ReviewImage guided radiofrequency ablation for small renal masses

- The detection of small renal masses (SRM) has increased due to the increased use of cross-sectional abdominal imaging. Renal parenchyma preservation has become the standard of care.
- Thermal ablation (TA) is discussed and often offered for all patients with SRM as near-equivalent treatment without respect to age or co-morbidities. As provider experience improves and long-term outcome studies become available, TA is becoming increasingly accepted as a potential new standard of care for solid SRM.
- This review will highlight the role of image guided TA. We will discuss radiofrequency ablation (RFA) however, the principles will apply to any TA device. Improvements in image guided hardware/software has improved accuracy of probe placement.

The diagnosis of incidental small renal masses (SRM) has increased during the past two decades secondary to the increased use of various abdominal imaging modalities. In the past decade there has been a shift from radical nephrectomy to nephron sparing surgery techniques where partial nephrectomy has become the standard of care. Thermal ablation (TA) modalities such as freezing or heating delivered percutaneously for the treatment of small renal masses (SRM) is now offered in many Institutions as a treatment option. Clinical guidelines have indicated that TA is appropriate for select patients that are medically high risk or elderly. In our institution and in select centers, TA is discussed and often offered for all patients with SRM as equivalent treatment without respect to age or co-morbidities. As provider experience improves and long-term outcome studies become available, TA is becoming increasingly accepted as a potential new standard of care for solid SRM. This review will highlight the role of image guided radiofrequency ablation (RFA) techniques and their application focusing on the different imaging modalities for RFA application which, most commonly, include percutaneous (Magnetic Resonance Imaging (MRI) and computerized tomographic (CT). Our aim is to summarize those studies along with long term follow up.