Scientific Letter
Evaluation of the Response to the Radiofrequency Treatment of a Pulmonary Nodule by Contrast-enhanced Ultrasound (CEUS)
Evaluación de la respuesta al tratamiento con radiofrecuencia de un nódulo pulmonar mediante ecografía con contraste (CEUS)
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Se observa un nódulo subpleural sólido (flecha) en un paciente con enfermedad metastásica de un carcinoma escamoso cutáneo de células basales. Este nódulo se decidió tratar mediante ARF guiada por TC. B) Corte axial con el paciente en decúbito supino, durante la realización de la ARF guiada por TC. Se utilizó una aguja tipo «paraguas» (flecha). C) CEUS pulmonar de la misma lesión. No se observa captación de contraste durante todo el procedimiento, lo que indica una respuesta completa al tratamiento ablativo. D) PET-TC de tórax del mismo paciente un año después del tratamiento ablativo. Muestra disminución en el tamaño de la lesión tratada y ausencia de captación de FDG (flecha), concordante esto con una respuesta completa. Se observó un aumento patológico de la FDG en la lesión del lóbulo inferior izquierdo tratada con radioterapia (estrella).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alfredo Páez-Carpio, Ivan Vollmer, Pilar Paredes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Páez-Carpio" ] 1 => array:2 [ "nombre" => "Ivan" "apellidos" => "Vollmer" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "Paredes" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212920301579" "doi" => "10.1016/j.arbr.2020.03.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301579?idApp=UINPBA00003Z" ] ] "EPUB" => 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Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "531" "paginaFinal" => "532" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alfredo Páez-Carpio, Ivan Vollmer, Pilar Paredes" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Alfredo" "apellidos" => "Páez-Carpio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ivan" "apellidos" => "Vollmer" "email" => array:1 [ 0 => "vollmer@clinic.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Pilar" "apellidos" => "Paredes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiología (CDI), Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Nuclear (CDI), Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la respuesta al tratamiento con radiofrecuencia de un nódulo pulmonar mediante ecografía con contraste (CEUS)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 686 "Ancho" => 900 "Tamanyo" => 125796 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT with iodinated IV contrast: lung window. A solid subpleural nodule (arrow) is seen in a patient with metastatic disease of cutaneous squamous cell carcinoma of the basal cells. This node was treated using CT-guided RFA. (B) Axial slice with patient in a supine position during CT-guided RFA. An umbrella needle (arrow) was used. (C) Pulmonary CEUS of the same lesion. No contrast uptake is observed throughout the procedure, indicating a complete response to ablative treatment. (D) Chest PET-CT of the same patient 1 year after ablative treatment, showing a decrease in the size of the treated lesion and no FDG uptake (arrow), consistent with a complete response. A pathological increase in FDG was observed in the left lower lobe lesion treated with radiation therapy (star).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Computed tomography (CT)-guided radiofrequency ablation (RFA) is a minimally invasive technique used to treat solid tumors that offers a reliable alternative to surgery in oligometastatic lung disease<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and in early stage primary lung cancer.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> A major challenge in treating lung lesions with RFA has been the reliable evaluation of treatment response after the procedure. Unlike surgical resection, in which a histopathological analysis is performed post-procedure, the treated tumor is left <span class="elsevierStyleItalic">in situ</span> during RFA, so direct histopathological verification is not possible. The options currently available for post-procedure follow-up are CT,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> positron emission tomography (PET), and dual-modality imaging (PET-CT).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> CT and PET are unable to detect microscopic tumor foci and are less than optimal in the detection of early recurrence.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Contrast-enhanced ultrasound (CEUS) is a technique that has been used for years in the immediate follow-up of the ablative treatment of focal lesions, especially in liver and kidney disease.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Given the history of CEUS as a technique in evaluating the response of lesions treated with RFA in other parts of the anatomy, it is possible that in subpleural lesions accessible by ultrasound examination, CEUS may have the potential to be a complementary tool to CT and PET-CT in the evaluation of lung lesions treated by RFA.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 73-year-old man who was diagnosed in August 2010 with cutaneous squamous cell carcinoma of the basal cells after years of skin lesions on the cheek and shoulder. Treatment involved surgical resection of the affected areas, and subsequent locoregional recurrences were also treated surgically. The patient then presented with a new recurrence involving 2 subpleural solid pulmonary nodules in the right lower lobe and another lesion in the left lower lobe. Palliative chemotherapy was administered, composed of carboplatin, 5-fluorouracil, and cetuximab, and complementary treatment with taxol. Subsequent radiological controls showed stable disease until November 2016, when an increase in the size of the lesions was reported (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The multidisciplinary committee of our center decided to perform CT-guided RFA on the 2 lesions located in the right lower lobe and to apply radiation therapy to the contralateral lesion.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">On January 30th, 2017, CT-guided RFA was performed on the 2 nodules located in the right lower lobe. One lesion was treated with a 3<span class="elsevierStyleHsp" style=""></span>cm umbrella needle (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), which resulted in mild pneumothorax and halo after treatment, and the other was treated with a 2<span class="elsevierStyleHsp" style=""></span>cm straight needle. In the immediate follow-up CT, right pneumothorax was observed which required the placement of a chest tube, as the patient had developed dyspnea. He subsequently presented with moderate right pleural effusion, treated by ultrasound-guided pleural drainage on February 28th, 2017. During the procedure, pulmonary CEUS was performed to assess a potential infection in the lesion treated with RFA. The lesion showed no contrast uptake throughout the examination; this finding was suggestive of necrosis, indicating a complete response to RFA (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Subsequent CT and PET-CT monitoring confirmed complete response to date (January 10th, 2019) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D).</p><p id="par0020" class="elsevierStylePara elsevierViewall">CEUS has been shown to be a comparable alternative to CT and MRI in the evaluation of the response of neoplastic lesions treated with RFA, particularly in liver and kidney disease.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> In pulmonary CEUS, entities such as pulmonary infarctions or necrosis tend not to show contrast uptake during the entire examination,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> so in the post-RFA CEUS follow-up contrast enhancement would not be expected in lesions with complete response. Given the increasing use of RFA as alternative treatment to surgical resection in patients with oligometastatic or primary early-stage lung disease and the difficulty of detecting early recurrences by CT and PET-CT,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> pulmonary CEUS may be a complementary tool in the post-treatment monitoring of subpleural lesions accessible to ultrasound evaluation, especially when CT and PET-CT assessment are unclear. In addition, pulmonary CEUS may be useful to guide the biopsy of subpleural lesions in which recurrence is suspected.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">A factor limiting the evaluation of lung lesions by CEUS may be the lack of scientific literature available for the characterization of the different histological types of lung tumors, since only retrospective studies are available.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> As such, since the expected pretreatment appearance of lung lesions has not been established, it is difficult to compare them with the post-treatment image.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This is the first reported case of response assessment of percutaneous pulmonary treatment with CEUS. Additional studies are required to prove the usefulness of this technique in this context.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Páez-Carpio A, Vollmer I, Paredes P. Evaluación de la respuesta al tratamiento con radiofrecuencia de un nódulo pulmonar mediante ecografía con contraste (CEUS). Arch Bronconeumol. 2020;56:531–532.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 686 "Ancho" => 900 "Tamanyo" => 125796 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest CT with iodinated IV contrast: lung window. A solid subpleural nodule (arrow) is seen in a patient with metastatic disease of cutaneous squamous cell carcinoma of the basal cells. This node was treated using CT-guided RFA. (B) Axial slice with patient in a supine position during CT-guided RFA. An umbrella needle (arrow) was used. (C) Pulmonary CEUS of the same lesion. No contrast uptake is observed throughout the procedure, indicating a complete response to ablative treatment. (D) Chest PET-CT of the same patient 1 year after ablative treatment, showing a decrease in the size of the treated lesion and no FDG uptake (arrow), consistent with a complete response. A pathological increase in FDG was observed in the left lower lobe lesion treated with radiation therapy (star).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Lencioni" 1 => "L. Crocetti" 2 => "R. Cioni" 3 => "R. Suh" 4 => "D. Glenn" 5 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 40 | 26 | 66 |
| 2024 September | 35 | 17 | 52 |
| 2024 August | 68 | 37 | 105 |
| 2024 July | 39 | 20 | 59 |
| 2024 June | 43 | 22 | 65 |
| 2024 May | 81 | 35 | 116 |
| 2024 April | 28 | 24 | 52 |
| 2024 March | 32 | 20 | 52 |
| 2024 February | 30 | 24 | 54 |
| 2023 March | 10 | 5 | 15 |
| 2023 February | 34 | 15 | 49 |
| 2023 January | 29 | 24 | 53 |
| 2022 December | 36 | 31 | 67 |
| 2022 November | 48 | 25 | 73 |
| 2022 October | 52 | 32 | 84 |
| 2022 September | 36 | 23 | 59 |
| 2022 August | 36 | 39 | 75 |
| 2022 July | 27 | 34 | 61 |
| 2022 June | 25 | 36 | 61 |
| 2022 May | 28 | 34 | 62 |
| 2022 April | 34 | 25 | 59 |
| 2022 March | 38 | 34 | 72 |
| 2022 February | 19 | 21 | 40 |
| 2021 September | 1 | 0 | 1 |
| 2020 October | 1 | 0 | 1 |
| 2020 August | 1 | 4 | 5 |
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