Indications by Organ
- Liver HCC — ≤3 cm, ≤3 nodules; BCLC 0/A curative intent
- Liver metastases — colorectal, neuroendocrine; oligometastatic
- Renal cell carcinoma — T1a (≤4 cm); poor surgical candidate
- Lung — primary NSCLC T1, metastases; poor surgical candidate
- Bone — painful metastases (osteoid osteoma — curative)
- Adrenal — metastases, functioning adenoma (cryo preferred)
- Thyroid — benign nodule; papillary microcarcinoma (selected)
- Breast — fibroadenoma, early invasive (investigational)
RFA vs Microwave vs Cryoablation
- RFA — electrical current, 50–100°C; heat sink limits near vessels
- Microwave — electromagnetic, faster; less heat sink effect
- MWA — larger ablation zones; preferred for large tumors (>3 cm)
- Cryoablation — ice ball visible on CT/MRI; lower pain during treatment
- Cryo — preferred near bowel, bile duct (cryoanalgesia effect)
- Ablation margin — 5–10 mm of normal tissue around tumor
- Heat sink — large vessel (>3 mm) prevents effective heating
- Hydrodissection — protect bowel, bile duct with 5% dextrose injection
Full Tumor Ablation Playbook
Electrode/probe selection, organ-specific technique, hydrodissection, and imaging follow-up
Response Assessment and Complications
- CT/MRI at 1 month — non-enhancement = complete ablation
- Enhancement at margin — residual viable tumor, re-ablate
- mRECIST / LI-RADS TR — HCC post-treatment response
- Post-ablation syndrome — fever, malaise (1–3 days)
- Hemorrhage — perihepatic hematoma; tract embolization if needed
- Bile duct injury — biloma, biliary stricture; near central ducts
- Pneumothorax — lung ablation; thoracic procedures
- Cryoshock — massive cryo (rare); systemic inflammatory response