Page 201 - Read Online

Page 8 of 11 Cicero et al. Mini-invasive Surg 2019;3:25 I http://dx.doi.org/10.20517/2574-1225.2018.012

A BB

C D

Figure 10. Follow-up after cryoablation. A: 84 years old patient with 5 cm RCC; B: Postoperative day 1 and enhancement; C: no tumor
persistence and often a repeated CEUS after 1 month is recommended in lesions that maintain vascularity on postoperative to exclude
residual tumor; D: MR after 6 months confirms the success of the cryoablation treatment. CEUS: contrast enhancement ultrasonography;
RCC: renal cell carcinoma

[27]
exophytic tumors ; and (3) tumors with a diameter > 3 cm compared with smaller tumors, have an higher
[27]
rates of residual disease after the first treatment .
Anyway, follow-up can be performed by CEUS, CT or MRI. CT and MRI are the best options for the
patient because of their high resolution and chance to detect recurrences. However, as for the diagnostic
pathway, the cumulative radiation dose could be very high. Another problem is that the CT scan requires
iodine contrast, which is a well-known nephrotoxic substance.

The current guidelines don’t explain the tyme and duration imaging follow up after ablation treatment.
The AUA recommends cross-sectional imaging at 3 months and 6 months after ablation, then annually for
5 years. After ablation treatments, the timing of initial follow up varies according to operator’s preference;
the range is from day 0 to 1 month post operatively [28-30] . Generally, the majority of residual tumor is
detected within the first 3 months after ablation, the urge for early short interval follow-up. According
[26]
to Matin et al. , the most frequent timing of recidive is within the first 3 months after treatment: this is
important in order to programme an early follow up.

CEUS is increasingly used during follow-up and particularly on close postoperative time: day 1 to 1 month.
The main aim is looking complications.

The first imaging sign of tumor persistence after ablation treatment, is the persistence of vascularization
in enhancement to imaging. This signal is the first post operative day not allow to diagnose a failure of
the procedure. For this reason, it is important to perform a CEUS at 30 days to evaluate a successful or
[8]
uncessful ablation [Figure 10] .