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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	周清華, 范亞光, 王穎, 等. 中國肺部結節分類、診斷與治療指南(2016年版). 中國肺癌雜志, 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.	葉欣, 王俊, 危志剛, 等. 熱消融治療肺部亞實性結節專家共識 (2021年版). 中國肺癌雜志, 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.	馮迪, 周成偉, 王海濤, 等. CT引導下熱消融聯合活檢對肺結節的診斷效能. 全科醫學臨床與教育, 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.	劉寶東, 李元博, 胡牧, 等. 對高度可疑肺癌同時進行CT引導下肺穿刺活檢和射頻消融的臨床研究. 中國微創外科雜志, 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.	魏穎恬, 肖越勇, 張嘯波, 等. CT引導下射頻消融肺結節聯合術中穿刺活檢的臨床應用及預防出血措施. 中國介入影像與治療學, 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.	郭蘭坤, 肖越勇, 魏穎恬, 等. CT引導下肺結節熱消融聯合術中即時活檢的可行性. 中國介入影像與治療學, 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, 吳慶琛. 電磁導航支氣管鏡下微波消融術在肺結節治療中的應用進展. 重慶醫學, 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.	王東東, 李曉光, 李彬, 等. 經同軸套管穿刺活檢同步微波消融治療高度可疑惡性肺結節. 介入放射學雜志, 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.	李向陽, 穆峰, 陳繼冰, 等. CT引導下經皮冷凍消融治療肺磨玻璃結節的研究. 介入放射學雜志, 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.	楊佳穎, 楊武威, 溫銘杰. 磨玻璃結節肺癌消融治療的研究進展. 北京醫學, 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.	張肖, 肖越勇, 李成利. 影像學引導下肺結節冷凍消融專家共識(2022版). 中國介入影像與治療學, 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.	張嘯波, 肖越勇, 張肖, 等. 針道封堵技術預防CT引導下經皮穿刺肺結節射頻消融同步活檢出血. 中國介入影像與治療學, 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. 周清華, 范亞光, 王穎, 等. 中國肺部結節分類、診斷與治療指南(2016年版). 中國肺癌雜志, 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. 葉欣, 王俊, 危志剛, 等. 熱消融治療肺部亞實性結節專家共識 (2021年版). 中國肺癌雜志, 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. 馮迪, 周成偉, 王海濤, 等. CT引導下熱消融聯合活檢對肺結節的診斷效能. 全科醫學臨床與教育, 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. 劉寶東, 李元博, 胡牧, 等. 對高度可疑肺癌同時進行CT引導下肺穿刺活檢和射頻消融的臨床研究. 中國微創外科雜志, 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. 魏穎恬, 肖越勇, 張嘯波, 等. CT引導下射頻消融肺結節聯合術中穿刺活檢的臨床應用及預防出血措施. 中國介入影像與治療學, 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. 郭蘭坤, 肖越勇, 魏穎恬, 等. CT引導下肺結節熱消融聯合術中即時活檢的可行性. 中國介入影像與治療學, 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, 吳慶琛. 電磁導航支氣管鏡下微波消融術在肺結節治療中的應用進展. 重慶醫學, 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. 王東東, 李曉光, 李彬, 等. 經同軸套管穿刺活檢同步微波消融治療高度可疑惡性肺結節. 介入放射學雜志, 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. 李向陽, 穆峰, 陳繼冰, 等. CT引導下經皮冷凍消融治療肺磨玻璃結節的研究. 介入放射學雜志, 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. 楊佳穎, 楊武威, 溫銘杰. 磨玻璃結節肺癌消融治療的研究進展. 北京醫學, 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. 張肖, 肖越勇, 李成利. 影像學引導下肺結節冷凍消融專家共識(2022版). 中國介入影像與治療學, 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. 張嘯波, 肖越勇, 張肖, 等. 針道封堵技術預防CT引導下經皮穿刺肺結節射頻消融同步活檢出血. 中國介入影像與治療學, 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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content