Endoscopic ultrasound-guided lymph node ablation with a novel radiofrequency ablation probe: feasibility study in an acute porcine model
submitted24 April 2013
accepted after revision 16 December 2013
06 February 2014 (eFirst)
Background and study aims: Radiofrequency ablation (RFA) is an accepted method of tissue destruction for solid organ tumors. Endoscopic ultrasound (EUS)-guided RFA has been used for lesions in the pancreas and liver, but there is limited experience of lymph node ablation using EUS-guided RFA. The aim of this study was to determine feasibility and safety of prototype EUS-guided RFA of mediastinal lymph nodes.
Methods: This was an endoscopic experimental feasibility study in a porcine model. After EUS-guided puncture of targeted lymph nodes, the stylet of a 19-G needle was replaced by a prototype RFA probe. RFA was performed by ERBE generator (bipolar settings: 10 watts, effect 2, 2 minutes). The animals were euthanized, and the targeted lymph nodes were identified and removed for histology and measurement of the effect achieved.
Results: A total of 18 mediastinal lymph nodes were ablated (mean size 20.8 ± 6.6 mm in the long axis). The average length of exposed probe was 10.0 ± 3.0 mm. The mean length and diameter of necrosis was 9.8 ± 3.6 mm and 5.5 ± 1.6 mm, respectively. Linear regression comparing needle length with necrosis diameter revealed a coefficient gradient of r = 0.92 (P = 0.0001). With EUS-RFA a mean of 17.6 ± 10.3 % (range 8.0 % – 53.2 %) of the respective lymph node area was ablated. No complications (i. e. hemodynamic instability, local bleeding, tissue damage) occurred during the procedure. Technical problems included stripping of the probe by the EUS needle and bending of the tip of the probe.
Conclusions: EUS-RFA of lymph nodes was performed safely and successfully using a prototype EUS-compatible probe. This method may have the potential for future use in patient care.
* These authors contributed equally to the work.
- 1 Fritscher-Ravens A, Cuming T, Olagbaiye F et al. Endoscopic transesophageal vs. thoracoscopic removal of mediastinal lymph nodes: a prospective randomized trial in a long term animal survival model. Endoscopy 2011; 43: 1090-1096
- 2 Nonoshita T, Sasaki T, Hirata H et al. High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer. Radiat Med 2007; 25: 373-377
- 3 Seo MH, Jeen YT, Park SJ et al. Assessment on the potential role of applying cryoprobe for tissue ablation. Clin Endosc 2012; 45: 67-72
- 4 Enestvedt BK, Ginsberg GG. Advances in endoluminal therapy for esophageal cancer. Gastrointest Endosc Clin N Am 2013; 23: 17-39
- 5 McGahan JP, Dodd GD. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 2001; 176: 3-16
- 6 Gadaleta C, Catino A, Ranieri G et al. Radiofrequency thermal ablation of 69 lung neoplasms. J Chemother 2004; 16 : 86-89
- 7 Weng M, Zhang Y, Zhou D et al. Radiofrequency ablation versus resection for colorectal cancer liver metastases: a meta-analysis. PLoS One 2012; 7: e45493
- 8 Gamblin TC, Christians K, Pappas SG. Radiofrequency ablation of neuroendocrine hepatic metastasis. Surg Oncol Clin N Am 2011; 20: 273-279
- 9 Gao F, Gu Y, Huang J et al. Radiofrequency ablation of retroperitoneal metastatic lymph nodes from hepatocellular carcinoma. Acad Radiol 2012; 19: 1035-1040
- 10 Kennedy TJ, Cassera MA, Khajanchee YS et al. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol 2013; 107: 324-328
- 11 Varadarajulu S, Jhala NC, Drelichman ER. EUS-guided radiofrequency ablation with a prototype electrode array system in an animal model (with video). Gastrointest Endosc 2009; 70: 372-376
- 12 Carrara S, Arcidiacono PG, Albarello L et al. Endoscopic ultrasound-guided application of a new hybrid cryotherm probe in porcine pancreas: a preliminary study. Endoscopy 2008; 40: 321-326
- 13 Gaidhane M, Smith I, Ellen K et al. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) of the pancreas in a porcine model. Gastroenterol Res Pract 2012; 2012: 431451
- 14 Wang KX, Ben QW, Jin ZD et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290