Eric de Kerviler

The aim of this study was to evaluate the feasibility of cryoablation of renal tumours without sedation. We prospectively evaluated 149 computed tomography-guided renal cryoablation procedures that were performed at our institution between 2009 and 2013. The patients received only 1 g of IV paracetamol prior to the procedure; intraprocedural, local anaesthesia was administered. We recorded the date and duration of the procedure, size and location of the tumour, number of cryoneedles used, need for dissection with saline or carbon dioxide and intraprocedural degree of pain, which was scored using an established visual analogue pain score (VAS) (0–10). Multivariate analysis was used to identify the associations between the recorded parameters and VAS. An interventional radiologist and a technician could perform all procedures without the help of anaesthesiologists and with adequate analgesia. The pain level ranged from 0 to 8 (mean, 2.0). It did not correlate with the tumour size or with the number of cryoneedles. It was significantly greater when the ice ball involved renal cavities (p = .0033) and when carbon dioxide was used for dissection (p p = .0381). This study demonstrates that the cryoablation of renal tumours is feasible by interventional radiologists alone using a combination of IV paracetamol and local anaesthesia.

Purpose To evaluate the accuracy of the apparent diffusion coefficient (ADC) provided by diffusion-weighted imaging (DWI) in predicting the response to neoadjuvant chemotherapy (NACT) at baseline in patients according to their breast tumour phenotypes. Materials & methods This retrospective study was approved by our institutional review board. One hundred eighteen consecutive women with locally advanced breast cancer who had undergone NACT followed by breast surgery were included. DWI was performed at 1.5 T less than 2 weeks before NACT. We studied the correlation between pretreatment ADC and response in pathology after surgery according to immunohistochemical features and intrinsic subtypes (luminal A, luminal B, HER2-enriched, and triple-negative tumours). Results After surgery, the pathologist recognized 24 complete responders (CRps) and 94 non-complete responders (NCRps). No difference was identified between the pretreatment ADCs of the CRp and NCRp patients. There were differences in pretreatment ADCs among the luminal A (1.001 ± 0.143 × 10⁻³ mm²/s), luminal B (0.983 ± 0.150 × 10⁻³ mm²/s), HER2-enriched (1.132 ± 0.216 × 10⁻³ mm²/s), and triple-negative (1.168 ± 0.245 × 10⁻³ mm²/s; P = 0.0003) tumour subtypes. In triple-negative tumours, the pretreatment ADC was higher in NCRp (1.060 ± 0.143 × 10⁻³ mm²/s) than in CRp patients (1.227 ± 0.271 × 10⁻³ mm²/s; P = 0.047). Conclusion Pretreatment ADC can predict the response of breast cancer to NACT if tumour subtypes are considered. Key Points • Apparent diffusion coefficient helps clinicians to assess patients with breast cancer. • Pretreatment ADC is related to tumour grade and hormone receptor status. • Pretreatment ADC is lower in luminal A and B than in triple-negative tumours. • Pretreatment ADC is higher in complete than in non-complete responders to neoadjuvant chemotherapy.

To illustrate that Breast-MRI performed in high spatial resolution and low temporal resolution (1 minute) allows the measurement of kinetic parameters that can assess the final pathologic response to neoadjuvant chemotherapy in breast cancer.

Until recently, only nuclear medicine techniques allowed combining whole-body anatomical and functional information. Now, diffusion-weighted imaging seeks to compete with these techniques in the field of oncology, providing assessment of tumour spread, characterizing lesions and evaluating therapeutic response. The first issue has been widely evaluated since the first published whole-body diffusion-weighted images looking like scintigraphy. Optimal background suppression and diffusion weighting highlighted tumours with restricted diffusion. For the two latter issues, ADC seems to represent the key element; it should allow differentiation between benign and malignant tissue, and active from inactive lesions after treatment. This is of paramount importance for the monitoring of lymphomas treated with chemotherapy alone, or for solid tumors treated by neoadjuvant therapies. However, imaging protocols still differ between studies, and there is considerable overlap in ADC values between healthy and neoplastic tissues. Despite this difficulty to identify a clinically reliable threshold for malignancy, there is no doubt that ADC will represent as a reliable biomarker in the future for some malignancies, and lymphomas represent a helpful model for this purpose.