Urology gynecology ri renal tumor p taourel
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JFIMThis document discusses interventional radiology techniques for renal tumors, including biopsy and radiofrequency ablation (RF). It first covers using biopsy for diagnosing small solid renal tumors, noting its accuracy and importance for determining appropriate treatment. RF is then discussed as a treatment option for renal tumors. The technique, evaluation criteria pre-procedure, expected results from studies showing effectiveness rates of 80-90% and predictive factors for success, and post-procedure follow up are summarized. RF ablation is indicated for tumors under 4 cm, especially if exophytic or in high-risk patients.
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Please find the power point on Carcinoma of rectum. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
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C Hoeffel, P Rousset imaging of peritoneal carcinomatosis jfim hanoi 2015
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Adrenal imaging
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1. Restaging lung cancer patients after induction therapy is difficult to interpret based on radiographic methods alone due to their poor predictive value in assessing tumor response and mediastinal involvement.
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Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
Urology gynecology ri renal tumor p taourel
- 1. Interventional Radiology in the renal tumor : Biopsy and RF P. Taourel (Montpellier)
- 3. Solid Tumors Invasive tumor = Cancer Staging Fat = Angiomyolipoma Characterized by imaging Small tumors : adenocarcinoma ?, oncocytoma? AML without fat Diagnosis difficulties
- 4. Be careful with US in angiomyolipoma AML • Characteristics : – Hyperechoic ≥ : sinusal fat – Homogeneous • Be careful – Calcification – Hypoechoic rim • 30% of cancers are hyperechoic • US can not characterize an angiomyolipoma : CT Cancer
- 5. AML diagnosis = fat • < -20 UH • Easy AML typique (-60 UH)
- 6. • Tiny content of fat may be challenging AML à faible contingent adipeux
- 7. CT identification of the fat • Thin slice Temps néphrographique • Adapted ROI • ≤ - 20 UH • No IV contrast Sans injection, coupes fines
- 8. How to recognize AML without fat • 5 à 15% • Orientation criteria – STB – Multiple AML in a young woman – US – Spontaneously hyperdense (= muscle) + hypervascular – Présence de vaisseaux anévrismaux • MRI ? • Biopsy +++ Biopsy : AML)
- 9. Solid Tumors Invasive tumor = Cancer Staging Fat = Angiomyolipoma Characterized by imaging Small tumor without fat : adk, aml without fat, oncocytoma Diagnosis difficulties
- 10. CT Temps cortical (artériel) • Fast enhancement (cortical phase) • Washout • Scarr hypodense : central + small + starr Temps néphrographique
- 11. Small oncocytoma < 4 cm • Characterization : difficult • Enhancement : homogeneous • Scarr : missing (10%) Small homogeneous oncocytoma
- 12. • Solid tumor in multicystic kidney Biopsy= ONCOCYTOMA No iv cortical 35 sec tubular 80 sec
- 13. Solid renal tumor without fat on CT ≤ 4 cms must be biopsied • Only one tumor must be characterized : AML • Incidence of benign lesion : 20% ( if ≤ 2 cms) • Biopsy easy to perform
- 14. CT value to characterize tumor • Consecutive study of 99 solid renal tumor without fat • 18 G biopsy with FU • CT accuracy – B (25%) / M (75%) Millet AJR 2011
- 15. CT findings • Morphologic criteria – siza – Ball versus bean – Segmental inversion – scarr – Interface with the parenchyma • Critères cinétiques – Enhancement intensity – Time-course pattern
- 17. Ischemia
- 18. ONCOCYTOMA ADK
- 19. Wegener Lymphoma
- 20. adk oncocytoma
- 24. A weak significant finding of benignancy : progressive enhancement • • • • Sen = 60% Spe = 73% PPV = 43% (prevalence of benignancy) NPV = 84% – AJR 2011 Millet et al
- 26. Biopy of small renal tumor is mandatory • Benign versus malignant : impact ++++ • Type of adk : impact ? • Grade : impact + – Partial surgery – Temperature ablation – Active FU
- 27. • 187 solid tumors ≤ 4cms • 145 Malignant • 132 renal cancers, – 61 surgery – 36 RF – 35 FU Millet J Urol 2012
- 28. Table 1 Biopsy-surgery correlation for the histologic subtype Biopsy subtype Surgical subtype Clear cell Clear cell Chromophobe Tubulopapillary Unclassified Chromophobe Tubulopapillary Unclassified 55 13 5 1
- 29. Table 2 Biopsy-surgery correlation for the Fuhrman grade Biopsy grade Surgical grade G1 G1 G2 G3 G4 G2 G3 7 11 33 2 2 6 G4
- 30. To conclude on diagnosis : the biopsy of renal tumor is • Easy (LD if lesion in upper part of the kidney) • Accurate • Useful (25% of benign lesion) • Mandatory (no CT characteriation) • Impact on treatment of adk (weak underestimation of the grade)
- 32. Radiofrequency of renal tumors • Why ? (overdiagnosis and overtreatment ?) • How ? • What results ? • When ?
- 34. → Ionic agitation → Friction with heat in the tissues → Thermal damage with heating → Nécrosis of coagulation (50 – 100 ° ) → ≥ 100 ° carbonization with non efficiency of the treatment
- 38. What evaluation before ? • Proof of malignancy (25% : B) • Size of the lesion : < 3cm, 3-5 cm • Localization de la lésion : ball vs bean central or not • Contact = pleura, bowel, ureter
- 41. What technique ? • • • • decubitus Ureteral stent Hydrodissection Displacement of the mass by the electrode
- 45. What FU ? • 2 questions : – Efficiency – Recurrence • Sémiologie uniqvoque – fat stranding – Rim finding (no significance) • Enhancement : residu or recurrence – nodules or croissants (triphasic CT)
- 53. M2
- 54. What FU ? • 2 questions : – Efficiency – Recurrence • Sémiologie uniqvoque – fat stranding – Rim finding (no significance) • Enhancement : residu or recurrence – Cortico-medullary phase
- 56. M2
- 58. M8 FU : 2m, 6m, 1y, then every y
- 59. What results : ? • Efficiency : 80 – 90 % • Predictive factors : – exophytic (oven effect) – < 3 cm
- 64. What results ? Excise,ablate or observe : the small renal mass dilemna J Urol 2008
- 65. What results : a metaanalaysis age PN Cryoablation RF FU 5037 (77,8 %) 496 (7,7 %) 607 (9,4 %) 331 (5,1 %) size 60 65,7 67,2 68,9 3,40 2,56 2,69 3,04 J Urol 2008
- 66. What results : a meta analysis FU (month) Dgc pathol : K LR 2,6 % 4,6 % 11,7 % PN Cryoablation RF 54 18 16 87 % 76 % 88 % FU 33 91 % M 5,6 % 1,2 % 2,3 % 0,9 % J Urol 2008
- 67. Ablation of renal tumor : (cryoablation or RF) • • • • Tm < 4 cm exophytic or parenchymateous Age > 70 ans cobormidity or failure renal factor risk or • Recurrence after partial nephrectomy or • VHL syndroma