Description of Event or Problem · 1
ELDERLY MALE PATIENT WITH METASTATIC RENAL CELL CARCINOMA REFERRED FOR PERCUTANEOUS MICROWAVE ABLATION OF A RIGHT UPPER LOBE LUNG METASTASIS. THE PATIENT PRESENTED FOR SCHEDULED ABLATION. THE PROBE WAS PLACED PERCUTANEOUSLY IN/ADJACENT TO THE NODULE IN THE RIGHT UPPER LOBE. CT IMAGES CONFIRMED APPROPRIATE PROBE POSITIONING. THE PLAN WAS TO TREAT FOR APPROXIMATELY 40W AT 5 MINUTES WHICH SHOULD HAVE PROVIDED AN ABLATION ZONE LARGE ENOUGH TO FULLY ENCOMPASS THE LESION WITH A MARGIN. AFTER 5 MINUTES OF TREATMENT AT 40W, INTRA-PROCEDURAL FLUOROSCOPY SHOWED NO CLEAR GROUND GLASS ENCOMPASSING THE LESION (TYPICALLY GROUNDGLASS IS PRESENT AFTER TREATMENT). THEREFORE, TREATMENT WAS CONTINUED FOR AN ADDITIONAL 1 MINUTE AT 40W AND THEN A FINAL MINUTE AT 60W, FOR A TOTAL OF 7 MINUTES. IMAGES WERE ACQUIRED 10 MINUTES AFTER COMPLETING THE 7 MINUTES OF TREATMENT AND STILL NO SIGNIFICANT GROUNDGLASS WAS SEEN SURROUNDING THE LESION. GIVEN THAT EXTRA ENERGY HAD BEEN USED FOR AN EXTENDED TREATMENT OF 7 MINUTES WHICH SHOULD GIVE A MORE THAN ADEQUATE ABLATION ZONE, THE DECISION WAS MADE TO COMPLETE THE PROCEDURE. THE PATIENT HAD A FOLLOW-UP CT WHICH SHOWED THAT THE TREATED NODULE IN THE RIGHT UPPER LOBE HAD NOT SIGNIFICANTLY CHANGED IN SIZE AND THERE WAS NO SIGNIFICANT ABLATION ZONE. GIVEN THAT THE PROBE HAD BEEN APPROPRIATELY PLACED AND THE MACHINE WAS RUN PROPERLY (IN THE PRESENCE OF AMICA REP), THIS IS MOST CONSISTENT WITH A TECHNICAL FAILURE OF THE AMICA ABLATION MACHINE. THE REPRESENTATIVE FROM BOSTON SCIENTIFIC WAS MADE AWARE OF THE EVENT.