem, 2019, 19(9): 1150-1160.
2.	周清华, 范亚光, 王颖, 等. 中国肺部结节分类、诊断与治疗指南(2016年版). 中国肺癌杂志, 2016, 19(12): 793-798.Zhou QH, Fan YG, Wang Y, et al. China national guideline of classification, diagnosis and treatment for lung nodules (2016 version). Chin J Lung Cancer, 2016, 19(12): 793-798.
3.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4.	叶欣, 王俊, 危志刚, 等. 热消融治疗肺部亚实性结节专家共识 (2021年版). 中国肺癌杂志, 2021, 24(5): 305-322.Ye X, Wang J, Wei ZG, et al. Expert consensus for thermal ablation of pulmonary subsolid nodules (2021 edition). Chin J Lung Cancer, 2021, 24(5): 305-322.
5.	He YT, Zhang YC, Shi GF, et al. Risk factors for pulmonary nodules in north China: A prospective cohort study. Lung Cancer, 2018, 120: 122-129.
6.	Liu Y, Luo H, Qing H, et al. Screening baseline characteristics of early lung cancer on low-dose computed tomography with computer-aided detection in a Chinese population. Cancer Epidemiol, 2019, 62: 101567.
7.	Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
8.	Dupuy DE, Zagoria RJ, Akerley W, et al. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol, 2000, 174(1): 57-59.
9.	Kwan SW, Mortell KE, Hippe DS, et al. An economic analysis of sublobar resection versus thermal ablation for early-stage non-small-cell lung cancer. J Vase Interv Radiol, 2014, 25: 1558-1564.
10.	冯迪, 周成伟, 王海涛, 等. CT引导下热消融联合活检对肺结节的诊断效能. 全科医学临床与教育, 2023, 21(3): 231-234.Feng D, Zhou CW, Wang HT, et al. Diagnostic efficacy of CT-guided thermal ablation combined with biopsy for pulmonary nodules. Clin Educ Gen Pract, 2023, 21(3): 231-234.
11.	刘宝东, 李元博, 胡牧, 等. 对高度可疑肺癌同时进行CT引导下肺穿刺活检和射频消融的临床研究. 中国微创外科杂志, 2017, 17(1): 7-10, 14.Liu BD, Li YB, Hu M, et al. A clinical study of computed tomography guided biopsy followed by radiofrequency ablation for suspicious lesions in lung cancer. Chin J Minim Invasive Surg, 2017, 17(1): 7-10, 14.
12.	魏颖恬, 肖越勇, 张啸波, 等. CT引导下射频消融肺结节联合术中穿刺活检的临床应用及预防出血措施. 中国介入影像与治疗学, 2021, 18(1): 8-12.Wei YT, Xiao YY, Zhang XB, et al. Clinical application of CT-guided percutaneous RFA combined withhalfway biopsy for pulmonary nodule and management forprevention of intraoperative bleeding. Chin J Interv Imaging Ther, 2021, 18(1): 8-12.
13.	郭兰坤, 肖越勇, 魏颖恬, 等. CT引导下肺结节热消融联合术中即时活检的可行性. 中国介入影像与治疗学, 2022, 19(3): 129-133.Guo LK, Xiao YY, Wei YT, et al. Feasibility of CT-guided thermal ablation combined with immediate intraoperative biopsy of pulmonary nodules. Chin J Interv Imaging Ther, 2022, 19(3): 129-133.
14.	李林峻, 吴庆琛. 电磁导航支气管镜下微波消融术在肺结节治疗中的应用进展. 重庆医学, 2023, 52(4): 613-617.Li LJ, Wu QC. Application progress of electromagnetic navigation bronchial mirror microwave ablation in the treatment of lung nodules. Chongqing Med J, 2023, 52(4): 613-617.
15.	王东东, 李晓光, 李彬, 等. 经同轴套管穿刺活检同步微波消融治疗高度可疑恶性肺结节. 介入放射学杂志, 2018, 27(11): 1040-1044.Wang DD, Li XG, Li B, et al. Simultaneous core needle biopsy and microwave ablation via coaxial cannula for highly suspected malignant pulmonary nodules. J Interv Radiol, 2018, 27(11): 1040-1044.
16.	Palussiere J, Catena V, Buy X. Percutaneous thermal ablation of lung tumors-radio frequency, microwave and cryotherapy: Where are we going? Diagn Interv Imaging, 2017, 98(9): 619-625.
17.	Brace CL, Hinshaw JL, Laeseke PF, et al. Pulmonary thermal ablation: Comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology, 2009, 251(3): 705-711.
18.	Thomas JV, Nour-Eldin AN, Moritz HA, et al. Thermal ablation of lung tumors: Focus on microwave ablation. Rofo, 2017, 189(9): 828-843.
19.	Amgad MM, Etay Z, Stephen BS, et al. Microwave ablation in primary lung malignancies. Semin Interv Radiol, 2019, 3 6(4): 326-333.
20.	Macchi M, Belfiore MP, Floridi C, et al. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol, 2017, 34(5): 96.
21.	Maxwell AWP, Healey TT, Dupuy DE. Microwave ablation of lung tumors near the heart: A retrospective review of short-term procedural safety in ten patients. Cardiovasc Interv Radiol, 2017, 40(9): 1401-1407.
22.	Huang G, Yang X, Li W, et al. A feasibility and safety study of computed tomography-guided percutaneous microwave ablation: A novel therapy for multiple synchronous ground-glass opacities of the lung. Int J Hyperthermia, 2020, 37(1): 414-422.
23.	Kim KY, Jin GY, Han YM, et al. Cryoablation of a small pulmonary nodule with pure ground-glass opacity: A case report. Korean J Radiol, 2015, 16(3): 657-661.
24.	李向阳, 穆峰, 陈继冰, 等. CT引导下经皮冷冻消融治疗肺磨玻璃结节的研究. 介入放射学杂志, 2021, 30(10): 1072-1076.Li XY, Mu F, Chen JB, et al. CT-guided percutaneous cryoablation for the treatment of pulmonary ground-glass nodules. J Interv Radiol, 2021, 30(10): 1072-1076.
25.	杨佳颖, 杨武威, 温铭杰. 磨玻璃结节肺癌消融治疗的研究进展. 北京医学, 2021, 43(10): 987-990.Yang JY, Yang WW, Wen MJ. Research progress on ablation therapy for ground glass nodules in lung cancer. Beijing Med J, 2021, 43(10): 987-990.
26.	张肖, 肖越勇, 李成利. 影像学引导下肺结节冷冻消融专家共识(2022版). 中国介入影像与治疗学, 2022, 19(1): 2-6.Zhang X, Xiao YY, Li CL. Expert consensus for image-guided cryoablation of pulmonary nodule (2022 edition). Chin J Interv Imaging Ther, 2022, 19(1): 2-6.
27.	Liu S, Zhu X, Qin Z, et al. Computed tomography-guided percutaneous cryoablation for lung ground-glass opacity: A pilot study. J Cancer Res Ther, 2019, 15(2): 370-374.
28.	Kim MN, Kim BK, Han KH, et al. Evolution from WHO to EASL and mRECIST for hepatocellular carcinoma: Considerations for tumor response assessment. Expert Rev Gastroenterol Hepatol, 2015, 9(3): 335-348.
29.	Rangamuwa K, Leong T, Weeden C, et al. Thermal ablation in non-small cell lung cancer: A review of treatment modalities and the evidence for combination with immune checkpoint inhibitors. Transl Lung Cancer Res, 2021, 10(6): 2842-2857.
30.	张啸波, 肖越勇, 张肖, 等. 针道封堵技术预防CT引导下经皮穿刺肺结节射频消融同步活检出血. 中国介入影像与治疗学, 2021, 18(1): 13-17.Zhang XB, Xiao YY, Zhang X, et al. Needle tract occlusion technology for prevention of pulmonary hemorrhage during CT-guided percutaneous radiofrequency ablation and simultaneous biopsy of pulmonary nodules. Chin J Interv Imaging Ther, 2021, 18(1): 13-17.

1. Dube PN, Sakle NS, Dhawale SA, et al. Synthesis, biological investigation and docking study of novel chromen derivatives as anti-cancer agents. Anticancer Agents Med Chem, 2019, 19(9): 1150-1160.
2. 周清华, 范亚光, 王颖, 等. 中国肺部结节分类、诊断与治疗指南(2016年版). 中国肺癌杂志, 2016, 19(12): 793-798.Zhou QH, Fan YG, Wang Y, et al. China national guideline of classification, diagnosis and treatment for lung nodules (2016 version). Chin J Lung Cancer, 2016, 19(12): 793-798.
3. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4. 叶欣, 王俊, 危志刚, 等. 热消融治疗肺部亚实性结节专家共识 (2021年版). 中国肺癌杂志, 2021, 24(5): 305-322.Ye X, Wang J, Wei ZG, et al. Expert consensus for thermal ablation of pulmonary subsolid nodules (2021 edition). Chin J Lung Cancer, 2021, 24(5): 305-322.
5. He YT, Zhang YC, Shi GF, et al. Risk factors for pulmonary nodules in north China: A prospective cohort study. Lung Cancer, 2018, 120: 122-129.
6. Liu Y, Luo H, Qing H, et al. Screening baseline characteristics of early lung cancer on low-dose computed tomography with computer-aided detection in a Chinese population. Cancer Epidemiol, 2019, 62: 101567.
7. Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
8. Dupuy DE, Zagoria RJ, Akerley W, et al. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol, 2000, 174(1): 57-59.
9. Kwan SW, Mortell KE, Hippe DS, et al. An economic analysis of sublobar resection versus thermal ablation for early-stage non-small-cell lung cancer. J Vase Interv Radiol, 2014, 25: 1558-1564.
10. 冯迪, 周成伟, 王海涛, 等. CT引导下热消融联合活检对肺结节的诊断效能. 全科医学临床与教育, 2023, 21(3): 231-234.Feng D, Zhou CW, Wang HT, et al. Diagnostic efficacy of CT-guided thermal ablation combined with biopsy for pulmonary nodules. Clin Educ Gen Pract, 2023, 21(3): 231-234.
11. 刘宝东, 李元博, 胡牧, 等. 对高度可疑肺癌同时进行CT引导下肺穿刺活检和射频消融的临床研究. 中国微创外科杂志, 2017, 17(1): 7-10, 14.Liu BD, Li YB, Hu M, et al. A clinical study of computed tomography guided biopsy followed by radiofrequency ablation for suspicious lesions in lung cancer. Chin J Minim Invasive Surg, 2017, 17(1): 7-10, 14.
12. 魏颖恬, 肖越勇, 张啸波, 等. CT引导下射频消融肺结节联合术中穿刺活检的临床应用及预防出血措施. 中国介入影像与治疗学, 2021, 18(1): 8-12.Wei YT, Xiao YY, Zhang XB, et al. Clinical application of CT-guided percutaneous RFA combined withhalfway biopsy for pulmonary nodule and management forprevention of intraoperative bleeding. Chin J Interv Imaging Ther, 2021, 18(1): 8-12.
13. 郭兰坤, 肖越勇, 魏颖恬, 等. CT引导下肺结节热消融联合术中即时活检的可行性. 中国介入影像与治疗学, 2022, 19(3): 129-133.Guo LK, Xiao YY, Wei YT, et al. Feasibility of CT-guided thermal ablation combined with immediate intraoperative biopsy of pulmonary nodules. Chin J Interv Imaging Ther, 2022, 19(3): 129-133.
14. 李林峻, 吴庆琛. 电磁导航支气管镜下微波消融术在肺结节治疗中的应用进展. 重庆医学, 2023, 52(4): 613-617.Li LJ, Wu QC. Application progress of electromagnetic navigation bronchial mirror microwave ablation in the treatment of lung nodules. Chongqing Med J, 2023, 52(4): 613-617.
15. 王东东, 李晓光, 李彬, 等. 经同轴套管穿刺活检同步微波消融治疗高度可疑恶性肺结节. 介入放射学杂志, 2018, 27(11): 1040-1044.Wang DD, Li XG, Li B, et al. Simultaneous core needle biopsy and microwave ablation via coaxial cannula for highly suspected malignant pulmonary nodules. J Interv Radiol, 2018, 27(11): 1040-1044.
16. Palussiere J, Catena V, Buy X. Percutaneous thermal ablation of lung tumors-radio frequency, microwave and cryotherapy: Where are we going? Diagn Interv Imaging, 2017, 98(9): 619-625.
17. Brace CL, Hinshaw JL, Laeseke PF, et al. Pulmonary thermal ablation: Comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology, 2009, 251(3): 705-711.
18. Thomas JV, Nour-Eldin AN, Moritz HA, et al. Thermal ablation of lung tumors: Focus on microwave ablation. Rofo, 2017, 189(9): 828-843.
19. Amgad MM, Etay Z, Stephen BS, et al. Microwave ablation in primary lung malignancies. Semin Interv Radiol, 2019, 3 6(4): 326-333.
20. Macchi M, Belfiore MP, Floridi C, et al. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol, 2017, 34(5): 96.
21. Maxwell AWP, Healey TT, Dupuy DE. Microwave ablation of lung tumors near the heart: A retrospective review of short-term procedural safety in ten patients. Cardiovasc Interv Radiol, 2017, 40(9): 1401-1407.
22. Huang G, Yang X, Li W, et al. A feasibility and safety study of computed tomography-guided percutaneous microwave ablation: A novel therapy for multiple synchronous ground-glass opacities of the lung. Int J Hyperthermia, 2020, 37(1): 414-422.
23. Kim KY, Jin GY, Han YM, et al. Cryoablation of a small pulmonary nodule with pure ground-glass opacity: A case report. Korean J Radiol, 2015, 16(3): 657-661.
24. 李向阳, 穆峰, 陈继冰, 等. CT引导下经皮冷冻消融治疗肺磨玻璃结节的研究. 介入放射学杂志, 2021, 30(10): 1072-1076.Li XY, Mu F, Chen JB, et al. CT-guided percutaneous cryoablation for the treatment of pulmonary ground-glass nodules. J Interv Radiol, 2021, 30(10): 1072-1076.
25. 杨佳颖, 杨武威, 温铭杰. 磨玻璃结节肺癌消融治疗的研究进展. 北京医学, 2021, 43(10): 987-990.Yang JY, Yang WW, Wen MJ. Research progress on ablation therapy for ground glass nodules in lung cancer. Beijing Med J, 2021, 43(10): 987-990.
26. 张肖, 肖越勇, 李成利. 影像学引导下肺结节冷冻消融专家共识(2022版). 中国介入影像与治疗学, 2022, 19(1): 2-6.Zhang X, Xiao YY, Li CL. Expert consensus for image-guided cryoablation of pulmonary nodule (2022 edition). Chin J Interv Imaging Ther, 2022, 19(1): 2-6.
27. Liu S, Zhu X, Qin Z, et al. Computed tomography-guided percutaneous cryoablation for lung ground-glass opacity: A pilot study. J Cancer Res Ther, 2019, 15(2): 370-374.
28. Kim MN, Kim BK, Han KH, et al. Evolution from WHO to EASL and mRECIST for hepatocellular carcinoma: Considerations for tumor response assessment. Expert Rev Gastroenterol Hepatol, 2015, 9(3): 335-348.
29. Rangamuwa K, Leong T, Weeden C, et al. Thermal ablation in non-small cell lung cancer: A review of treatment modalities and the evidence for combination with immune checkpoint inhibitors. Transl Lung Cancer Res, 2021, 10(6): 2842-2857.
30. 张啸波, 肖越勇, 张肖, 等. 针道封堵技术预防CT引导下经皮穿刺肺结节射频消融同步活检出血. 中国介入影像与治疗学, 2021, 18(1): 13-17.Zhang XB, Xiao YY, Zhang X, et al. Needle tract occlusion technology for prevention of pulmonary hemorrhage during CT-guided percutaneous radiofrequency ablation and simultaneous biopsy of pulmonary nodules. Chin J Interv Imaging Ther, 2021, 18(1): 13-17.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress in ablation therapy of pulmonary nodules

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